Elementary Student Bullying Questionaire 4th Grade A track

1. Default Section

 
1. Gender:
2. This is how safe I feel in each of these places:
Very unsafeKind of unsafeKind of safeVery safe
On the bus
In the lunch room
On the playground
In the bathroom
Walking to or from school
In the hall
At the bus stop
In my classroom
3. How often have you noticed bullying going on in these places in the last month?
NeverOnce or twiceA few times a weekAlmost 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?
NeverOnce or twiceA few times a weekAlmost 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:
NeverOnce or twiceA few times a weekAlmost everyday
Called hurtful names
Threatened
Left out of things on purpose
Being teased in a mean way
Hit or kicked or pushed
6. During the last month at school how often did you:
NeverOnce or twiceA few times a weekAlmost everyday
Leave somone out of things on purpose
Call someone hurtful names
Threaten someone
Tease someone in a mean way
Hit, kick or push someone
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