BULLY FREE” MEANS ALL STUDENTS

BULLY FREE” MEANS ALL STUDENTS:

• 
  Deserve to feel safe at school.
  

• 
  Do not bully others.
  

• 
  Help others who are being bullied.
  

• 
  Tell an adult at home or at school when others are bullied.
  

• 
  I
  32
  nclude students who are left out.
  

33

4 5 6

Student Name ____________________________________________________________________
Grade/Teacher __________________________________________________
Date/Time _____________________________________________________
Referral by _____________________________________________________
*Put an X here if the incident was NOT OBSERVED/HEARD____________________

Location: Playground Cafeteria Hallway

Bathroom Classroom Bus

__________ 1. Obey the directions given by adults.

__________ 2. Use appropriate volume and language.

__________ 3. Show respect for people and property.

__________ 4. Keep hands, feet and objects to yourself.

__________ 5. Walk in the school.

__________ 6. Severe infraction refer to principal

*Incidents of bullying require adults to fill out the Bullying Report Form

Details:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Follow-up Consequence:

_______________________________________________________________________

teachable moment loss of privilege fix-it plan silent table “Think Tank”