Machine-extracted text of a publicly
posted document, provided for reference and search. The original document at
the link above is authoritative.
Clear Form
Investigation ID Number_______
(YY/YY/SS/#)
Colchester Public Schools
Safe School Climate Specialist
Investigation Summary Report
Date of Initial Bullying Report: ______________ Date of Investigation Conclusion: _____________
School: _______________________________ Investigator: __________________________________
Attach to this Investigation Summary Report all Incident Reports in order by date.
Date/time by which both the targeted student and alleged bully’s parents/guardians were notified that an
investigation commenced: Date: Time:
Name(s) and grade(s) of reported victim(s)
Has the student been absent as a result of this incident? Yes, total days________ No Unknown
Name(s) of suspected bully(ies) Age School Grade
_________________________ _______ ________ _______
_________________________ _______ ________ _______
_________________________ _______ ________ _______
_________________________ _______ ________ _______
Incident
Names(s) of interviewed witnesses Age School Grade Report #
_________________________ _______ ________ _______ ________
_________________________ _______ ________ _______ ________
_________________________ _______ ________ _______ ________
_________________________ _______ ________ _______ ________
Location of incident:
On school property On the school bus Off school property Electronic Unknown
Incident Description
Provide a detailed summary of the incident.
Investigation Notes
Provide a description of the steps taken during the investigation process.
Findings
Provide an executive summary of the investigatory findings.
Conclusion
Explain whether or not this is a verified case of bullying. Refer to [include policy number here] for the
definition of bullying.
If there is a verified act of bullying, provide the date/time by which both the targeted student and
bully’s parents/guardians were notified that a verified act of bullying has occurred (Must be no later than
48 hours after the completion of an investigation).
Date: Time:
Revised
4.26.21
2
Actions Taken
Provide a description of the recommended actions to be taken as a result of the outcome of this
investigation. Be sure to include all recommended disciplinary and non-disciplinary measures.
Submission Checklist (Attach all required documents in the order listed below and submit originals to
school administration. Send a copy to the District Safe School Climate Coordinator for all verified acts of
bullying.)
Investigation Summary
All Incident Report Forms (Student, Staff or Parent )
Parent Notification Letter(s)
Parent Contact/Meeting Log(s)
_____________________________________________________________________________________
School Climate Specialist Date
_____________________________________________________________________________________
Building Administrator Date
Print
Revised
4.26.21
3