Bullying Prevention and Intervention Plan

Mohawk Trail Regional School District

Shelburne Falls, Massachusetts 01370

November 2010
Revised April 2011
 Bullying Prevention and Intervention Plan

Table of Contents

Introduction…………………………………………………
……………..Page 1

Executive Summary
………………………………………………………
Page 2

Goals of the Bullying Prevention and Intervention Plan

………………Page 3

Definitions……………………………………………………
…………….Page 4

Policy
Scope…………………………………………………………
……..Page 6

Building the Foundation and

Framework……………………………….Page 7

Bullying, Antidiscrimination, and Harassment

Policies………………...Page 8

Implementation Procedures
……………………………………………..Page 20

Learning the
Guidelines…………………………………………………
Page 24
 Working
Together………………………………………………………
..Page 26

Measuring Our
Progress………………………………………………...Page
29

Appendices……………………………………………………
…………..Page 33

Bullying Prevention and Intervention Plan

Mohawk Trail Regional School District
24 Ashfield Road
Shelburne Falls, Massachusetts 01370
November 2010
Revised March 2011

Introduction

Mohawk Trail Regional School District expects that all members of the school
community will treat one another in a civil, respectful manner. The District is committed
to providing and maintaining a safe, secure, and positive school climate and culture. This
positive culture will increase student engagement and promote academic achievement.
The District will purposefully build a kind, inclusive community.

The District will create a safe environment for all students and will teach all
students strategies to prevent and respond to teasing, bullying, and harassment. We will
teach pro-social values through our social skills curriculum and teachers, staff, and
administrators will be role models of ethical behavior.

The District understands that members of certain student groups such as students
with disabilities, students who identify as gay or lesbian, or racial minorities may be more
vulnerable to becoming targets or aggressors. Teachers and staff will monitor vulnerable
students and provide additional support, as needed.
 The District will not tolerate unlawful or disruptive behavior including bullying,
cyberbullying, harassment, or retaliation in school buildings, on school grounds, or at
school-related activities. We will promptly investigate all bullying reports, take prompt
action to stop bullying behavior, and restore a sense of safety for targets.

The District is committed to working with students, staff, families, law

enforcement agencies, and the community to prevent bullying. We have established this
Bullying Prevention and Intervention Plan to prevent, intervene, and respond to incidents
of bullying, cyberbullying, harassment, and retaliation. The Superintendent of Schools
and the principals are responsible for implementing, enforcing, and reviewing and
revising the Plan annually.

Executive Summary
The Mohawk Regional School District’s Bullying Prevention and Intervention
Plan is based in part on surveys of four constituencies, students in grades 3-6, students in
grades 7-12, teachers, administrators, and staff, and parents. Surveys were available
online and were completed between September 10 and October 9, 2010. Over 50% of
each constituent group completed surveys.
Here are the key findings of the surveys. Percentage points are rounded to the
nearest percent. The percentages are percentages of respondents.

Key Findings

 70% of middle and high schools students report they had not been bullied at
school.
 87% of parents think their child’s school does an average to excellent job of
making school a safe place.
 60% of parents report their children always feel safe at school.
 96% of teachers, staff, and administrators agree that Student Handbooks are
used to disseminate the District’s Bullying Policy.
 85% of teachers, staff, and administrators report that parents/guardians are
notified within 24 hours when a bullying incident occurs.
 60% of elementary students did not tell anyone when a bullying incident
occurred.
 36% of parents say their child has been bullied at school.
 30% of parents say that school rules of conduct are only sometimes enforced.
 38% of parents have never been invited to participate in an anti-bullying
program at their child’s school.
  87% of teachers and staff say they hold conferences with bullies as a
consequence of bullying and 75% issue a warning, two of the most frequently
used interventions.

The survey data the District gathered indicates that teachers, administrators, staff,
parents, and students have work to do.

Next Steps
 All students need to be encouraged to respond and report bullying and
harassment.
 Teachers and staff need to learn the process for reporting and investigating
incidents so they can share responsibility with their principals.
 Teachers, administrators, and staff need to consistently enforce rules of
conduct for all students.
 Teachers, administrators, and staff may want to explore additional, stronger
interventions for bullies, including making amends, restorative justice, and
community service.
 The District needs to organize and implement parent education programs
about bullying, the role of bystanders, and related parenting issues.

Goals of the Bullying Prevention and Intervention Plan

The goals of the Bullying Prevention and Intervention Plan are to:
 Create and maintain a safe and positive, caring, and tolerant school climate.
 Define what constitutes bullying and harassment.
 Reinforce the District’s commitment to investigate and respond to bullying and
harassment.
 Develop procedures to respond to bullying and harassment reports.
 Clarify disciplinary actions and the extent to which Mohawk Trail Regional
School District administrators must respond according to District policies and
procedures.
 Definitions
Bullying is defined as victimization, intimidation or mistreatment of an individual by
other(s), based on physical, psychological, or social power or perceived power. Bullying
includes cyberbullying and may constitute a crime. Bullying includes behavior that may
cause physical and/or emotional harm, and such behavior is unwelcome, intentional, and
repeated. Bullying can be verbal, physical, direct or face-to-face, or indirect, for example,
through another person or in written form. Bullying is generally a pattern of behavior
directed at another individual, rather than a single, isolated incident. Bullying does not
include harassment.

Bullying is repeated abuse by any member of the District community. It may be written,
visual, verbal, or electronic. It may be a physical act or gesture. Behavior is considered
bullying if it does any of the following:
 causes physical or emotional harm to the target or damage to the target’s property
 places the target in reasonable fear of harm to him/herself, or of damage to his/her
property
 creates a hostile environment at school for the target
 infringes on the rights of the target at school
 materially and substantially disrupts the education process or the orderly
operation of a school.

Harassment is unwelcome, intentional, discriminatory behavior toward an individual or

group motivated by real or perceived membership in a protected category including race,
ethnicity/national origin, religion, disability, gender, sexual orientation, or age.
Sexual Harassment is a sexual advance, request for sexual favor, or behavior of a sexual
nature when:
1. submission to or rejection of such advance, request, or behavior is
made either explicitly or implicitly a term or condition of employment,
or as a basis for employment decisions, or decisions regarding student
evaluation, or participation in school programs or activities, OR
2. sexual advance, request, or behavior that has the purpose or effect of
unreasonable interfering with an individual’s work or school
performance by creating an intimidating, hostile, humiliating, or
sexually offensive environment.
Sexual harassment may occur student to student, adult to student, student to adult, adult
to adult, male to female, female to male, male to male, and/or female to female.

Cyberbullying is any willful, single or repeated harm through, but not limited to, Web
pages, social networking sites, email, instant messaging or text messaging using
computers, cell phones and other electronic devices. Cyberbullying is intentional and
results in social/emotional harm and distress, for example:
 Sending offensive or threatening text messages over the Internet by
computer, cell phone, or electronic network
 Posting offensive or threatening text, images, audio, or video to a Web
page, through a cell phone or electronic network, including social
networking sites
 Sending a threatening intimidating, graphic or sexually explicit photo
or video via the Internet, or using a cell phone or electronic network,
including social networking sites

Cyber-harassment is willful and repeated harm inflicted through but not limited to, Web
pages, social networking sites, email, instant messaging or text messaging using
computers, cell phone, or electronic network, when the target is an individual or
individuals who are members of a protected group, either real or perceived.

Hazing is any behavior or method of initiation into a student organization, whether on

public or private property, which willfully endangers the physical or mental health of any
individual. Such behavior includes beating, whipping, branding, forced calisthenics,
exposure to weather, forced consumption of any food, liquor, beverage, drug, or other
substance, or any other brutal treatment or forced physical activity which is likely to
adversely affect the health and safety of an individual or which subjects an individual to
extreme mental stress, including sleep deprivation, or extended isolation. Hazing is a
form of bullying.

Retaliation is any form of intimidation, reprisal, or harassment by a school community

member directed against another school community member, for reporting or filing a
complaint, for aiding the filing of a report or complaint, for cooperating in an
investigation, or for taking action consistent with this policy.
School community is a group of individuals who are connected with District schools
including students, teachers, administrators, paraprofessionals, parents, coaches, school
committee and local educational council members, and interested townspeople.

