Harassment, Intimidation and Bullying-Digital Reporting Form 338

HIB 338 Form
Harassment, Intimidation, or Bullying (HIB) Reporting Form
To Be Completed by Families/Caregivers

This form should be used by parents or guardians to report allegations of HIB. A written statement from the alleged victim or other evidence may be attached to the back of this HIB 338 Form (e.g., screenshot, text thread, etc.). Once the form is received by the school, the principal is responsible for implementing the school district’s policy and procedures. An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident. Should you have any questions about the investigation, please contact the school principal. 

 

Complete the form below to provide detailed information of the alleged HIB incident. If some fields are not applicable or if you are uncertain of the response, you may skip those fields. This form may be submitted anonymously. 

HIB 338 Form Harassment, Intimidation, or Bullying (HIB) Reporting Form. To Be Completed by Families / Caregivers This form should be used by parents or guardians to report allegations of HIB. A written statement from the alleged victim or other evidence may be attached to the back of this HIB 338 Form (e.g., screenshot, text thread, etc.). Once the form is received by the school, the principal is responsible for implementing the school district’s policy and procedures. An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident. Should you have any questions about the investigation, please contact the school principal. Directions Complete the form below to provide detailed information of the alleged HIB incident. If some fields are not applicable or if you are uncertain of the response, you may skip those fields. This form may be submitted anonymously.

 

If you prefer to remain anonymous, leave this section blank. Individuals filling out this HIB 338 Form as an anonymous reporter may consider adding their name as a witness section of this form (below).

 

Complete this section with the names of any potential witnesses

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.

 

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? Check one below and submit this form to the Superintendent.

Yes - Follow your school district’s policies for other reports (e.g., code of student conduct, referral to counseling services, etc.).

No- Refer to your school district’s HIB policy for initiating an HIB investigation

 

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? Check one and proceed as directed.

Yes- Notify the principal of this determination in writing and direct the principal to initiate an HIB investigation per the district’s policy.

No- Follow your school district’s policies for other reports (e.g., code of student conduct, referral to counseling services, etc.) and maintain a copy of this form.

If the answer to question 1 is no, follow your school district’s policies for HIB investigations and maintain a copy of this form