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

What is your gender?

Male

Female

Do you feel safe on your way to and from school?

Never

Sometimes

Often

Always

If you ride a school bus, do you feel safe on the bus?

Never

Sometimes

Often

Always

I don't ride the bus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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