Policy Scope
Bullying, cyberbullying, harassment or cyber-harassment is prohibited in
classrooms, on school premises, immediately adjacent to school premises, traveling to
and from school, or at school-sponsored events, whether or not the events are held on
school premises.

Traveling to and from school includes on a school bus or other school vehicle, at
school bus stops, and walking to and from school within a reasonable time before and
after school.

Bullying or harassment, including cyberbullying and cyber-harassment, can occur

in locations not mentioned above, if the incident results or could result in substantial
disruption of the school learning environment or orderly day-to-day operation of
the school.
 Building the Foundation and Framework

Leadership
The following leaders will be responsible for implementing and enforcing the
District’s Bullying Prevention and Intervention Plan:

District Equity Officer – The Superintendent of Schools has primary

responsibility for enforcing the Plan at the district level and serves as District
Equity Officer. He/she handles public and media relations and is the spokesperson
for the district. The District Equity Officer is aware of all bullying incidents and
investigations.

School Equity Officer – The principals have primary responsibility for enforcing
the Plan at the school level. They handle incidents and investigations. They report
to the District Equity Officer. They are responsible for gathering and maintaining
data about bullying and harassment incidents at their schools.

Chiefs of Police – The chiefs of police of each of the towns within the District
consult with the District as needed.

Data Manager – A data manager maintains records of all bullying incidents and
investigations for the District. He/she monitors data and reports to the District
Equity Officer. District professional development and parent education programs
will be planned based on data received.

Anti-Bullying Leadership Team – The Anti-Bullying Leadership Team is

composed of students, teachers, parents, administrators, staff, law enforcement
officers, community-based agencies, and community members who are appointed
to serve, and whose purpose is to oversee annually the implementation and
progress of the Plan. The Anti-Bullying Leadership Team may recommend to the
District Equity Officer that revisions be made in the Plan.

District Bullying, Harassment and Anti-Discrimination Policies

Mohawk Trail Regional School District policies that address bullying,

harassment, and anti-discrimination are:

 Bullying Prevention Policy

 Non-Discrimination Policy
 Non-Discrimination on the Basis of a Disability Policy
 Sexual Harassment Policy
The text of these District policies is included below on pages 8 through 19.

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 JICFB

BULLYING PREVENTION POLICY

The Mohawk Trail Regional School District is committed to providing a safe, positive
and productive educational environment where students can achieve the highest academic
standards. No student shall be subjected to harassment, intimidation, bullying, or
cyberbullying.

“Bullying” is the repeated use by any member of the MTRSD community of a written,
visual (including images), verbal, or electronic expression, or a physical act or gesture, or
any combination thereof, directed at a target that:
· causes physical or emotional harm to the target or damage to the target’s property;
· places the target in reasonable fear of harm to him/herself, or of damage to his/her
property;
· creates a hostile environment at school for the target;
· infringes on the rights of the target at school; or
· materially and substantially disrupts the education process or the orderly
operation of a school.

“Cyber-bullying” means bullying through the use of technology or any electronic

communication, which shall include, but shall not be limited to, any transfer of signs,
signals, writing, images, sounds, data or intelligence of any nature transmitted in whole
or in part by a:

· wire
· radio
· electromagnetic
· photo-electronic or photo-optical system, including, but not limited to, electronic
mail, internet communications, instant messages or facsimile communications.

Cyber-bullying shall also include the creation of a web page or blog in which the creator
assumes the identity of another person or knowingly impersonates another person as
author of posted content or messages, if the creation or impersonation creates any of the

conditions enumerated in the definition of bullying.

Cyber-bullying shall also include the distribution by electronic means of a

communication to more than one person or the posting of material on an electronic
medium that may be accessed by one or more persons, if the distribution or posting
creates any of the conditions enumerated in the definition of bullying.

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Bullying and cyber-bullying may occur in and out of school, during and after school
hours, at home and in locations outside of the home. When bullying and cyber-bullying
are alleged, the full cooperation and assistance of parents and families are expected.

for the purpose of this policy, whenever the term bullying is used it is to denote either
bullying, or cyber-bullying.

Bullying is prohibited:

•    On school grounds;

•    On property immediately adjacent to school grounds;

•    At school-sponsored or school-related activities;

•    At functions or programs whether on or off school grounds

•    At school bus stops;

•    On school buses or other vehicles owned, leased or used by the school district; or,

•    Through the use of technology or an electronic device owned, leased or used by the
Mohawk Trail Regional School District;

Bullying and cyber-bullying are prohibited at a location, activity, function or program

that is not school-related or through the use of technology or an electronic device that is
not owned, leased or used by the Mohawk Trail Regional School District if the act or acts
in question:

•    create a hostile environment at school for the target;

•    infringe on the rights of the target at school; and/or

•    materially and substantially disrupt the education process or the orderly operation of a
school.

3
Prevention and Intervention Plan

The Superintendent and/or his/her designee shall oversee the development of a

prevention and intervention plan, consistent with the requirements of this policy, as well
as state and federal laws. All district stakeholders, which may include teachers, school
staff, professional support personnel, coaches, school volunteers, administrators,
community representatives, local law enforcement agencies, students, parents and
guardians, shall be invited to comment. The bullying prevention and intervention plan
shall be reviewed and updated at least annually.

The Principals are responsible for the implementation and oversight of the bullying
prevention and implementation plan within his or her school.

Reporting

Students, who believe that they are a target of bullying, observe an act of bullying, or
who have reasonable grounds to believe that these behaviors are taking place, should
report incidents to a member of the school staff. The target shall not be subject to
discipline for failing to report bullying.

Each school shall have a means for anonymous reporting by students of incidents of
bullying. No formal disciplinary action shall be taken solely on the basis of an
anonymous report.

Any person who knowingly makes a false accusation of bullying shall be subject to
disciplinary action.

Parents or guardians, or members of the community, are encouraged to report an incident

of bullying as soon as possible.

A member of a school staff shall immediately report any instance of bullying the staff
member has witnessed or become aware of to the school Principals or their designee.

4
Investigation Procedures

The Principals or their designee, upon receipt of a viable report, shall contact support
staff to assess an alleged target’s needs for protection and create and implement a safety
plan that shall restore a sense of safety for that student.

The school Principals or a designee shall promptly investigate the report of bullying,
using a Bullying/Cyber-bullying Report Form which may include interviewing the
alleged target, alleged perpetrator, staff members, students and/or witnesses.

The Principals or their designee shall promptly contact the parents or guardians of a
student who has been the alleged target or alleged perpetrator of bullying. The actions
being taken to prevent further acts of bullying shall be discussed.

Confidentiality shall be used to protect a person who reports bullying, provides

information during an investigation of bullying, or is witness to or has reliable
information about an act of bullying.

If the school Principals or a designee determine that bullying has occurred he/she shall
take appropriate disciplinary action and if it is believed that criminal charges might be
pursued against the perpetrator, the Principals shall consult with the appropriate members
of the school’s administrative team including the Superintendent to determine if the
police should be involved. If it is warranted, the local law enforcement agency shall be
notified.

The investigation shall be completed within fourteen school days from the date of the
report. The parents or guardians shall be contacted upon completion of the investigation
and informed of the results, including whether the allegations were found to be factual,
whether a violation of this policy was found, and whether disciplinary action has or shall
be taken. At a minimum the Principals or his/her designee shall contact, as appropriate,
the parents or guardians as to the status of the investigation on a weekly basis.

Disciplinary actions for persons who have committed an act of bullying or retaliation
shall be in accordance with district disciplinary policies.

5
Each school shall document any incident of bullying that is reported per this policy and a
file shall be maintained by the Principals or designee. A monthly report shall be provided
to the Superintendent.

Confidentiality shall be maintained to the extent consistent with the school's obligations
under law.

Retaliation

Retaliation against a person who reports bullying, provides information during an

investigation of bullying, or witnesses or has reliable information about bullying shall be
prohibited. Safety plans for those who report shall be provided as necessary.

Target Assistance

The Mohawk Trail Regional School District shall provide counseling or referral to
appropriate services, including guidance, academic intervention, and protection to
students, including targets, witnesses, and perpetrators, affected by bullying, as
necessary.

