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Bullying Incident Monitoring Form ... - TrustNET - The Learning Trust

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Bullying Incident Monitoring Form ... - TrustNET - The Learning Trust Powered By Docstoc
					2
     1
                Incident number




           EG
                Number of victims




     1
                                                                                                                                                               School -




     M
                Gender of victims

                Ethnicity of victims




     18
     2
                Number of perpetrators

                Gender of perpetrators




    M
    M
                Ethnicity of perpetrator(s)




    08
    18
                First incident recorded for perpetrator(s)




     Yes
                Type of Incident:




     A
                A/ Disability B/ Sexual Orientation
                C/ Racial D/ Gender E/Religious Belief

                What form did the Incident take?
                A/ Verbal abuse B/ Refusal of co-operate
                C/ Abuse of personal property D/ Physical


     A
                abuse
                E/ Abuse of school property F/ Cyber
                Bullying
                G/ Other

                Support to victim(s)?
                A/ Staff support B/ Peer group C/
                Parental/Carer
     A&C
                                                                                                                                                                          Bullying Incident Monitoring Form



                                                               To complete, enter a letter or number in each box using codes attached as in example 1 below.




                D/ Other agency E/None needed

                Is the victim vulnerable?

                Action taken with perpetrator(s)?
                                                                                                                                                               Term -




                A/ Immediate discussion B/ SMT involved
     A&C




                C/ Parent/Carer Involved D/ Fixed-term
                exclusion
                E/Permanent Exclusion F/ Other agency
                 G/ None needed
     D




                Did the incident involve an adult?
                A/Staff B/ Parents/Carers C/ Visitors D / No
     D




                How were incidents followed up?
                A/ Contact with Learning Trust
                B/ Contact with the Police C/ Contact with
                Social Services D/ None needed
3


4


5


6


7


8


9


10
                                      Bullying Monitoring Form Ethnicity Codes.


When completing the bullying monitoring forms, please use the codes below when providing information about both the victim(s)
and perpetrator(s) ethnicity.



                 Code                                     Ethnicity
                  01                      English
                  02                      Scottish
                  03                      Welsh
                  04                      Irish
                  05                      Traveller of Irish Heritage
                  06                      Albanian
                  07                      Greek/Greek Cypriot
                  08                      Turkish
                  09                      Turkish Cypriot
                  10                      White Eastern European
                  11                      White Western European
                  12                      White Other
                  13                      Gypsy Roma
                  14                      White and Black Caribbean
                  15                      White and Black African
                  16                      White and Asian
                  17                      Any Other Mixed Background
                  18                      Indian
                  19                      Pakistani
20   Bangladeshi
21   Any Other Asian Background
22   Caribbean
23   Angolan
24   Congolese
25   Ghanaian
26   Nigerian
27   Sierra Leonian
28   Somali
29   Sudanese
30   Other Black African
31   Any Other Black Background
32   Chinese
33   Afghan
34   Kurdish
35   Latin/South/Central American
36   Vietnamese
37   Orthodox Jewish
38
39   Any Other Ethnic Group
40   Information not available

				
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