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[en] Other -#- 016 - Bullying Survey
1
During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?
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During the last week, how many times, if any, has someone spread rumors about you?
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During the last week, how many times, if any, has someone pushed you, shoved you, tripped you, or spit on you?
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This survey is not required for your class. If you choose not to complete this
survey, your grade in the class will not be affected in any way.
Please see the explanations below to fully understand what bullying means.
Physical bullying happens when there is hitting, kicking, punching, taking peoples’ belongings or
other acts that hurt people physically and that happen repeatedly (not just one time). Verbal bullying happens when people are teased in a mean way or called hurtful names.
Indirect bullying happens when people spread mean rumors about others, when people are
intentionally kept out of a “group,” or when mean gestures are made towards others.
Cyber bullying happens when people are teased, taunted, or threatened through the use of e-mail, cell
phone, text messaging, instant messaging, or other electronic methods.
During the last week, how many times, if any, has someone threatened you with harm?
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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 or other things?
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During the last week, how many times, if any, has someone destroyed your property on purpose?
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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?
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During the last week, how many times, if any, has someone used cell phones or the Internet to say or post hurtful things about you?
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Where have you been physically, verbally or indirectly bullied in the past?
(check all locations that you have personally been bullied)
I have not been bullied in the past 2 months
In a classroom (while the teacher was out of the room)
In a classroom (while the teacher was present in the room)
In the restroom
In the hallways
At the bus stop
On the school bus
On school property outside of the school building
On the stairways
In the parking lot
At after school activities
In the cafeteria
On the way to or from school (walking, biking, etc.)
In the locker room
Other (please specify)
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How do you usually react when you see someone being bullied at school? (check only one)
I have never seen anyone being bullied at our school
I join in with the bullying
I watch but do not join in
I try to stop the bullying by talking to those involved
I tell a teacher or other adult
I do nothing
I would like to help, but I don’t know what to do
Other (please specify)
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Why do you think that students in this school bully others?
(check all of the answers that you think are true)
To show off
To be popular
To get things like money or other people’s property
To feel powerful
To get attention
Because the bullied student is of a different race/ethnicity
Because the bullied student lacks athletic ability
Because the bullied student is small in size
Because the bullied student is overweight
Because the bullied student is of a different sexual orientation
Because of the way the bullied student dresses
Because the bullied student has a disability
Other (please specify)
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When teachers or other adults see bullying happen at school, how often do they try to stop it?
(Choose only one answer)
Almost always
Some of the time
Almost never
Not sure
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Does your school have rules against bullying?
Yes
No
I don’t know
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What is your gender?
Male
Female
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How old are you?
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What grade are you in?
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What is your race?
Please select
African American/Black
Caucasian/White
Hispanic/Latino
Multi-racial
Asian
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Other
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Thank you very much for taking your time to complete this survey. Remember, your answers are completely confidential.
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