{This form is used by all staff to report peer-to-peer aggression. Students are sent directly to the office only in severe situations in which there is a continuing risk of harm.
This is an internal form only- you may decide to shred this form after use, as it will contai names of other students. In school implementing a color coded or tiered reporting system in which the most severe behaviors are to be reported to the office and moderately severe behaviors are reported to the homeroom teacher or advisor for tracking, two versions of this form should be used. Each form should be on a different color of paper and each should list the behaviors it should be used for.}
Use to reports the following behaviors:
-
-
-
Student: ____________________ Grade: ________ Teacher: _________
_________________________
Staff member completing form
___________ location
_________________ date&time
___Witnessed by me ___ Reported by students: Who?
________________________________________________________________________
________________________________________________________________________
If you did not witness the behavior, which other students were nearby?
________________________________________________________________________
________________________________________________________________________
Description of events: (Please be specific)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other details:
From Schools Where Everyone Belongs , by Stan Davis, Research Press, © 2005, 2010 http://www.stopbullyingnow.com

This is the letter a school sends home when a student has been aggressive. Note: print the peer mistreatment behavior grid on the reverse side.
A note from the School
Dear ,
As children develop through these years, they are learning how to treat others and how to meet their needs in positive ways. I am writing to let you know that your child
_____________ had a learning experience in school today. I knew you’d want to know.
THE DETAILS:
What was reported?
What your child said
Investigation (if necessary):
To help all our students treat each other safely and respectfully, we have a set of consequences for actions that could hurt someone else (see other side of this letter). Your child’s consequence is _________________________.
If ____________________ does this again, the next consequence will be
_________________________.
Please sign and return this letter so I know you have seen it. Let me know if you have any questions.
Date: _____________________ Thank you.
__________________________
Principal or Designee
_____________________________
Student Signature
__________________________
Parent Signature
From Schools Where Everyone Belongs , by Stan Davis, Research Press, © 2005, 2010 http://www.stopbullyingnow.com

{This is the format for the reflection process, which is done after students know what their consequences are. We have found that focusing on these questions as part of the investigation process is also helpful, but that the largest benefit comes from using them after the process of investigation and assigning consequences is completed. At that point there is less incentive for guessing the right answer and more likelihood that students will actually reflect on their behavior. Students who are in recess detention complete this form. The supervisor of that consequence works with them, helping them to edit their answers over and over and asking them to redo what they have written until they have taken responsibility. We work with students during this time to help them acknowledge their actions, discover and feel the effect of those actions on others, and find new ways to reach the goals they were working toward through the aggressive actions. }
Think-about-it form
Date: ________________
Name: ___________________________________
What did you do?
Please be specific. Start with “I.” Tell me later about what the other student did.
What was wrong with what you did?
Who did you hurt? How do you know you hurt them? What did you hear them say or see on their face(s) that showed you that you hurt them?
What problem were you trying to solve?
Did you want attention? Did you want to be left alone? Were you trying to have fun? Were you already mad about something else?
Next time you have that problem, how will you solve it without hurting anyone?
Please list three ways to solve this problem in the future without hurting anyone else. Circle the one you plan to use.
From Schools Where Everyone Belongs , by Stan Davis, Research Press, © 2005, 2010 http://www.stopbullyingnow.com

{This is the log form on which we keep track of young people assigned to inside recess.
Note the language at the bottom. When we tell students: “This time inside doesn’t count if you make noise,” we are communicating something quite different than if we say: “If you make noise one more time I am keeping you in for another recess.” The first statement puts responsibility on the shoulders of the student. The second makes the loss of another recess the result of an adult’s choice.}
Week of __________________________
Name Grade What did s/he do? TAI form done
Dates (circle when done)
Add any makeup days
Please let students know that inside recess(or detention or silent lunch or in school suspension) time only counts if they arrive on time, sit quietly, avoid interacting with each other, and complete the think about it form accurately. If they fool around, play, talk with each other, or refuse to complete the form correctly they are choosing to stay in for more days. Add those days to the log with a note.
From Schools Where Everyone Belongs , by Stan Davis, Research Press, © 2005, 2010 http://www.stopbullyingnow.com