Os Bullying Survey Grade 4/5 (Spring 2013)

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Please answer as honestly as possible for bullying incidents that occurred in school or on the bus within the past month.

Has this happened to you during the past month?

Check all that apply

I was hit, pushed, or kicked by other kids.

Other kids said mean things, teased me, or called me names.

Other kids told stories about me that were not true.

Other kids did not let me join in what they were doing.

Other kids took things that belonged to me.

Other kids threatened to hurt me or take things.

If any of these happened to you, please describe any situation you would like us to know about.

Skip this question if you don't have a situation to tell about.

If you were bullied in the last month, what did you do?

Check all that apply. Skip this question if you were not bullied in the last month.

I got help from an adult at school.

I got help from another kid

I hit, kicked, or pushed the kid.

I told the kid to stop.

I told the kid I agreed with what he or she said about me.

I avoided the kid so I would not get hurt or teased again.

I got help from my parents.

I ignored it or walked away.

I said mean things, teased or called the kid names.

I tried to stop the kid by saying or doing something funny.

I said things to myself to help myself feel better.

I did nothing.

If you were bullied in the last month, where did it happen?

Check all that apply. Skip this question if you were not bullied in the last month.

In the classroom

On the playground

In the hallway

In the lunchroom

In the bathroom

On the bus

Did you witness any of these during the past month?

Check all that apply. Skip this question if you did not witness any of these.

I saw someone get hit, pushed or kicked by other kids.

I heard kids say mean things, tease, or call someone names.

I heard kids tell stories that were not true.

I saw kids not let someone join in what they were doing.

I saw or heard that kids took things that belonged to someone else.

I heard kids threaten to hurt someone or take things.

If you witnessed bullying in last month, please describe any situation you would like us to know about.

Skip this question if you don't have a situation to tell about.

If you witnessed bullying, saw or heard things in the last month, what did you do?

Check all that apply. Skip this question if you did not witness bullying or do any of these things.

I did nothing.

I asked the kids who was hurt, teased, or left out to play with me.

I helped the kids who was hurt, teased, or left out to get away.

I helped the kid come up with ideas about how to handle the problem.

I got help from an adult at school.

I stood up to the kid who was teasing or hurting the other kid.

I talked to the kid who was hurt, teased, or left out about how he or she felt.

If you witnessed bullying in the last month, where did it happen?

Check all the apply. Skip this question if you did not witness bullying in the past month.

In the classroom

On the playground

In the hallyways

In the lunchroom

In the bathroom

On the bus

Do you agree with the following statements?

Check all that you believe are true.

I feel safe in my classrooms.

I feel safe on the playground.

I feel safe in the hallways.

I feel safe in the lunchroom.

I feel safe in the bathrooms.

I feel safe on the bus.

The kids at my school help if they see someone being bullied or picked on.

The kids at my school tell adults at school when other kids are being or picked on.

At my school, if someone is alone at lunch or recess, others will invite him or her to join in.

There are clear rules at my school.

The teachers and staff at my school help if they see someone being bullied or picked on.

Kids who misbehave take a lot of my teacher's time.

Adults at my school care that students do the best schoolwork they can.

My school tries to make everyone feel included.

I like going to school.

Most people at my school are kind.

I am a:

Choose one from the list.

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