Bullying Survey
THE ANSWERS TO THESE QUESTIONS ARE PRIVATE. Your name will not be included in this form. We need your honest opinion. Please check the boxes and leave any comments at the end of this survey that you would like to share.
* Required
Gender
*
Boy
Girl
Required
Age
*
Your answer
What is bullying? Examples:
Bullying is when someone is being hurt either by words or actions on purpose, usually more than once, feels bad because of it, and has a hard time stopping what is happening to them.
VERBAL BULLYING includes: Teasing, Name-calling, Threatening to cause you harm, Taunting
SOCIAL BULLYING includes: Leaving someone out on purpose, Telling others not to be friends with someone
Spreading rumors about someone, Embarrassing someone in public
PHYSICAL BULLYING includes: Hitting/Kicking/Pinching, Spitting, Tripping/Pushing, Taking or breaking someone’s things, Making mean or rude hand gestures
CYBER BULLYING includes: Constant mean texts, Hurtful comments on Facebook or other Social Platforms, Prank calls
Being Hurt by Words or Actions and You Have a Hard Time Stopping What is Happening
1. Have you ever been bullied in Durkin Park School?
*
Yes
No (If you answered "No" skip to question #12)
Required
2. If Yes, how recently?
*
This month
This year
This week
Last year
Required
3. Were you bullied by a group of children or someone on their own?
*
Someone on their own
A group
Required
4. Were other students present to witness this?
Yes
No
5. How were you bullied? Check all that apply.
Called names
Were left out of group on purpose
Threatened
Hit, kicked, punched, and/or choked
Sent nasty messages to your phone or email
Forced into doing something you didnt want to do like: steal or damage other's property
Had untrue rumours spread about you
Other:
6. Where did it happen?
*
Classroom
Hallway
Lunchroom
Playground
On the way to or from school
Text and/or Email
Other:
Required
7. How did it make you feel?
Sad
Angry
Lonely
Scared
Embarrased
Other:
8. Did you tell anyone?
Yes
No
9. If No, what stopped you from telling someone?
Your answer
10. If Yes, who did you tell?
Adult at school
Family: Mom, Dad, Aunt, Uncle, Brother, Sister
Friend
Other:
11. What happened after you told someone?
The bullying completely stopped
The bullying did not stop
The bullying got worse
The bullying stopped, but restarted again
Other:
12. Do you feel like school takes bullying seriously?
*
Yes
No
Not sure
13. If Yes, what does the school do to stop bullying?
Your answer
14. Have you ever bullied anyone?
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Yes
No
Required
15. Have you ever witnessed someone being bullied?
*
Yes
No
Required
16. If Yes, what did you do?
Tried to help
Told someone
Did nothing
Other:
17. Please tell us anything you would like share about bullying. Such as need help helping someone that is being bullied or you are being bullied.
Your answer
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