Training and Assessment

Annual training shall be provided for school employees and volunteers who have
significant contact with students in preventing, identifying, responding to, and reporting
incidents of bullying.

Age-appropriate, evidence-based instruction on bullying prevention shall be incorporated

into the curriculum for all K to 12 students.

Publication and Notice

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Annual written notice of the relevant sections of the bullying prevention and intervention
plan shall be provided to students and their parents or guardians, in age-appropriate
terms.

Annual written notice of the bullying prevention and intervention plan shall be provided
to all school staff.  The faculty and staff at each school shall be trained annually on the
bullying prevention and intervention plan applicable to the school.

Relevant sections of the bullying prevention and intervention plan relating to the duties of
faculty and staff shall be included in the school employee handbook.

The bullying prevention and intervention plan shall be posted on the Mohawk Trail
Regional School District’s website.

REFERENCES:    Massachusetts Department of Elementary and Secondary Education’s

Model Bullying Prevention and Intervention Plan

LEGAL REFS.:      Title VII, Section 703, Civil Rights Act of 1964 as amended
Federal Regulation 74676 issued by EEO Commission
Title IX of the Education Amendments of 1972
603 CMR 26.00
MGL 71:37O
MGL 265:43, 43A
MGL 268:13B
MGL 269:14A

CROSS REFS.:      AC, Nondiscrimination

ACAB, Sexual Harassment
JBA, Student-to-Student Harassment
JICFA, Prohibition of Hazing
JK, Student Discipline Regulations

First Reading: October 13, 2010

Adoption: November 10, 2010
Mohawk Trail Regional School District Committee
 
This draft is based on the proposed policy from the Massachusetts Association of School
Committees.

7
 AC

NONDISCRIMINATION POLICY

Public schools have the responsibility to overcome, insofar as possible, any barriers that
prevent children from achieving their potential. The public school system will do its part.
This commitment to the community is affirmed in the following statements of school
committee intent to:

1. Promote the rights and responsibilities of all individuals as set forth in the State
and Federal Constitutions, pertinent legislation, and applicable judicial
interpretations.

2. Encourage positive experiences in human values for children, youth and adults,
all of whom have differing personal and family characteristics and who come
from various socioeconomic, racial and ethnic groups.

3. Work toward a more integrated society and to enlist the support of individuals as
Well as groups and agencies, both private and governmental, in such an effort.

4. Use all appropriate communication and action techniques to air and reduce the
grievances of individuals and groups.

5. Carefully consider, in all the decisions made within the school system, the
potential benefits or adverse consequences that those decisions might have on the
human relations aspects of all segments of society.

8
6. Initiate a process of reviewing policies and practices of the school system in order
to achieve to the greatest extent possible the objectives of this statement.

The committee’s policy of nondiscrimination will extend to students, staff, the general
public, and individuals with whom it does business; No person shall be excluded from or
discriminated against in admission to a public school of any town or in obtaining the
advantages, privileges, and courses of student of such public school on account of race,
color, sex, religion, national origin, politics, disability, or sexual orientation. If you have
a complaint or feel that you have been discriminated against because of your race, color,
sex, religion, national origin, disability, or sexual orientation, register your complaint
with the Title IX compliance officer.

Page 1 of 2.

AC

LEGAL REFS.: Title VI, Civil Rights, Act of 1964

Title VII, Civil Rights, Act of 1964, as amended by the Equal
Employment Opportunity Act of 1972
Executive Order 11246, as amended by E.O. 11375
Equal Pay Act, as amended by the Education Amendments of 1972
Title IX, Education Amendments of 1972
Rehabilitation Act of 1973
Education For All Handicapped Children Act of 1975
M.G.L. 71B: 1 et seq. (Chapter 766 of the Acts of 1972)
M.G.L. 76:5; Amended 1993
M.G.L. 76:16 (Chapter 622 of the Acts of 1971)
Board of Education Chapter 622 Regulations Pertaining to Access
to Equal Educational Opportunity, adopted 6/24/75, as amended
10/24/78
Board of Education 603 CMR 2600
Board of Education Chapter 766 Regulations, adopted 10/74, as
amended through 3-28-78

CROSS REFS.: ACA-ACE Subcategories for Nondiscrimination

FEGA, Contractor’s Fair Employment
GBA, Equal Opportunity Employment
JB, Equal Educational Opportunities

9
Adopted: May 28, 1997
Mohawk Trail Regional School District Committee
Reviewed September 23, 2010

ACE/Students
And JBA

NONDISCRIMINATION ON THE BASIS OF DISABILITY

I. Policy
The Mohawk Trail Regional School District (MTRSD) will not exclude from
employment any otherwise qualified individual with a disability as defined by the
Americans with Disabilities Act (ADA), solely by reason of his/her disability.
Employment review and hiring will be based upon the applicant/employee’s
ability to perform the essential functions of a job as determined by the MTRSD.
Further, it is the policy of the MTRSD that reasonable accommodation will be
made for an otherwise qualified applicant or employee with a disability, unless
the accommodation imposes an undue financial or administrative hardship on the
operation of its program.

II. Grievances
See Discrimination Complaints Policy ACG

III. Employment Training Assurance

The MTRSD annual will provide supervisors with training and information about
ADA employment requirements. Materials include information on reasonable
accommodation, procedures and protocols, and essential vs. nonessential job
functions.

10
First Reading: January 10, 2001
Adoption: February 14, 2001
Mohawk Trail Regional School District Committee

11
 ACAB

SEXUAL HARASSMENT POLICY

MOHAWK TRAIL REGIONAL SCHOOL DISTRICT

Statement of Policy
It is the goal of the Mohawk Trail Regional School District (“the district”) to promote an
educational and working environment that is free from sexual harassment. Sexual
harassment can interfere with a student’s academic performance and emotional and
physical well being. Sexual harassment of a student or employee is illegal, as is any
retaliation against a student or employee who has complained about sexual harassment,
or against anyone who has cooperated with the investigation of a sexual harassment
complaint. The policy of the District will be to oppose and prohibit unlawful harassment
based on sex, sexual orientation, or marital status.

The District has responsibility to investigate all complaints, verbal or written, of sexual
harassment, and to discipline or take appropriate action against any member of the school
community who is found to have violated this policy.

If a student believes an incident to have constituted sexual assault, the complainant/the

district will report it to the police and it will be prosecuted as a crime. Likewise, any
incident of alleged or suspected sexual abuse of a student will be reported immediately to
the appropriate state agencies.

DEFINITION OF SEXUAL HARASSMENT

Sexual harassment is a form of sex discrimination prohibited under Title IX of the Equal
Amendments of 1972 and Massachusetts General Laws, Chapter 151C. Sexual
harassment as it relates to student-to-student interaction is defined as unwelcome sexual
advances, requests for sexual favors, and other verbal, visual, or physical conduct of a
sexual nature. Sexual harassment is defined for adult-student interaction as any sexual
advances, requests for sexual favors and other verbal, visual or physical contact of a
sexual nature. Sexual harassment is also defined as conduct of a sexual nature which
affects an individual’s employment, academic status or progress, or which creates a work
or educational environment that is intimidating, hostile, or offensive.

This sexual harassment policy applies to harassment of students by students, students by

staff, staff by students, or staff by staff. It applies to both males and females, and applies
whether the harassment is between people of the same or different gender. Sexual
harassment may also include harassment regarding a person’s sexual orientation.

Sexual harassment can include, but is not limited to:

Verbal Conduct
1) Unwanted sexual or lewd comments; sexual epithets; jokes, written or oral references
to sexual conduct; spreading rumors regarding an individual’s sex life; comments or

12
 inquiries regarding an individual’s sexual activity, deficiencies or prowess; unwanted
pressure for sexual favors or dates; calling attention to another’s gender or sexuality
in a negative or embarrassing way;
2) Offensive sounds such as whistling or making kissing sounds;
3) Displaying sexually suggestive objects, pictures, cartoons;

Insulting language not of a sexual nature may be dealt with in a separate disciplinary
procedure.

