Bullying Incident Report Form

A structured, factual record for reporting a bullying incident

---

How to use this template

• Complete this form within 24 hours of the incident being reported or witnessed, while details are still fresh and accurate.
• Complete one form per incident, not per pupil or per term, so each report stays specific, dated and easy to review later.
• Use factual, neutral language throughout — record what was reported or observed, not a conclusion about intent or character.
• Keep the sections on the pupil(s) affected and the pupil(s) alleged to be involved separate, so the form never reads as a verdict.
• Complete every section; write “None reported” or “N/A” rather than leaving a field blank.
• Store the completed form securely and share it only with those who need it, in line with your organisation’s safeguarding policy and local reporting requirements.
• Set and keep the review date in the follow-up section — a report that is never revisited cannot show whether the situation improved.

---

Section 1: Report information

Date form completed: [DATE FORM COMPLETED] Organisation name: [ORGANISATION NAME] Site / location: [SITE OR LOCATION] Full name of person reporting: [REPORTER FULL NAME] Reporting in the capacity of: ☐ Staff member ☐ Parent or guardian ☐ Pupil ☐ Other Role / position, if staff (optional): [REPORTER ROLE OR POSITION] Reporter contact details: [REPORTER PHONE OR EMAIL]

Filled in by the person completing the form — identifies who is reporting, in what capacity, and where the report is filed.

---

Section 2: Pupil(s) affected

Name(s) of pupil(s) affected: [NAMES OF PUPILS AFFECTED] Year / class / group: [YEAR, CLASS OR GROUP] Additional notes (optional): [ADDITIONAL NOTES ON PUPILS AFFECTED]

Name every pupil the incident was reported or observed to affect. This section is about impact, not conduct.

---

Section 3: Pupil(s) alleged to be involved

Name(s) of pupil(s) alleged to be involved: [NAMES OF PUPILS ALLEGED TO BE INVOLVED] Year / class / group: [YEAR, CLASS OR GROUP] Additional notes (optional): [ADDITIONAL NOTES ON PUPILS ALLEGED TO BE INVOLVED]

Name every pupil reported or observed as alleged to be involved. “Alleged” means reported, not established — keep the wording factual and do not name a verdict.

---

Section 4: The incident

Date of incident: [DATE OF INCIDENT] Time of incident: [APPROXIMATE TIME] Location: [LOCATION OF INCIDENT] Is this a repeat occurrence? ☐ First reported occurrence ☐ Repeat occurrence ☐ Unknown Type of incident: ☐ Physical ☐ Verbal ☐ Social exclusion ☐ Online or digital ☐ Damage to property ☐ Other If “Other”, specify (optional): [DETAIL IF OTHER TYPE] Account of what was reported: [FACTUAL ACCOUNT OF WHAT WAS REPORTED OR OBSERVED]

Describe only what was reported or observed. Write what happened, not a judgement about it.

---

Section 5: Witnesses

Witness name(s) and role (staff / pupil / other): [WITNESS NAMES AND ROLES] Summary of witness accounts (optional): [SUMMARY OF WHAT WITNESSES REPORTED]

List anyone who saw or heard the incident. Write “None reported” if no witnesses were identified.

---

Section 6: Immediate action & support

Immediate action taken: [IMMEDIATE ACTION TAKEN] Support offered to pupil(s) affected: [SUPPORT OFFERED TO PUPIL(S) AFFECTED] Were families informed? ☐ Yes ☐ No Date families were informed (if applicable): [DATE FAMILIES WERE INFORMED] Informed by (name / role): [NAME AND ROLE OF PERSON WHO INFORMED FAMILIES] Channel used (if applicable): ☐ In person ☐ Phone call ☐ Email ☐ Messaging platform ☐ Letter ☐ Other

Record what was done straight away — the situation on the day, not the longer-term follow-up.

---

Section 7: Follow-up

Review date: [REVIEW DATE] Outcome of review: [OUTCOME OF REVIEW] Was this escalated? ☐ Yes ☐ No Escalated to whom (optional): [NAME OR ROLE ESCALATED TO] Further follow-up notes (optional): [FURTHER FOLLOW-UP NOTES]

Set a review date at the time the form is completed — this section is what makes the report actionable, not archival.

---

Section 8: Signatures

Completed by (printed name): [PRINTED NAME OF PERSON WHO COMPLETED THE FORM] Role / position: [ROLE OR POSITION] Signature: [SIGNATURE] Date: [SIGNATURE DATE] Reviewed by (printed name, optional): [PRINTED NAME OF REVIEWER] Reviewer signature (optional): [REVIEWER SIGNATURE] Reviewer date (optional): [REVIEWER DATE]

Signed by the person who completed the form and, where your safeguarding policy requires it, by the person who reviewed it.