Appendix
3 Template for recording
bullying
behaviour
1. Name
of pupil
being bullied
and
class
group
Name
Class
2. Name(s)
and
class(es)
of
pupil(s)
engaged
in bullying
behaviour
5. Name
of
person(s)
who
reported
the
bullying
concern
Pupil concerned
|
|
Other Pupil
|
|
Parent
|
|
Teacher
|
|
Other
|
|
6. Type
of Bullying
Behaviour
(tick
relevant
box(es))
*
Physical Aggression
|
|
Cyber-bullying
|
|
Damage
to Property
|
|
Intimidation
|
|
Isolation/Exclusion
|
|
Malicious
Gossip
|
|
Name
Calling
|
|
Other
(specify)
|
|
7. Where
behaviour
is regarded
as
identity-based
bullying,
indicate
the
relevant
category:
Homophobic
|
Disability/SEN
related
|
Racist
|
Membership
of
Traveller
community
|
Other
(specify)
|
|
|
|
|
|
8. Brief
Description
of
bullying
behaviour
and
its impact
9.
Details
of
actions
taken
Signed
(Relevant Teacher)
Date
Date submitted
to Principal/Deputy
Principal
* Note: The categories
listed
in the
tables
3, 4
& 6 are
suggested
and
schools
may
add
to or
amend
these
to suit
their
own
circumstance