Harassment/Bullying Investigation Form
Oklahoma School Security Act (70 O.S. § 24-100.3) requires each district to “Establish a
procedure for investigation of all incidents of harassment, intimidation, bullying, or threatening
behaviors reported to school officials for the purpose of determining the severity of the incidents
and their potential to result in future violence.” This form will assist districts in investigating
reported incidents of such behavior.
Person(s) Assigned to Investigation
Date Assigned: _________________________________________________________________
Name: ___________________________________________ Title: _______________________
Name: ___________________________________________ Title: _______________________
Incident Details
Student Affected:
____________________________________ Grade:_____ Class: ________________
Student(s) Initiating Bullying/Harassment:
____________________________________ Grade:_____ Class: ________________
____________________________________ Grade:_____ Class: ________________
Witness: ______________________________________________________________________
Witness: ______________________________________________________________________
Please list all witnesses including students and/or staff.
Documentation
Written statement of student victim Physical evidence (if applicable)
Written statement of witness/bystander Medical information (if applicable)
Written statement of alleged offender Copy of police report (if applicable)
Interview/notification of parents Copy of report form (if applicable)
Interview of staff witness Copy of incident notification (if applicable)
Action Taken
Interviewed alleged student victim Reviewed physical evidence
Interviewed alleged offender Reviewed medical information
Interviewed witnesses Reviewed bus incident information
Interviewed staff involved (list names) Reviewed student records
_______________________________ Reviewed social history between parties
_______________________________ Considered history of prior behavior
_______________________________ Other: ____________________________
Interviewed alleged student victim’s parents _________________________________
Interviewed alleged offender’s parents _________________________________
