Harrassment-Incident Reporting Form
Harrassment-Incident Reporting Form

 

 

 
 

IMPORTANT: Incidents reported through this system will be reviewed by staff during school hours and is strictly for the use of Lake Bluff students and parents.

DO NOT USE THIS SYSTEM TO REPORT EMERGENCIES THAT REQUIRE IMMEDIATE ATTENTION. Instead, call 911.

If you need additional support, you may also contact the Lake County Crisis Center at 847-377-8088.

This incident form should be filled out when you have a concern about something that happened to you or someone you know. Situations such as harassment, intimidation, depression, or someone hurting themselves are very serious and should be addressed by someone who can help. You are not required to use your name, but please do if you would like someone to follow up with you. We will do our best to handle each situation quickly, sensitively, and confidentially.  

Thank you for being honest and serious with your report.

Required *

 
 

Please complete the information in this section.
NOTE: Your name is NOT REQUIRED to complete this form.

First Name:   

Last Name:

Role: *

School: *

 
 

Describe what happened:*

 
 

When did this happen?*

 
 

Where did this happen?*

 
 

Who was involved in this situation?

 
 

Did anyone else see what happened? Yes   No

If yes, who?

 
 

Describe whether this was a one-time incident or part of an ongoing problem.

 
 

What sort of help would you like with this situation?

 
   



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