Physical Conduct
Whether or not it involves physical touching
1) Suggestive looks or leering;
2) Restraining someone’s movement in a sexual way, following a person, laughing at a
person who is being harassed;
3) Any unwelcome physical touching:

PROCEDURES FOR DEALING WITH SEXUAL HARASSMENT COMPLAINTS

The district will take an assertive and active role in protecting its staff and students from
sexual harassment. A person who believes he or she is being harassed sexually is
encouraged to identify the behavior as offensive and request that the harasser stop the
behavior. If this is not possible or the offensive behavior does not stop, then staff and
students should immediately report such instances in accordance with the following
procedure:

Reporting
1) Any person who feels s/he has been sexually harassed by a student or staff member,
or has knowledge or belief of conduct which has occurred that might be sexual
harassment, should speak to or send a note to any school personnel that s/he trusts
(i.e. teacher, nurse, counselor, coach, principal, or assistant principal) or should tell
his/her parents who should then notify school personnel. The procedure begins when
school personnel have been notified. It is the obligation of school personnel to report
allegations of conduct which could be sexual harassment.

2) School personnel shall be responsible for documenting the complaint in written form
and providing a copy to the school principal within one working day. (The
complainant may, but is not required to, file his/her own written complaint.) The
school principal or superintendent’s designee will serve as the Title IX Investigator
for handling all sexual harassment complaints. If the principal is the subject of the
complaint, the district superintendent is authorized to handle all aspects of the
complaint, including receiving the written complaint form.

Investigation
3) The Investigator shall conduct an investigation of the complaint, including conferring
at least once with the student or staff who claims to have been harassed and at least
once with the person charged in order to obtain his/her response to the complaint.

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 Each student may bring a peer advisor or parent to any such meeting. The
investigator will also interview significant witnesses to the alleged harassment.

Consequences
4) Where the Investigator determines that there has been a violation of this policy,
she/he
a) attempt to solve the matter informally through having the harasser and victim,
if willing; sit down with a third party. Informal resolution may be appropriate
for non-physical, student-to-student interactions;
b) take disciplinary action. This will include a written warning that such
behavior must cease, and may also include, as appropriate:
c) verbal/written reprimands
d) a letter/meeting with parents
e) suspension/expulsion from school
f) transfer, suspension, termination of employment
g) referral to the Massachusetts Commission Against Discrimination, or other
appropriate state or federal law enforcement or other agencies.

5) If, after investigation, the Investigator determines that the sexual harassment has
occurred, s/he will notify the parties, including parents/guardians, by certified mail, of
his/her finding and action(s) taken.

6) If the determination is that there was not a violation of this policy, the matter will be
closed. The Investigator will notify the Complainant and alleged harasser that the
matter has been closed.

Appeal
If any party does not agree with the decision, it may be appealed to the superintendent
within ten days of notification. The superintendent may designate an individual to
investigate the complaint.

Confidentiality
Any report of sexual harassment will be kept confidential to the extent permitted by law,
involving as few people as possible. The goal will be to conduct a thorough and fair
investigation, while protecting the privacy of all parties involved, to the extent feasible.
If harassment is found, the goal is to stop the behavior. Where more effective
remediation may require the use of name(s), disclosure will be limited to those with an
immediate need to know.

Retaliation
It is unlawful to retaliate in any form against any person who has filed a complaint for
sexual harassment or who has cooperated in an investigation of a complaint. If retaliation
occurs, it can be considered grounds for suspension and exclusion from school of a
student, dismissal of staff, and/or further disciplinary action.

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False Reports/Accusations
Because of the serious and private nature of this offense, false accusations of harassment
will be treated as disciplinary offenses and will result in the same level of punishment as
that applied to harassment behavior. A false accusation is one made in bad faith, not a
complaint that could not be corroborated or which did not rise to the level of unlawful
harassment.

State and Federal Agencies

Students and employees may contact these anti-discrimination enforcement agencies:
Massachusetts Commission Against Discrimination
436 Dwight Street, Suite 220 or One Ashburton Place
Springfield, MA 01103 Boston, MA 02108
Tel. (413) 739-2145 Tel. (617) 727-3990

U.S. Department of Education/Office of Civil Rights

John W. McCormack Post Office and Courthouse, Room 222
Post Office Square, Boston, MA 02109

First reading: January 13, 1999

Second reading and Adoption: March 10, 1999
Mohawk Trail Regional School District Committee

15
 Implementation Procedures

Reporting
Any member of the school community, students, staff, parents, or other
community members may make a complaint and report bullying or retaliation behavior
orally or in writing. Bullying and Harassment Incident Complaint Reporting Forms
(Appendix A) can be found in a school’s main office, nurse’s office, and guidance office.
This form can also be found on the homepage of the District’s website at
www.mohawkschools.org The form can be used to report retaliation as well as bullying
or harassment. Forms in other languages will be available as needed. A developmentally
appropriate form written for elementary students is also available. (Appendix C) Forms
should be returned to the school office.

Any school community member may make an anonymous report of bullying,

harassment, or retaliation by downloading and printing an Anonymous Bullying Report
Form (Appendix B) available on the homepage of the district’s website and on the
homepages of each school’s website. In addition, anonymous reporting forms are
available at local public libraries. A standard Complaint and Reporting Form can be used
as an anonymous form by omitting the name of the one filing the report. Anonymous
information cannot be used by itself for disciplinary proceedings, but it may lead to an
investigation into the allegation. Anonymous Bullying Report Form can be used to report
retaliation as well as bullying or harassment.

Any member of the school community who retaliates against another for reporting
bullying or harassment, or who knowingly makes a false accusation of bullying or
harassment will be subject to disciplinary action. The Incident Report Form and the
Anonymous Report Form can also be used to report retaliation incidents. Incidents of
retaliation will be treated very seriously and will be responded to promptly.

All individuals who are reported as aggressors, targets, witnesses, or are otherwise
involved in a bullying incident will be afforded the same protection regardless of their
legal status.

Investigation
Investigations are coordinated by the building Equity Officer (EO). At the middle
and high school the vice principal is the Equity Officer and at the elementary level the
principal is the EO. Investigations will be carried out by the EO or his designee.

There are circumstances in which an incident is referred to the District Equity

Officer or Superintendent of Schools.
 When a parent, guardian, or student feels an incident was not resolved at
the building level.
 When an incident involves the Equity Officer or principal or other
building staff responsible for an investigation.

16
  When a situation remains unresolved after an investigation and corrective
action. Usually this would be two or more substantiated incidents
involving a single individual or group.
 Adult to adult bullying behavior.

Investigations of bullying, harassment, or retaliation are documented using the

Bullying and Harassment Incident Report Tracking Form (Appendix C) and the RITA
(Report, Investigate, Take Action) Protocol Checklist (Appendix D). These forms will be
used to help determine whether or not bullying, harassment, or retaliation occurred and
will document the type of violation. The forms will document the corrective or
disciplinary action taken and the notification of all relevant individuals. The RITA
Protocol Checklist will serve as a reference throughout the process to ensure appropriate
steps are taken and follow-through is completed. If allegations are substantiated,
completed forms are sent to the District Data Manager. The Data Manager will monitor
whether the aggressor has been the subject of a previous complaint in another building.
Investigation of the complaint will be concluded within 14 school days of the
filing of the initial report. Most investigations will be concluded within 10 school days.

Take Action
If the complaint against the aggressor is substantiated the investigator’s report
will:
 Provide for reasonable, timely, and age-appropriate corrective action
intended to stop the bullying or retaliation behavior and prevent its
reoccurrence.
 Document steps to address the effect of the bullying or retaliation
behavior on the target.
 Document steps to protect the target and/or one who filed the
complaint from retaliation.
 Provide corrective action for anyone who knowingly makes a false
report of bullying, harassment, or retaliation.
 The Equity Officer will have an educational discussion with the
aggressor and bystanders about the consequences of bullying behavior
and the fact that everyone is now aware of the situation. Equity Officer
will discuss the consequences if bullying behavior continues or if
retaliation occurs.

In exceptional cases in which a formal investigation is not needed and immediate

action is required, the Equity Officer may immediately inform targets, aggressors, and
bystanders about the consequences of bullying or retaliation in school and immediately
follow-through with consequences.

