Harassment, Intimidation, or Bullying (HIB) Reporting Form 338

 
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 HIB 338 Reporting Form  
Please complete all sections of this form. It will be submitted to the building principal via e-mail. Please note that formal disciplinary action may not be taken solely on the basis of an anonymous report.

 
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  SCHOOL INFORMATION
   
  School District- Mahwah Township Public Schools
   
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  INDIVIDUAL COMPLETING THE FORM
   
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  INCIDENT INFORMATION
   
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  School Principal/Designee and Superintendent Section
To be Completed by School Principal/Designee and Superintendent

Note: The completed form must be kept on file in the school. The principal must promptly submit a copy of this form to the superintendent.

Utilization of Preliminary Determination Provision
If the school district’s policy permits the use of a preliminary determination for reports of HIB, question 1 and 2 below must be completed on every form. School districts who do not permit the use of a preliminary determination for reports of HIB, should leave this section blank.

Question for the School Principal/Designee
1. Was a preliminary determination made not to initiate an HIB investigation because the reported incident or complaint is a report outside the scope of the definition of HIB?

Yes No

Question for the Superintendent
2. If the answer to question 1 is yes, will you require the school principal/designee to initiate an HIB investigation based on the scope of the definition of HIB?

Yes No

Incident Tracking
If your school district utilizes a tracking system to track alleged incidents of HIB, insert the incident number.

Incident number:___________________

   
 
 
 
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