Fall 2019 Bullying Survey

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For these questions, please think of this definition of bullying:

Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.

1. What grade are you in? *

3rd Grade

4th Grade

5th Grade

2. What best describes your gender? *

Boy/Male

Girl/Female

3. Have you been bullied at school in the last month? *

Yes

4. About how often are you bullied at school? *

1 or 2 times this year

2 or 3 times a month

About once a week

Several times a week

I have not been bullied at school.

5. What are the ways that you have been bullied? Check as many as you need. *

Verbal (words)

Exclusion (someone didn’t let you join their group)

Physical (someone physically hurt you)

Rumors (someone told untrue things about you)

Damage (someone is breaking/bothering your stuff)

Threats (someone is saying they’re going to hurt you or do something bad to you)

Another Way

I have not been bullied at school.

Required

6. Where are you being bullied? Check as many as you need. *

Playground

Hallway

Your classroom or complex

Chinese room

Music room

Art room

Gym

Library

Science Lab

Bathroom

Cafeteria

Bus

Somewhere Else

I have not been bullied at school.

Required

7. Do you feel afraid of being bullied at school?

Never

Sometimes

Often

Always

Clear selection

8. When you are bullied, do you feel that teachers or other adults try to put a stop to it? *

Never

Sometimes

Often

Always

I have not been bullied at school.

9. If there is anything else you want Ms. Lloyd to know about bullying at Dixie or if you would like to tell Ms. Lloyd about a specific time you were bullied, please type it here. Put YOUR name if you want a response.

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