17
 Notification
Following preliminary screening, parents/guardians of all students involved
in a bullying, harassment, or retaliation incident will be notified by an Equity
Officer or his designee within one school day of the filing of a bullying, harassment,
or retaliation report or complaint.
When criminal charges may be pursued against the aggressor, the local law
enforcement agency must be notified by the Equity Officer.
When the incident involves students from more than one school or school district,
the Equity Officer immediately notifies the principal of the other school so both schools
can address the incident promptly.
The Equity Officer will notify the aggressor’s parents/guardians, in accordance
with state and federal privacy laws, of disciplinary action taken. Parents will be informed
about the seriousness of retaliation. Counseling or a referral to an outside agency will be
offered to the aggressor’s family.
The Equity Officer will notify the target’s parents/guardians, in accordance with
state and federal privacy laws, that action has been taken to stop the bullying behavior,
and prevent both reoccurrence and retaliation. Parents will be informed about the
seriousness of retaliation and advised to report any retaliation incidents. Counseling or a
referral to an outside agency will be offered to the target’s family.
The Equity Officer will notify the individual who filed the complaint, in
accordance with state and federal privacy laws, if he/she was not the target or
parent/guardian, that his/her complaint has been investigated and action has been taken.
The individual will be informed about the seriousness of retaliation and advised to report
any retaliation that occurs.

Safety Plans
Each school’s Equity Officer in consultation with his staff will develop a safety
plan for targets of bullying, harassment, or retaliation. An individual who reports,
witnesses, or cooperates in an investigation and feels threatened or intimidated will have
a safety plan. Students who provide information as part of an investigation, or students
who are reliable witnesses, or who might be aware of bullying and provide relevant
information, are all entitled to safety plans. All provisions for protection and for safety
plans apply to all students who are in any way part of a bullying incident as target,
aggressor, witness, bystander, or informant.
The Safety Plan will include:
 A Safe Zone or area where the target or others can go to get help from
a trusted adult.
 A protocol for informing all relevant adults (bus driver, counselor,
playground monitor, etc.) of the situation that exists between the
target/others and the aggressor.
 A plan to monitor less structured areas of the school like hallways,
cafeteria, bus, and playground.
 Weekly assessment of the effectiveness of the Safety Plan.
 A plan of action to be taken in the event of retaliation against the target
or any other individual.

18
 Requirements for Students with Disabilities
Students with disabilities may need additional support at school as they develop
social skills. For students identified as being on the Autism spectrum or having a
disability that affects social skills development, the IEP or 504 Team needs to evaluate
that student’s vulnerability as a bully or a target. The IEP Team will need to specifically
address the social skills needed to avoid becoming a bully or a target as well as how to
respond if bullying occurs.
The IEP or 504 team can recommend pragmatic language and /or counseling
services to supplement a school's social skills curriculum. The social skills curriculum
may require reinforcement, repetition, or modification to reach a student with identified
social skills deficits. This is often provided by small group instruction but may be
provided through individualized instruction.
A guidance counselor, school adjustment counselor, or psychologist monitors a
student’s social skills development and responds to socially challenging circumstances in
the school environment. Concerns are reported to a student’s family promptly and
diplomatically. If a student with an identified disability is involved in a bullying,
harassment, or retaliation incident, either as a target or aggressor, there should be careful
consideration of the student’s disability.

19
 Learning the Guidelines

Staff Professional Development

Leadership Training
In Spring 2011, Administrators who serve as District Equity Officer and Equity
Officers in each school will receive leadership training about bullying prevention and
intervention procedures and plan implementation. They will learn strategies for
intervention to stop bullying and retaliation, information about the power differential
between aggressor and target, identification of students at risk for bullying, as well as
information about Internet safety and cyber-bullying. Middle School team of teachers and
student leaders attended an all-day anti-bullying workshop at Westfield State University
in January 2011. An administrator will receive two days of facilitator training in Steps to
Respect in April 2011.

Staff Training
In Spring through Fall 2011 District school staff will have professional
development about the Plan and its implementation. Staff will learn strategies for
intervention to stop bullying and retaliation, information about the power differential
between aggressor and target, identification of students at risk for bullying, as well as
information about Internet safety and cyber-bullying. Classroom teachers in grades K-6
will receive training in Second Step and Steps to Respect. Middle and High School
teachers will receive training in Olweus. Olweus will be implemented in Middle and
High School in Fall 2011. At staff meetings in District schools there will be school-wide
training in Responsive Classroom and social skills development, in the use of anti-
bullying and social skills curriculum, as well as a review of reporting and investigation
procedures. In addition to classroom teachers, this training will include specialists,
paraprofessionals, coaches, bus drivers, and cafeteria workers. The District leadership
team will continue to look for opportunities for teachers to attend workshops and
conferences, like the anti-bullying conferences at Westfield State University. Teachers
may choose to attend anti-bullying and social skills training in Summer Academy, a
summer program for teachers sponsored jointly by Franklin and Hampshire County
school districts, and the Collaborative for Educational Services, Northampton.

Training for Specialists

In Spring through Fall 2011 school nurses, psychologists, guidance and
adjustment counselors, special educators, and paraprofessionals who work with socially
vulnerable students will be trained in bullying prevention and intervention strategies for
students with disabilities. They will learn strategies for intervention to stop bullying and
retaliation, information about the power differential that exists between aggressor and
target, identification of students at risk for bullying, as well as information about Internet
safety and cyber-bullying. They will identify at-risk students and ensure those students
and their families receive additional support, as needed. Individuals may choose to attend
Summer Academy to take courses in Social Thinking, Steps to Respect, and other anti-
bullying programs.

20
 Training in Use of Social Skills Curriculum
In Spring through Fall 2011 teachers will have training about how the Bullying
Prevention and Intervention Plan connects to adopted social skills and anti-bullying
programs. They will connect what they learn about programs to strategies for intervention
to stop bullying and retaliation, information about the power differential between bully
and target, as well as information about Internet safety and cyber-bullying.

Annual Training
In subsequent years the District will notify all teachers annually about the Plan
and procedures. There will be additional annual training for new teachers. Within the
first two weeks of school, all staff will receive an annual written notice of the Plan
through published information about the plan. The Plan will be posted on the District
website and on all school websites. Printed copies of the plan will be available in the
school offices of all District schools and in the District’s Central Office. Teachers and
staff will be notified about the provisions of the plan related to staff duties including the
reporting procedure, power differential, at-risk students, and cyber-bullying. A colleague
or administrator will provide an overview of the social skills curriculum. Parents will
receive annual notification about the Plan, and reporting and investigation procedures.
We will distribute a parent brochure annually at the beginning of each school year and to
new students’ parents when a student is enrolled in the District.

Other Professional Development

There will be on-going professional development opportunities in the areas of
social skills development and bullying and retaliation prevention and intervention. These
opportunities may include films, book groups, lectures, and panel discussions.
Professional development events will address bullying and retaliation, power differential
between bully and target, identification of at-risk students, and Internet safety.
Professional development events may be open to parents and interested community
members.

21
 Working Together

Parent and Community Engagement

District and school level parent education programs will be held in Spring/Fall
2011 to explain the District Plan and procedures to parents/guardians and to advise
parents how they can help reinforce the Plan at home. In subsequent years, once parents
understand the Plan, it will be explained annually.
The District has developed a brochure about bullying for parents/guardians.
(Appendix F) We will distribute this brochure to all parents annually and to new parents
when their child is enrolled in the District.
There will also be additional educational programs to explain District social skills
curriculum and to engage in problem solving about parenting issues. Parents will learn
about the bullying power differential and about online safety.
The Anti-Bullying Leadership Team will annually evaluate the effectiveness of
the District Plan and the effectiveness of District anti-bullying programs. They will make
recommendations to the District Equity Officer.
The District will reach out to community organizations like Department of
Children and Families, Kiwanis, United Arc, Clinical and Support Options, and religious
organizations. Their advice and resources will support the District, its families, and
students.

