Bullying School Survey

What is Bullying? Bullying happens in many different forms. It's doing, saying or acting in a way that hurts
someone else or makes him or her feel bad on purpose. Some kinds of bullying are:
-Verbal (name-calling)
-Physical (punching, pushing)
-Social (leaving someone out of a game or group on purpose)
-Extortion (stealing someone's money or things)
-Cyberbullying (using e-mail, instant messaging, the Internet, mobile phones, etc. to bully others)
Are you a boy or girl? ______________________

How old are you? ________________

Have you been bullied in this school? Yes ________

No ___________

How often has this happened? Once _____

Twice ______

Were the bullies My age ______ Older than me _______

Where did it happen? ______ in the classroom
______in the commons area

More _______
Younger than me _______

_____ in the restroom

_______ on the school bus

_______ in the hallway

_______ outside of school

_____ home

If it happened somewhere else, please explain this:

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Did you report the bullying to a teacher or principal? ________ Yes

________ No

Did you report the bullying to your parents?

________ Yes

________ No

If you reported it, did it stop?

________ Yes

________ No

Have you seen others being bullied?

________ Yes

________ No

Did you report it?

________ Yes

________ No

If you didnt report it, what stopped you?

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Could your school do more to stop bullying?

________ Yes

________ No

What do you think should be done to stop bullying at your school?

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If you would like to give your name so that a member of the staff can talk with you about bullying, please sign
below. We promise that this will be treated in confidence. Only sign this if you want to.
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Print Name

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Signature

Anonymous Survey about Bullying

Definition
Bullying is a conscious, willful, deliberate and hostile behavior by one or more people, which is intended to
harm others. Bullying can happen anywhere. It may happen to children or adults in places such as: in the home,
at public facilities, on the bus, in the parks, in the neighborhood or at school.
Please answer the following questions by checking the answer that best fits for you:
1. Bullying is a problem in our community.
a) Strongly Agree

b) Agree

c) Disagree

d) Strongly Disagree

e) Dont Know

2. Do you know of someone in our community who has been bullied in the last 12 months? Yes No
2a) If you have answered yes to question 3, please circle all those that apply:
a) Parent

e) Stranger

b) Step Parent

f) Friend

c) Guardian

g) Co-worker

d) Brother or Sister

h) Other_____________

2b) If yes, where did the bullying take place? (Please circle all that apply)
a) Workplace

e) Parks

b) Neighborhood

f) School Bus School

c) In the Home

g) School

d) Recreation Facilities

h) Other_____________

3. How should bullying be dealt with? (Please circle one or more choices)
a) Teach those being bullied how to get help.
b) Teach peers and bystanders to stop others from bullying.
c) Teach the community the signs of bullying and strategies to address them.
d) Other________________
4.

I would like to learn more about (Please circle one or more choices)

a) Lessons that may prevent bullying such as: bullying education, communication, inclusion and empathy.
b) Teaching the bullied to stand up for themselves.
c) Teaching peers and bystanders to get involved.
d) Identifying the signs of bullying.
e) Cyberbullying.
f) Other__________________
Other Comments you might like to make:
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