I cut this down the middle and keep them in a box in my classroom. Students know they cannot come up to me to "tattle" unless they are bleeding, throwing up, or there is some other major emergency. Most things have to be written on the form, which I review at the end of the day and then respond accordingly. Most kids don't want to make the effort to fill out the form, so they figure out how to solve their problems on their own. Win-win!