Policy, Procedures, and Student Social-Emotional Learning

All Students
When the Bullying Prevention and Intervention Plan is adopted by the school
committee and accepted by the Department of Elementary and Secondary Education, the
District and its schools will begin the process of explaining policies and procedures
contained in the Plan to all students.
While a Bullying Policy is contained in the District’s Student Handbook, and
parents and students are familiar with the District Bullying Policy, the District will ensure
that students understand, in a developmentally appropriate way, the procedures with
regard to
 Reporting an incident
 Understanding responsibility of a bystander, witness, or informant
 Knowing where forms are available and how to ask for a form
 Filing a complaint orally and in writing
 Filing an anonymous bullying, harassment, or retaliation report
 Understanding steps in an investigation
 Understanding if allegations are substantiated, appropriate actions will
result
 Knowing what to do if retaliation occurs
 Knowing what a safety plan is and when to ask for one whether one is
a target, bystander, witness, or informant.
The Bullying Prevention and Intervention Plan will be explained to students
annually during the first two weeks of the school year.

22
 Social Skills Curriculum
The District had previously adopted and implemented Second Step, published by
the Committee for Children, as our social skills curriculum in grades K - 6. In 2010 the
district purchased Steps to Respect, an evidence-based social skills curriculum with an
anti-bullying focus, also published by the Committee for Children.
In Kindergarten through Grade 2, students will study Second Step. In Second Step
students will learn pro-social values like empathy, anger management, and self control.
As part of social skills training, students will learn about alternatives to discipline like
restorative justice, making amends, and community service.
In grades 3 - 6 students will study Steps to Respect, which includes both explicit
antibullying instruction and ethical values lessons.
In grades 7 through 12, middle and high school faculty and staff have adopted
Olweus as their anti-bullying program. Olweus, started by Dr. Dan Olweus of the
University of Bergen, Norway, is the oldest, evidence-based bullying prevention
program. Teachers will receive Olweus training in Spring through Fall 2011, with
implementation to begin in Fall 2011. High school student leaders may enroll in
Hampshire County District Attorney’s office workshop, Cyber-Smart, to become trained
mentors. High school students will then be equipped to mentor elementary students about
the dangers of cyber-bullying. All students will be trained about cyber-bullying dangers
and instructed to report cyber-bullying immediately to parents, teachers, administrators,
staff, or other school personnel. Massachusetts Aggression Reduction Center has an anti-
bullying training program at Bridgewater State which is being considered by the middle
and high school Equity Officer.
All students will be trained about the important role bystanders play in stopping
bullying and retaliation and will be equipped to promptly step in when they see bullying
or retaliation occur.
The District timeline for implementation of a social skills curriculum is that in
2010 – 2011 Second Step and Steps to Respect will be taught. Concurrently, the middle
and high school will implement Olweus and other programs appropriate for middle and
high school students.
The District’s social skills curriculum will be evaluated annually for its
effectiveness by students, teachers, and administrators.

Students in Need of Additional Support

Counseling and Support Services

Students who need additional social-emotional support are currently receiving
counseling and guidance from school psychologists, guidance counselors, and special
educators. IEP and 504 Teams may explore implementing an evidence-based social skills
curriculum and additional time in social skills groups for students who are especially
vulnerable to bullying and harassment due to race, disability, or gender orientation. These
programs will be implemented in 2011 – 2012.
Any programs for vulnerable students will be evaluated annually for effectiveness
by students, teachers, and administrators.

23
 In addition, some students and families may be need to be referred to outside
services. School psychologists, guidance counselors, and/or special educators will help
students and families find the outside services they need in a timely way.

24
 Measuring Our Progress

In September 2010 the District conducted its first surveys about bullying to create
a baseline for instruction and to enhance school climate and culture. The following
surveys were posted online at https://www.surveymonkey.com.

Number of Percent Who

Survey Source of Survey Respondents Participated
Southern Poverty
Students Grades 3-6 Law Center 277 74%
Middle and High Young Adult Lit.
School Teacher Resources 368 64%
Teachers, Admin., Connecticut
and Staff Dept. of Education 239 74%
Province of Alberta
Parents/Guardians Canada 447 57%

Surveys were posted from Sept. 10, 2010 through Oct. 9, 2010. More than 50% of
each group responded to the surveys.
Complete survey results are included in Appendix E. Here are highlights of data
the District gathered to plan for the future.

Bullying Survey Grades 3 – 6

Students in the District’s six elementary schools, who are between 8 and 12 years
old, generally reported an absence of bullying behavior. For the most part when behavior
seemed like bullying it was usually “just kidding” or “we were just joking around.”
 28% of students responding reported they had been called names
 23% of respondents had been hit, kicked, or pushed.
 40% of students who responded reported these incidents while 60% did not
tell anyone.
 28% of students responding reported seeing someone else bullied.
 10% of respondents admitted they had bullied others.
Elementary students may have said what they thought adults wanted to hear, that
is, bullying is not a problem. The open response format of this survey may not have been
an effective format for elementary students. Next year when the District surveys
elementary students, we may want to use focus groups or some other method of gathering
data.

25
 Middle and High School Bullying Survey
70% of middle and high school students who responded report they had not been
bullied at school. 30% of middle and high school respondents admitted they had bullied
others.
Among middle and high school students as among elementary students, name
calling was the most prevalent form of bullying. 36% of respondents reported they had
been called names and 28% admitted they had called others names.
20% of respondents reported being kicked, hit, or tripped. 19% of students
responding said they had been ignored or excluded.
When bullying occurred, only 17% of middle and high school students told
anyone about the incident. 20% just ignored the incident and 11% avoided the bully.
60% of middle and high school students surveyed thought teachers and staff were
aware of bullying incidents. 25% of students surveyed thought school rules about conduct
and behavior were always enforced, while 37% said rules were sometimes enforced.
23% of respondents said they had participated in an anti-bullying program at
school.
Middle and high school respondents identified certain “hot spots” for bullying:

Bullying “Hot Spots” in Percent of Respondents that Identified

Middle and High School “Hot Spot”
Hallways 76%
Locker Rooms 44%
Cafeteria 41%
Lockers 38%
Note: Consistent with practices in other school systems, the District has recently installed security cameras in several
corridors of the middle/high school building. These cameras provide for increased oversight of the public hallways; a
significant reduction in student traffic during classes has already been noted.

Parent Survey About Bullying

Of the parents who responded to the Parent survey, 60% reported their child
always felt safe at school. 87% of parents surveyed thought their child’s school did an
average, above average or excellent job of making school a safe place.
36% of respondents said their child had been bullied at school. According to
parents surveyed, when bullying occurs it is most likely to happen in classrooms (31%),
hallways (30%), and on the playground (40%). Respondents also identified school buses
and cafeterias as places bullying occurs. About 10% of parents surveyed said their child
had stayed home from school to avoid being bullied.
28% of respondents reported that if their child were bullied at school, school
personnel would never report the incident. 35% of parents surveyed said rules of conduct
were enforced often, while 30% said rules were enforced sometimes. 42% of parents
surveyed weren’t sure what would happen if a student told an adult about bullying,
implying they did not know or were uncertain if adults would act on a report.
38% of respondents reported they had never been invited to participate in an anti-
bullying program at their child’s school. 36% had sometimes been invited to participate.
The parent survey had a box for parents to give additional information. 149
parents wrote anecdotes and comments about their child’s school experiences with
bullying.

26
 Bullying and School Climate Survey – Teachers, Administrators, and Staff
Teachers and staff surveyed said the following interventions were frequently used
with aggressors:
 87% had a conference with bully
 81% increased supervision
 75% issued a warning
 74% engaged aggressor in counseling
 73% used peer mediation
33% of teachers and staff surveyed said a list of verified bullying incidents is
immediately available for public inspection if parents ask. 78% of respondents said their
school does not have a list of verified acts of bullying incidents.
96% of respondents said that student handbooks are the method used to
disseminate the District’s Bullying Policy and that notification about the Bullying Policy
is given annually.
Teachers and staff surveyed believe parents of targets and aggressors should be
notified and 85% report parents/guardians are notified within 24 hours of an incident.

