Appendix 1 Template for recording bullying behaviour (DES)
- Name of pupil being bullied and class group
Name _________________________________________Class__________________
- Name(s) and class(es) of pupil(s) engaged in bullying behaviour
_________________________________________________________________________________
_________________________________________________________________________________ _________________________________________________________________________________
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3. Source of bullying concern/report (tick relevant box(es))* | 4. Location of incidents (tick relevant box(es))* | ||||
Pupil concerned | Playground | ||||
Other Pupil | Classroom | ||||
Parent | Corridor | ||||
Teacher | Toilets | ||||
Other | School Bus | ||||
Other |
- Name of person(s) who reported the bullying concern
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- Type of Bullying Behaviour (tick relevant box(es)) *
Physical Aggression | Cyber-bullying | ||
Damage to Property | Intimidation | ||
Isolation/Exclusion | Malicious Gossip | ||
Name Calling | Other (specify) |
- Where behaviour is regarded as identity-based bullying, indicate the relevant category:
Homophobic | Disability/SEN related | Racist | Membership of Traveller community | Other (specify)
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- Brief Description of bullying behaviour and its impact
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- Details of actions taken
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Signed ______________________________ (Relevant Teacher) Date ___________