Students Grades 3-8, Survey on Bullying
 

1. Post-Survey 2010

 
Directions: Think about each question carefully. Select the answer that best describes YOU. This survey is anonymous.

1. This is how I feel about being at my school:

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

 Very SafeSafeSo-SoUnsafeVery Unsafe
a. in my classroom
b. on the playground
c. in the lunch room
d. walking to/from school
e. in the bathroom
f. in the hall
g. at extended day

3. How often have these things happened to you at school?

 Everyday1 or 2 times a week1 or 2 times a month1 or 2 times a yearNever
a. teased in a mean way
b. called hurtful names
c. left out of things on purpose
d. threatened
e. hit, kicked, or pushed
For Questions 4-8, mark all that apply.

4. At school, who has:

 A group of girlsA group of boysA boyA girlNobody
a. bullied you
b. said mean things to you
c. teased you
d. called you names
e. tried to hurt you at school

5. In what grade is the student (or students) who bullies you?

6. When I am bullied, I:

7. If you have been bullied, whom have you told?

8. If you have been bullied, who has tried to help you?

9. If you have been bullied, what happened after you told someone?

10. How often do you hit, kick, or push other children?

11. How often do you:

 Every Day1 or 2 Times a Week1 or 2 Times a Month1 or 2 Times a YearNever
a. say mean things
b. tease others
c. call other children names

12. How often have you seen someone:

 Every Day1 or 2 Times a Week1 or 2 Times a Month1 or 2 Times a YearNever
a. being teased in a mean way
b. being threatened
c. left out of things on purpose
d. being called hurtful names
e. being hit, kicked, or pushed

13. How often have you noticed bullying going on in these places?

 Every Day1 or 2 Times a Week1 or 2 Times a Month1 or 2 Times a YearNever
a. in my classroom
b. on the playground
c. in the lunchroom
d. walking to or from school
e. in the bathroom
f. in the hall
g. at extended day
h. at car line
Mark all that apply in 14-15.

14. Who have you seen doing the bullying?

15. What grades are the bullies in?

16. What is your ethnic group? (optional)

17. Are you a boy or a girl?

Thank you for your answers!
Adapted from the Maine Project Against Bullying, http://lincoln.midcoast.com/~wps/against/bullying.html