What We Learned from Survey Process

This was the first time the District had conducted surveys online. We did not
know how respondents would react to the online format.
What we found was online surveys worked well, especially for families. The
Superintendent of Schools emailed families to tell them about the surveys and to send
them a link. The Superintendent also called families using an automated call system. We
sent out one follow-up email to families. Families responded well to the online survey
and appreciated the confidentiality it offered. They knew that their honest responses,
comments, and anecdotes would be anonymous.
Online surveys worked well for middle and high school students and teachers,
administrators and staff. For middle and high school students the surveys were taken in
computer labs at school. Teachers and staff had a link to their survey and could take it at
home or school. Participation was good but we emailed repeated reminders for middle
and high school students, teachers, and staff.
The online survey for elementary students was successful in that 74% of students
in grades 3 through 6 took the survey at school. The open response format was not the
best format for elementary students and did not yield as much useful information. Some
students may not have understood the questions and other students may have been
concerned with pleasing adults. In the future we want to explore other formats for
elementary students, like pre and post-assessments in Second Step and Steps to Respect
and focus groups with an adult moderator.

Future Bullying Surveys

The District plans to survey students, parents, teachers and staff annually, which
we began in September 2010.

27
 In the future years as part of our annual process we will survey in spring, revise in
summer, and post the Plan for comment in late summer/early fall. The purpose of climate
and bullying surveys is to
 enhance District and school climate
 evaluate the effectiveness of District social skills curriculum
 target parent education programs
 provide meaningful professional development for teachers and staff
The school and District climate surveys will also be used to help staff assess other
climate issues that are related to bullying and harassment, like enforcement of rules of
conduct.

28
29
 Appendices

Appendix A. Bullying and Harassment Incident Complaint Reporting Form

Appendix B. Anonymous Bullying Report Form

Appendix C. Elementary Bullying Report Form

Appendix D. Bullying and Harassment Incident Report Tracking Form

Appendix E. RITA Protocol Checklist for Bullying/Harassment

Appendix F. Parent Brochure

30
 Appendix A
BULLYING, HARASSMENT, AND RETALIATION INCIDENT COMPLAINT REPORTING FORM
______________________ School District – __________________ School
1. Name of Reporter/Complainant: __________________________________________________________________

2. Check whether you are the:

<INPUT TYPE=\ Target (of behavior) <INPUT TYPE=\Reporter (not the target of the behavior)

3. Check whether you are a:

<INPUT TYPE=\Student <INPUT TYPE=\ Staff member <INPUT TYPE=\ Other (specify)
_______________________________
<INPUT TYPE=\ Parent <INPUT TYPE=\ Administrator

3A. Provide your Contact Information/Telephone#: ___________________________________________________

4. If student, state your School: ______________________________________ Grade: _______ Homeroom: _______

5. If staff member, state your School or Work Site: ______________________________________________________

6. Information about the incident:

Name of target (of behavior): ______________________________________________ <INPUT TYPE=\ student <INPUT

TYPE=\ staff <INPUT TYPE=\ other

Name of subject of report/complaint: ______________________________________ <INPUT TYPE=\ student <INPUT

TYPE=\ staff <INPUT TYPE=\ other

Date(s) of incident(s): ___________________________________________________________________________

Time(s) when incident(s) occurred: _________________________________________________________________

Incident location(s) (be as specific as possible): ___________________________________________________________

7. Witnesses (list people who saw the incident OR have relevant information about the incident) :

Name: ________________________________________ <INPUT TYPE=\ student <INPUT TYPE=\ staff <INPUT TYPE=\ other
(specify) __________________

Name: ________________________________________ <INPUT TYPE=\ student <INPUT TYPE=\ staff <INPUT TYPE=\ other
(specify) __________________

8. Describe the details of the incident (names of persons involved, what occurred, and what each person did and said, including specific words used;
use additional paper if necessary):

9. Have you taken any action on this matter? Yes ________ No_________ (if “yes” please describe action taken and when; use additional
paper if necessary)

10. Signature of Reporter/Complainant: _________________________________________ Date: ________________

11. Form provided to: ________________________________ Position: _________________ Date: ________________

Signature: ______________________________________________________________ Date: ________________

31
PLEASE SEND COMPLETED FORM TO _________________________________________________.

32
 Appendix B
Mohawk Trail Regional School System
Office of Curriculum and Assessment
24 Ashfield Road, Shelburne Falls, MA 01370

Stop•A•Bully

Safe & Anonymous

This form may be used to report bullying, harassment, or

retaliation.
Date:
Submitted By: (optional)
School:
Name of Bully:
Grade of Bully:
Date of Incident:

Details of Incident:

Location of Incident:
Time of Incident:
Number of Witnesses:
Who has been told:
Number of times this has happened:
It is the responsibility of the school to investigate the accuracy of every Bully Report
and then take the steps necessary to stop any further harassment. The Mohawk
Trail Regional School System agrees to treat reports in a professional manner and
respect the person who submitted it in their desire to remain safe and anonymous.
This report is considered confidential whether you choose to remain anonymous or
not. School staff will show it only to the persons who are directly involved in this
incident.

33
 Submit completed form by mail or e-mail to
stopbullying@mohawkschools.org

Appendix C
Elementary
Bullying Report Form

Name:
______________________________________________________________
___

Date:
______________________________________________________________
____

WHO was involved?

Target
______________________________________________________________
___

Bully
______________________________________________________________
____

WHEN Date ____________________ Time:

_______________________________

WHERE
______________________________________________________________
_

WHAT happened?
_____________________________________________________

______________________________________________________________

__________

______________________________________________________________

__________

______________________________________________________________

__________

34
WHO saw what happened?

______________________________________________

______________________________________________________________

___________

______________________________________________________________

___________

WHO did you tell?

_______________________________________________________

______________________________________________________________

___________

______________________________________________________________

___________

WHAT did you do?

_______________________________________________________

______________________________________________________________

____________

______________________________________________________________

____________

35
 Appendix D
BULLYING, HARASSMENT, AND RETALIATION INCIDENT REPORT TRACKING FORM
______________________School District – School Name _____________________
TO BE COMPLETED BY ADMINISTRATORS OR THEIR DESIGNATED OFFICIAL(S)
1. Incident:
Race/Ethnicity
School/Building: _____________________ Name of Incident Reporter(s): ______________ Code Key
Date(s): _____________________ <INPUT TYPE=\Student <INPUT TYPE=\Employee <INPUT TYPE=\Other _________
Time(s): _____________________ Date of Report/Complaint: _________________ Use all that apply.
Location(s): _____________________
2. Target of behavior: A - Asian or Asian
American
Name ID # Age Grade Sex Race/ Repeat Target SPED/ELL Parent
AI/AN – American
(If not student indicate Ethnicity Target new to student Notified
Indian or Alaskan
if staff member/other) (Y/N) district (Y/N)
Native
(Y/N)
B – Black or
African American
PI – Pacific
Islander or Native
Hawaiian
3. Subjects(s) of the complaint/report: W – White/
Name ID # Age Grade Sex Race/ Repeat Target SPED/ELL Parent Caucasian
(If not student indicate if Ethnicity Target new to student Notified H – Hispanic,
staff member/other) (Y/N) district (Y/N) Latino, Chicano
(Y/N) ME – Middle
Eastern
BR – Brazilian
O - Other

4. Witnesses: (List people who saw the incident OR have pertinent information)
1) Name: __________________________ <INPUT TYPE=\Student <INPUT TYPE=\Staff Member <INPUT TYPE=\Other
________________________
Contact information/phone # ___________________________________________________________________
2) Name: __________________________ <INPUT TYPE=\Student <INPUT TYPE=\Staff Member <INPUT TYPE=\Other
________________________
Contact information/phone # ___________________________________________________________________
3) Name: __________________________ <INPUT TYPE=\Student <INPUT TYPE=\Staff Member <INPUT TYPE=\Other
________________________
Contact information/phone # ___________________________________________________________________
5. Summarize the details of the incident (Be as specific as possible, including who was involved, what each person did and said, specifying
the words used. Use additional paper if necessary.):
6. Action(s) taken by staff member(s) at time of incident:

