Eyðublað 1
Eineltismál Tilkynning og grunnupplýsingar Dagsetning __________ Nafn þolanda ____________________________________Bekkur ____ Nöfn meintra gerenda:________________________________________ Hver tilkynnir: □ kennari/starfsfólk _________________________________________ □ foreldri/forráðamaður ______________________________________ □ nemandi _______________________________________________ □ aðrir __________________________________________________ Hvernig vaknaði grunur: ______________________________________ ________________________________________________________ Hvar á eineltið sér stað: _______________________________________ Hve lengi hefur eineltið staðið yfir: _______________________________ Málsatvik: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ____________________________________________ Undirskrift _________________________________________________ Skjal geymist hjá námsráðgjafa