YIHAAW Bullying Report Form

First name

Last name

Date

I am a :

Phone

Email

Player(s) who were harmed?

Team or Division of Players

Players who did harm?

Date of Incident

Time of Incident

Location of Incident (including online)

What YIHAAW Event(s) did this occur at?

Nature of Bullying Reported

Physical (pushing, hitting, kicking, punching, spitting, slapping, or any use of violence against another person or another person’s property).

Emotional (being unfriendly or unwelcoming, excluding or intentionally ignoring someone, spreading rumors or lies about someone).

Verbal (saying mean or hurtful things, threatening a player or players, teasing, taunting, or tormenting).

Racist (racial taunts, grafitti, gestures, or other slurs)

Homophobic (remarks focusing on sexual orientation or gender identity)

Sexual (unwanted physical contact or sexually abusive comments)

Cyber/Online (any bullying via the internet)

Other

Please provide any other details that you feel are important.

Did you witness the event?

Yes

No

List any other potential witnesses to the event that you are reporting

File upload (ie. screenshot, message, email, photo)