7. Referred to the following designated official/administrator: _______________________________________

8. Initial parent/guardian notification:

Date__________time__________parent/guardian name____________________________________________
9. District Equity officer notified: <INPUT TYPE=\Yes <INPUT TYPE=\No
10. Police notified: <INPUT TYPE=\Yes <INPUT TYPE=\No Police Responded: <INPUT TYPE=\Yes <INPUT TYPE=\
No Responding Officer: ___________
Nature of police involvement (circle all that apply):
<INPUT TYPE=\Responded to school/bullying <INPUT TYPE=\Intervened during incident <INPUT TYPE=\ Took person
into custody
<INPUT TYPE=\ Other
11. Bias Indicators related to incident (circle any that apply):
<INPUT TYPE=\Aggressor and target are from different groups
<INPUT TYPE=\Derogatory words/writings/gestures used relating to target’s group Definition: “Group”
<INPUT TYPE=\Target belongs to a group that is relatively small in number in school An individual’s
<INPUT TYPE=\Aggressor had prior incidents with members of target’s group membership/classification
<INPUT TYPE=\Incident occurred on a holiday or date significant to target’s group based on race, color,
<INPUT TYPE=\Target perceives that incident was motivated by his/her group membership ethnicity, national origin,
<INPUT TYPE=\Target participates in an activity/club promoting his/her group religion, sex, sexual
12. Is behavior or incident potentially motivated by the target’s (circle any that apply): orientation, gender identity,
<INPUT TYPE=\Race/Color <INPUT TYPE=\ Ethnicity/National Origin <INPUT TYPE=\ or
Sexdisability.
(gender) <INPUT TYPE=\
Disability/SPED (actual or perceived)
<INPUT TYPE=\ Religion <INPUT TYPE=\ Gender identity (actual or perceived) <INPUT TYPE=\ Age <INPUT TYPE=\
Sexual Orientation (actual or perceived)
13. Injury to incident participants: <INPUT TYPE=\Yes <INPUT TYPE=\No If yes, state who was injured
and describe injuries:

13A. Caused serious bodily injury to another: <INPUT TYPE=\Yes No

14. Resolution process used

<INPUT TYPE=\ Formal <INPUT TYPE=\Informal <INPUT TYPE=\ Disciplinary code <INPUT TYPE=\Other
_______________________________________________

15. Report/complaint investigated by: ____________________________________________________________

16. Report/complaint sustained: <INPUT TYPE=\Yes <INPUT TYPE=\No
17. Determination made by: ____________________________________________________________________
18. Type of Incident (circle all that apply):
PERSONAL PROPERTY
<INPUT TYPE=\ Threats/intimidation <INPUT TYPE=\ Fight <INPUT TYPE=\Graffiti
<INPUT TYPE=\ Sexual harassment <INPUT TYPE=\ Physical attack, assault <INPUT TYPE=\
Property damage
<INPUT TYPE=\Harassment (except sexual) <INPUT TYPE=\ No weapon used <INPUT
TYPE=\Vandalism/destruction of property
<INPUT TYPE=\Discrimination <INPUT TYPE=\ Weapon(s) used <INPUT TYPE=\Arson
<INPUT TYPE=\Bullying --- Identify weapon(s) <INPUT TYPE=\Theft
<INPUT TYPE=\Cyber-Bullying/Harassment used: _________________ <INPUT TYPE=\Robbery
<INPUT TYPE=\Derogatory words/gestures <INPUT TYPE=\ Retaliation <INPUT TYPE=\Retaliation
<INPUT TYPE=\Other: ______________________ <INPUT TYPE=\Other:
_____________________________
19. Type of civil rights/anti-bullying policy violation found (circle all that apply):
<INPUT TYPE=\Student to student <INPUT TYPE=\Staff to student <INPUT TYPE=\ Student to staff <INPUT TYPE=\Staff to staff
<INPUT TYPE=\Other ______________________________
<INPUT TYPE=\Race/color <INPUT TYPE=\National origin/Ethnicity <INPUT TYPE=\Disability <INPUT TYPE=\Retaliation
<INPUT TYPE=\Religion <INPUT TYPE=\Sex (gender) <INPUT TYPE=\Sexual orientation <INPUT TYPE=\Bullying
<INPUT TYPE=\Age <INPUT TYPE=\None/not applicable
20. Disciplinary and corrective action taken (include programs or alternative actions employed):

20A. In-school suspension: <INPUT TYPE=\ Exclusion or expulsion: <INPUT TYPE=\

Out-of-school suspension: <INPUT TYPE=\ Removed to alternative setting (for SPED students): <INPUT TYPE=\

21. Additional comments:

22. Additional parent/guardian contact(with dates and times):

_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________

23. Other agency reports filed?

<INPUT TYPE=\ Yes <INPUT TYPE=\ No Agency:
_______________________________________________________________________________

Report Title: ______________________________________ Number/Name: _______________________________________

24. Designated official name: _________________________________
25. Designated official signature: _____________________________________ Date: ________________
26. Report forwarded to district equity coordinator? <INPUT TYPE=\ Yes Date:
________________

27. District equity coordinator signature: ________________________________ Date: ________________

 Appendix E
_____________________ School District
RITA Protocol Checklist for Bullying, Harassment, or Retaliation
(Report – Investigate – Take Action)

Alleged Target’s Name: _____________________________ EO’s Name: _____________________

Important Note: The Building Equity Officer (EO) is responsible for maintaining this checklist, even if s/he does not
complete each step her/himself. When completed, send copy to District Equity Officer.

Check Procedural Step Date & Comment/Reminder

(√) Initials of
“Checker”
A. Reporting
Incident Complaint Form (ICF) and/or Submitted by:
existing office referral form received. Received by:

ICF reviewed by building Equity

Officer (EO).
Copy of ICF sent to District Equity
Officer (DEO).
EO informs alleged aggressor(s) about
complaint.
EO informs alleged aggressor(s) about
retaliation.
EO informs alleged target that alleged
aggressor(s) has/have been told about
complaint & warned about retaliation.
Building administrator or EO informs P/G of If more than one, add’l info here:
parents/guardians (P/G) of both Target(s):
alleged target(s) & alleged
aggressor(s) about complaint & P/G of
investigation, if one is required. Aggressor(s): Names?

B. Investigating
NO / Incident is referred to District EO for If YES, give reason:
YES investigation (If YES, skip this
section).

Incident Report Tracking Form is

initiated to document investigation.
Interviews are completed.

Physical evidence is reviewed.

Check Procedural Step Date & Comment/Reminder
(√) Initials of
“Checker”
Investigation is completed within 5
days.
If not completed within 5 days, EO
informs all parties (including
parents/guardians) of first 5-day
extension
EO informs DEO of first extension.
If not completed within 5-day
extension, EO informs all parties
(including parents/guardians) of
second 5-day extension
EO informs DEO of second extension.
EO determines incident is bullying.

EO determines incident is harassment.

EO completes Incident Report

Tracking Form (plus brief written
report, if needed).
C. Taking Action:
Consequences & Notification
EO and/or Principal determine(s)
consequences, if any.
If consequences are given, EO informs
DEO
EO informs aggressor(s) &
parents/guardians of results and
consequences, if any.
EO informs target(s) &
parents/guardians of investigation’s
results (but NOT of consequences).
EO will inform staff member(s)
interviewed about complaint’s results.
Copies of this checklist, tracking form,
and any written reports are forwarded
to DEO.

NOTES:
If DEO does not receive notification of extension(s) and/or results/consequences within the time periods defined
by the Bullying/Harassment Policy, then the DEO is responsible for contacting the Building EO and/or Principal
to find out where and why the process has stalled.
Appendix F
Appendix F
 With Special Thanks

Thanks to the presenters of the workshops listed below. Their ideas, suggestions, and documents
have been invaluable to us in writing this plan.

Responding Effectively at the School and District Level to the MA Anti-Bullying Law
Presented on Oct. 4, 2010
Collaborative for Educational Services, Northampton, MA
Ms. Randy Ross, Equity and Diversity Specialist
New England Equity Assistance Center
Brown University, Providence RI

Bullying and Cyber-bullying: School District’s Obligation

Presented on Oct. 6, 2010
Collaborative for Educational Services, Northampton, MA
Ms. Regina Tate, Esq.
Murphy, Hesse, Toomey and Lehane, LLP
Quincy, MA

Thanks also go to consultant, Barbara Coloroso, Littleton, CO, who spoke by phone with us
regarding bullying surveys.