Bully Prevention Survey
Your answers are confidential, so please answer questions as honestly as possible.
What grade are you in?
Grade 9
Grade 10
Grade 11
Grade 12
Clear selection
What is your gender?
Male
Female
Clear selection
Do you feel safe on your way to and from school?
Never
Sometimes
Often
Always
Clear selection
If you ride a school bus, do you feel safe on the bus?
Never
Sometimes
Often
Always
I don't ride the bus
Clear selection
If you ride a bus, do you feel safe at the bus drop-off/pick-up area?
Never
Sometimes
Often
Always
I don't ride the bus
Clear selection
Have YOU been PHYSICALLY bullied by other students in the last three months?
Physical bullying examples: being hit, pushed, shoved, kicked, slapped, had property stolen
Never
One or two times
Three or four times
Every week
Every day
Clear selection
Have YOU been VERBALLY bullied by other students in the last three months?
Verbal bullying examples: called names, teased, insulted, threatened
Never
One or two times
Three or four times
Every week
Every day
Clear selection
Have YOU been SOCIALLY bullied by other students in the last three months?
Social bullying examples: excluded from a group, gossiped about, rumors spread
Option 1
Clear selection
Have YOU been SOCIALLY bullied by other students in the last three months?
Social bullying examples: excluded from a group, gossiped about, rumors spread
Never
One or two times
Three or four times
Every week
Every day
Clear selection
Have YOU been ELECTRONICALLY bullied by other students in the last three months?
Electronical bullying examples: threatened or embarrassed through e-mail, text message or social networking
Never
One or two times
Three or four times
Every week
Every day
Clear selection
Have YOU been bullied by other students in the last three months because of your GENDER??
Gender bullying examples: left out or treated badly b/c you are a boy or a girl, deragatory comments about you because of your gender, heard sexist comments
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you seen ANOTHER STUDENT being PHYSICALLY bullied in the last 3 months?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you seen ANOTHER STUDENT being VERBALLY bullied in the last 3 months?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you seen ANOTHER STUDENT being SOCIALLY bullied in the last 3 months?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you seen ANOTHER STUDENT being ELECTRONICALLY bullied in the last 3 months?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you seen ANOTHER STUDENT being bullied in the last 3 months because of his/her GENDER?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you stayed away from school in order to avoid being bullied since the start of this year?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
How often have you tried to help another student who was being bullied?
Never
One or two times
Three or four times
Every week
Every day
Clear selection
Where and how often does bullying occur?
Never
Sometimes
Often
Always
Before school
School entrances and exits
Classrooms
Hallways
Library
Computer rooms
Gym
Locker rooms
Bathrooms
School bus
On the way to and from school
Lunchroom/cafeteria
Parking lot
On school field trips/during school extracurricular activities
Off school property, but close to school
On the weekends
Never
Sometimes
Often
Always
Before school
School entrances and exits
Classrooms
Hallways
Library
Computer rooms
Gym
Locker rooms
Bathrooms
School bus
On the way to and from school
Lunchroom/cafeteria
Parking lot
On school field trips/during school extracurricular activities
Off school property, but close to school
On the weekends
Clear selection
Think of the last time you saw or heard another student being bullied. What did you do?
(Check any that are true for you.)
I have not seen or heard another student being bullied.
I ignored it.
I told my parents.
I told a teacher.
I told my principal, assistant principal, or another school administrator.
I told my school counselor.
I told my school nurse.
I told another adult at school (social worker, SRO, etc.)
I told an adult outside of school.
I told another student.
At the time, I helped the person being bullied.
Later on, I helped the person being bullied.
I stood and watched.
I made a joke about it.
I joined in the bullying.
I got someone to stop it.
I stood up to the person who was being a bully.
I got back at the bully later.
Other:
If you did NOT do anything the last time you saw someone being bullied, what was the reason?
(Check the THREE that most apply.)
I didn't want to get involved.
I was afraid.
I didn't know what to do or who to talk to.
I thought if I told someone, they wouldn't do anything about it anyway.
I didn't want to be a snitch.
The bullying wasn't so bad.
The person being bullied deserved it.
I did not know the person being bullied.
I do not like the person being bullied.
It wasn't my business or my problem.
I didn't want to get into trouble for telling.
I didn't want to become a target also.
Other:
What more can teachers and school administrators do to help stop bullying?
(Check the three that most apply.)
Enforce the rules we currently have in place.
Make new rules.
Supervise better.
Teach social skills.
Teach students about bullying and ways to stop it.
Teach teachers about bullying and ways to stop it.
Create a bully report form so students can make reports anonymously.
Make the consequences of bullying more severe.
Other:
One a scale of 1 to 5, with 1 being NO PROBLEM and 5 being MAJOR PROBLEM, please identify the types of bullying you think are the biggest issues at CHS:
1 (No problem at all)
2 (Slight problem)
3 (Moderate problem)
4 (Somewhat big problem)
5 (Severe/Major problem)
Physical bullying
Verbal bullying
Social bullying
Electronic bullying
Gender bullying/Sexual harrassment
1 (No problem at all)
2 (Slight problem)
3 (Moderate problem)
4 (Somewhat big problem)
5 (Severe/Major problem)
Physical bullying
Verbal bullying
Social bullying
Electronic bullying
Gender bullying/Sexual harrassment
Clear selection
Use the space below to tell us anything else you'd like us to know.
Your answer
Use the space below to tell us what teachers and school administrators can do to make our school safer or a nicer place to be.
Your answer
Your answer
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