Anonymous Safety & Bullying Report
A safe reporting channel: what is happening, to whom, and what help is wanted.
5 questions · 1 page · about 3 minutes to answer · fully editable after you start
Students report what adults make safe to report. This anonymous form provides the channel: what is happening and where, whether the reporter is the target or a witness, how long it has gone on, and – respecting the reporter's agency – what response they actually want, from just-watch to intervention.
Run it via an always-open anonymous collector promoted honestly. The what-response-do-you-want question matters: reports surge when students trust they keep some control of what happens next.
Replace [local emergency number, e.g. 000] and [local crisis line, e.g. Lifeline on 13 11 14] in its opening note with the services where your respondents live, before you share it: the numbers shown are Australia's. The Collect tab lists both until they are changed.
Template preview
This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.
Opens in the Light theme, or in your own default theme if you have set one — change it anytime to any of the 4 built-in looks, or build your own on a paid plan.
Page 1
Tell us what is happening
This form lets you report bullying or a safety concern that is happening to you or that you have seen. Tell us what you can, and you do not need every detail to start. It takes about 3 minutes.
If you are in danger or need help now, tell a teacher or another adult you trust straight away. In an emergency, call [local emergency number, e.g. 000]. For crisis support, call [local crisis line, e.g. Lifeline on 13 11 14].
Q1.Are you reporting something happening to you, or something you have seen?*
- Happening to me
- Happening to someone else
- Both
Q2.What is happening? Include where and when if you can.*
Q3.How long has it been going on?
- First time
- Weeks
- Months
- This school year or longer
Q4.What would you like to happen?*
- Adults to watch and be aware
- Someone to talk to me privately
- Direct intervention
- I am not sure - just recording it
Q5.Anything else that would help us understand? (Completely anonymous unless you choose to name yourself.)