PPPS Student Behaviour Portal Please enable JavaScript in your browser to complete this form. - Step 1 of 3Name *FirstLastYear levelYear 1Year 2Year 3Year 4Year 5Year 6Year 7Room NumberRoom 1.1Room 1.2Room 1.3Room 1.4Room 1.5Room 1.6Room 1.7Room 1.8Room 1.9Room 1.10Room 1.11Room 2.2Room 2.10Room 2.11Room 2.5Room 2.6Room 2.7Room 4.1Room 4.2Room 4.3Room 4.4When did this occurBefore schoolRecessLunchClass timeSpecialist class (PE, ARTS, French, Science)After schoolOtherWere you:InvolvedA witnessNextTick a box for the following to explain what has happenedBullying (Deliberate ongoing consistent verbal, physical and/or social behaviours that are aimed at causing you physical or psychological harm)Incident (A one off occasion where another student has deliberately used verbal, physical or social behaviours to cause you harm physically or psychologically)Name of the person(s) involved:Name 1Name 2Name 3Name 4Name 5Name 6NextWhat behaviour(s) was involved:Verbal abuse (Examples- name calling, putdowns, sexual putdowns, racial abuse)Physical abuse (Examples- kicking, pushing, punching, hitting, touching inappropriately, spitting)Cyber bullying (Examples- online gaming chat rooms, social media apps, text messaging)Socially excluding behaviours (Examples- not allowing you to play with friends or play games, moving away from you in class, telling others to stay away from you in class)What happened- Explain what happened with as much detail as possible so we can follow upWhat actions (if any) did you take?Spoke to a friend/classmate about itSpoke to a teacher/SSO about itTried to talk to the person(s) who have hurt me to solve the issue myselfHave not told anyoneI used verbal and/or physical violence back to defend myselfI have spoken to my parents/carers about itSubmit Bravery ⋅ Care ⋅ Challenge ⋅ Trust "The Best We Can Be"
