Addressing Bullying - Adult Form

Thank you for taking the time to complete this form. This form is for any adult to raise concerns of matters of bullying in our school.

This form will remain confidential once submitted, and will be handled in accordance to the school's Addressing Bullying Policy (available on our website) and the 'Addressing Bullying in Schools Act (NI) 2016'.

If you have emergent concerns about the wellbeing of a child, please contact the school directly on 028 4461 2253.

If there is an immediate danger to the child or children's wellbeing outside of school, get in contact the police by calling 999 - DO NOT HESITATE.

This form collects your name and email address - for further information on our Data Protection policies, please see our website.

1. Please state your name: *

2. What is your email? *

3. Please provide the names of the child/children involved: *

4. Please describe, in detail, what has been going on, and include any relevant information: *

5. For the child receiving the behavior, please select all that apply: *

Targeted - is focused on the child receiving the behavior?

Repetitive - does it happen a lot?

Intentional - do you think what is happening is intentionally happening?

Physical/Physiological - do you feel that is causing the child harm? Does it make the child feel bad or does it actually hurt them?

Website