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 338Form(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.
School Information
School District:
School:
Individual Completing Form
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
Name of individual completing this form:
Relation to individual involved in alleged incident of HIB
(e.g., parent, guardian, grandparent, etc.):
Phone number:
Email address:
Incident Information
Incident date (mm/dd/yyyy):
Approximate time of the incident:
Page 1 of 4
Describe the incident with as much detail as possible. (What was the incident? Who was involved in the incident? How
you were made aware of the incident? What happened at the time of the incident? How did the incident occur?)
Specific incident location(s) (e.g., on the morning school bus, in the science wing hallway, online via social media, etc.)
Alleged Offender(s)
Name(s) of alleged offender(s):
Based on your knowledge, select all that apply about the alleged offender(s):
Alleged offender(s) attends the above-named school.
Alleged offender(s) attends another school.
Alleged offender(s) works for the school/school district.
Alleged offender(s) does not work for the school/school district.
Alleged Victim(s)
Name(s) of alleged victim(s):
Based on your knowledge, select all that apply about the alleged victim(s):
Victim(s) attends the above-named school.
Victim(s) attends another school.
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Witnesses
Student Names:
Staff Names:
Parents Names:
Other Names (specify title or position for each):
Signature of the person Completing this HIB 388 Form:
Date:
Page 3 of 4
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.
1. Question for the School Principal/Designee
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 schools district policies for other reports. (eg., code of student conduct, referal to
counseling services, etc.).
No- Refer to your school district's HIB policy for initiating an HIB investigation.
Comments (Optional):
2. Question for the Superintendent
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 pricipal 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 the reports (e.g., code of student conduct, referral to
counselling services, etc.) and maintain a copy of this of this form.
If the answer to question 1 is no, follow your school district's policies for HIB investigation and maintain a copy of
this form.
Comments (Optional):
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