Bullying Survey

Bullying Survey

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Bullying Survey

Dear Student,

If you would please take time to fill out this short survey, your honesty in answering would be much appreciated by many.

1. During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

2. During the last week, how many times, if any, has someone spread rumors about you?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

3. During the last week, how many times, if any, has someone pushed you, shoved you, tripped you, or spit on you?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

4. During the last week, how many times, if any, has someone threatened you with physical harm?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

5. During the last week, how many times, if any, has someone tried to make you do things you did not want to do, for example, give them money?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

6. During the last week, how many times, if any, has someone destroyed your property on purpose?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

7. During the last week, how many times, if any, has someone left you out of or wouldn’t let you join in activities on purpose?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

8. During the last week, how many times, if any, has someone used a telephone, text message or the Internet to say or post hurtful things about you?

  • 1-3x
  • 4-6x
  • 6-9x
  • 10x or more
  • 0x

9. Around how many students attend your school?

500

10. What are the lowest and highest year groups taught at your school?

500

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