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1. Default Section

1. Gender:

2. This is how safe I feel in each of these places:

  Very unsafe Kind of unsafe Kind of safe Very safe
On the bus
At the bus stop
In the bathroom
On the playground
Walking to or from school
In the hall
In my classroom
In the lunch room

3. How often have you noticed bullying going on in these places in the last month?

  Never Once or twice A few times a week Almost everyday
In my classroom
On the playground
In the lunch room
Walking to or from school
In the bathroom
In the hall
On the bus
At the bus stop

4. How often have these things happened to you at school during the last month?

  Never Once or twice A few times a week Almost everyday
Teased in a mean way
Called hurtful names
Left out of things on purpose
Threatened
Hit or kicked or pushed

5. During the last month at school how often did you see someone:

  Never Once or twice A few times a week Almost everyday
Left out of things on purpose
Hit or kicked or pushed
Being teased in a mean way
Called hurtful names
Threatened

6. During the last month at school how often did you:

  Never Once or twice A few times a week Almost everyday
Hit, kick or push someone
Threaten someone
Leave somone out of things on purpose
Call someone hurtful names
Tease someone in a mean way

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