JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bullying and Harassment Survey
Bullying Questions: Check all that are true for you.
No names are collected using this survey tool.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1. During this school year how often have you been bullied at school?
*
Check all that are true for you.
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
2. During this school year how often have you seen someone being bullied?
*
Check all that are true for you.
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
3. How were you bullied?
*
I haven't been bullied
I have been teased and called names.
I have been hit, kicked or pushed.
Others leave me out of their group.
Others have taken my belongings.
Others don’t sit by me or talk to me.
Others say they will hurt me.
Others try to hurt me on the way to and from school.
Others bully me by phone or text message.
Required
4. How many kids have bullied you?
*
I haven’t been bullied.
One kid bullies me.
Two or more bully me.
Lots of kids bully me.
Required
5. During the past year how often did you miss school because you felt unsafe, uncomfortable or nervous at school or on your way to or from school?
*
Check all that are true for you.
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
6. If you have seen bullying at school, what did you do?
*
I haven’t seen any bullying.
Ignored it as none of my business.
Nothing, just watched.
Joined in on the fun.
Tried to stop the bully or help the victim
Asked for help from an adult of other student
Required
7. If you have been or are being bullied, why do you think it happens?
*
No one bullies me.
I don’t know why others bully me.
I act or look different.
I always do well in class.
I’m smaller or weaker.
I guess I deserve it.
Other reasons:
Required
8. How many times in the past year have you bullied, teased or made fun of someone?
*
Check all that are true for you.
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
9. Why are some kids bullies?
*
I don’t know.
They are bigger and stronger.
They think it is fun.
They want to get even for being bullied themselves.
They want to “show off” or impress their friends.
They fight in their own families.
Other reasons:
Required
10. During this past school year how often have you had your property stolen or deliberately damaged, such as your car, clothing, or books?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
11. How many times in the past year (the last 12 months) have you been afraid of being pushed, shoved, slapped, hit, or kicked by someone on school property?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
12. How many times in the past year (the last 12 months) have you been afraid of having your property stolen or deliberately damaged, such as your car, clothing, or books?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
13. How many times in the past year (the last 12 months) have you pushed, shoved, slapped, hit, or kicked someone on school property?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
14. How many times in the past year (the last 12 months) have you stolen or deliberately damaged property, such as someone’s car, clothing, or books?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
15. What do adults do at school when they see bullying?
*
Nothing, they ignore it.
Stop it and tell everyone to leave.
Stop it and solve the problem.
Other:
Required
16. Has an adult at school talked to your class about bullying?
*
No.
Once, and what they said helped me a lot.
Once, but they don’t really understand what’s going on
We talk regularly about bullying.
Required
17. What can adults at school do better to help stop bullying?
*
Supervise the school better
Make rules against bullying and discipline bullies.
Talk about bully prevention in class.
Help students work problems out.
Bullying is not a problem at our school.
Required
18. Have you ever carried a weapon to school?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
19. During this school year how often were you in a physical fight?
*
Never
Sometimes (1 to 2 times a month)
Regularly (1 to 2 times a week)
Every day
Required
Submit
Clear form
This form was created inside of Norwalk Schools.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report