District Harassment, Intimidation or Bullying Forms
The District Anti-Bullying Coordinator, in consultation with the school Anti-Bullying Specialists, the District Positive Behavioral Specialist, and members of the technology department, created the following forms.
Form One: The most recent amendments to the HIB Law require districts to use a centralized Reporting Form for acts of Harassment, Intimidation or Bullying. There is a form for student families in a pdf and word version and a form to be utilized by district staff. In addition to information on the parties involved in the incident, this form contains categories for the location, and type of behavior demonstrated by those involved. The information in these categories is tracked on the HIB report submitted to the Board of Education at Board meetings and is reviewed by the school and District level safety teams.
Form Two: The Investigation Form for acts of Harassment, Intimidation or Bullying is filled out by the Anti Bullying Specialist as he or she completes their investigation. Ultimately, the Anti Bullying Specialist will note their recommendation as to whether an act of HIB occurred and their rationale for the recommendation. The building principal will then determine if an act of HIB occurred, arrange for counseling and, where applicable, disciplinary action and forward the completed form to the Superintendent.
Form Three: The School Level Safety Team Form is reviewed by the safety team. Every school has a Safety Team comprised of a guidance counselor (Anti-Bullying Specialist), building administrator, safety officer and other staff members. They meet monthly to review office discipline referrals, HIB reports and other safety matters. The attached report guides the review of HIB reports during these meetings.
HIB Incident Reporting and Other Related Forms
NJ DOE HIB Reporting Form for student families - word version
HIB - Bullying Investigation Form 2
NJ Department of Education Students with Disabilities Suspension Form -
Must be used when a student is suspended who has disabilities
PBS - Request for Behavior Intervention Services Form
SA - Activity Supervisory Chart-
Request form for staffing school events.
SA - Alternative Program Graduation Requirements Checklist -
Please fill out this form before the alternative placement in order to identify courses completed.
SA - Alternative Program Checklist -
Please use this form to fill out course completions on middle school students being placed in the program.
SA - Out of District Placement Request Form
SA - Security Request for Police Coverage Form