7:180-AP1, E7 Exhibit-Response to Bullying

To be completed by the Building Principal and attached as a coversheet for the school office’s designated bullying report investigation and response folder. Place a copy of the completed coversheet only (not attachments) in each listed student’s temporary school student record. Redact all student names other than the student’s name for which the record pertains.

Investigator: _________________________________________ Title: ___________________

Investigation

File an interview form for each party interviewed in the designated investigation and response folder.

☐ Check here to indicate that all interview forms have been properly completed and filed.

Target: _____________________________________________ Date: ___________________

Aggressor: __________________________________________ Date: ___________________

Witnesses: __________________________________________ Date: ___________________

__________________________________________ Date: ___________________

Are there any prior documented incidents by the aggressor identified above? ☐ Yes ☐ No (Attach information)

If yes, have incidents involved target or target group previously? ☐ Yes ☐ No

Findings

☐ Bullying ☐ Other: __________________________________________________________

☐ Aggressor motivated by protected characteristics listed in policy 7:20, Harassment of Students Prohibited.

Bullying Investigation Response

Response and Plan for Target (Check all that apply and include descriptions.)

Contact parent/guardian: ________________________________________ Date:_______________

Circle contact method: Phone Email Letter In-person Other: _______________________

☐ Safety plan: _____________________________________________________________________

☐ Increase staff supervision: __________________________________________________________

☐ Education: _______________________________________________________________________

☐ Minimize contact with aggressor: ______________________________________________________

☐ District resources: (Student Services/IDEA/504) __________________________________________

__________________________________________

☐ Other: ___________________________________________________________________________

Target follow-up scheduled date: _________________________ Date and initial completed:__________

Parent/guardian follow-up date: ___________________________ Date and initial completed: _________

Circle contact method: Phone Email Letter In-person Other: _________________________

☐ Provide parent/guardian with copies of Board policies 2:260 and 7:180. Date: __________

Response and Plan for Aggressor (Check all that apply and include descriptions.)

Contact parent/guardian: ________________________________________ Date:_______________

Circle contact method: Phone Email Letter In-person Other: _______________________

☐ 7:190-E4, Aggressive Behavior Reporting Letter and Form sent Date: _______________

☐ Provide parent/guardian with copies of Board policies 2:260 and 7:180 Date: ______________

Restorative Responses

☐ Safety plan: ______________________________________________________________________

☐ Increase staff supervision: ___________________________________________________________

☐ Education: ________________________________________________________________________

☐ Non-District affiliated psychological services : _____________________________________________

☐ Alternative school assignment: _________________________________________________________

☐ Minimize contact with target: ___________________________________________________________

☐ District resources (Student Services/IDEA/504): ____________________________________________

☐ Other: _____________________________________________________________________________

Punitive Responses

☐ Loss of privileges: ____________________________________________________________________

☐ Detention: ___________________________________________________________________________

☐ Suspension: __________________________________________________________________________

☐ Expulsion: ____________________________________________________________________________

☐ Community agency service: _______________________________________________________________

☐ Reciprocal Reporting Act utilized: ☐ Yes ☐ No _______________________________________________

☐ Report to School Resource Officer/Law Enforcement: ____________________________________________

☐ Other: __________________________________________________________________________________

Aggressor follow-up date: __________________________________ Date and initial completed: _____________

Circle contact method: Phone Email Letter In-person Other: ________________________________

Parent/guardian follow-up date: _____________________________ Date and initial completed: _____________

Circle contact method: Phone Email Letter In-person Other: ________________________________

☐ Contact District complaint manager: ________________________ Date: _____________________________

☐ Target response implementation: ______________________________________________________________

☐ Aggressor response implementation: ___________________________________________________________

☐ Systemic culture/climate intervention: ___________________________________________________________

☐ Referral to address needs for ideal conditions for developmental learning: _______________________

☐ Other: _____________________________________________________________________________________

Submit reports to: ☐ Building Principal (if not the investigator) Date: ___________________

☐ Superintendent Date: ___________________

Signature of investigator: ______________________________________ Date: ____________________________

Date Adopted: March 21, 2023