School counseling
Cyberbullying Incident Documentation Template for Students
Student is being cyberbullied but has not documented incidents, so teachers and parents have no clear picture of the scope or pattern of harm.
Cyberbullying often feels chaotic and overwhelming to the student because they are in the middle of it. Without documentation, the pattern is invisible to adults who can help. Screenshots disappear, incidents blur together, and the student cannot articulate what is happening. Documentation creates evidence and clarity.
This template teaches the student to record incidents in a way that can be shown to trusted adults.
Cyberbullying Incident Documentation Template for Students
Each time a bullying incident happens, fill out this template while it is fresh:
Date and time it happened:
Platform (Instagram, Snapchat, text, Discord, etc.):
Who was involved:
What was said or posted: (Write it exactly, even if it is hurtful.)
Who saw it:
How it made you feel:
Did you respond: (If yes, what did you say?)
Did you take a screenshot: (Yes/No. If yes, label it with date and time.)
Who have you told:
You do not have to fill this out perfectly. The point is to keep a record. After each incident, add to your document.
Share this with a trusted adult: parent, school counselor, or teacher. They need to see the pattern. One incident looks like a disagreement. A pattern is bullying.
Keep this document safe. You might need it if school staff or parents need to take action.
Do not delete the evidence, even if you want to forget about it. The evidence is what gets adults to take this seriously.
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