You are here

502.10E2 Anti-Bullying and Anti-Harassment Witness Form

Name of witness:____________________________________________________________________________

Position of witness:___________________________________________________________________________

Date of testimony, interview:____________________________________________________________________

Description of incident witnessed:________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Any other information:__________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature: ______________________________________________

Date: ____/____ /____