2011-2012 (A) Doerschuk and Ridenbaugh-5
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1
. Have you witnessed someone being bullied at Faircrest in the past month?
Have you witnessed someone being bullied at Faircrest in the past month?
Yes
No
2
. If yes, who was doing the bullying? (First and last name)
If yes, who was doing the bullying? (First and last name)
3
. If yes, who was the person being bullied? (First and last name)
If yes, who was the person being bullied? (First and last name)
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4
. What type of bullying have you witnessed at Faircrest? Check all that apply.
What type of bullying have you witnessed at Faircrest? Check all that apply.
I have never witnessed bullying at Faircrest
Called mean names
Excluded (purposely left kids out of their groups)
Hit, kicked, pushed, punched
Told false lies or rumors
Threatened
Racial comments
Sexual comments
Took or damaged belongings
Other (please specify)
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5
. Where have you witnessed bullying occur at Faircrest? Check all that apply.
Where have you witnessed bullying occur at Faircrest? Check all that apply.
I have never witnessed bullying at Faircrest
Recess
Hallway
Classroom (with teacher)
Classroom (without teacher)
Bathroom
Lunchroom
To / From School
Bus Stop
On the bus
Other (please specify)
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6
. What do you do when you see someone bullied at school?
What do you do when you see someone bullied at school?
I have never seen bullying at school.
I join in the bullying.
Sometimes I laugh. It can be funny.
Ignore it. It’s none of my business.
Nothing. I just watch.
I try to stop the bullying or help the victim.
I get help from adults or other students.
Other (please specify)
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7
. What do adults do when they see someone bullied at Faircrest?
What do adults do when they see someone bullied at Faircrest?
Nothing, they ignore it.
They stop it and tell bystanders to leave.
They stop it and help solve the problem.
Other (please specify)
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8
. Do you feel safe at Faircrest?
Do you feel safe at Faircrest?
Yes
No
Sometimes
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9
. If you are a bully to other students, why do you do it?
If you are a bully to other students, why do you do it?
I want to get even with others.
I want peple to leave me alone.
My friends and I think its fun.
I was taught to stick up for myself.
I don’t bully.
Other (please specify)
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10
. Why do you think some kids are bullied more than others?
Why do you think some kids are bullied more than others?
They look or act differently.
They are too smart.
They are “Teachers’ Pets”.
They are weaker or smaller.
They just ask for it or deserve it.
I don’t know.
Other (please specify)
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