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
In the lunch room
In my classroom
In the bathroom
On the playground
In the hall
At the bus stop
Walking to or from school
On the bus
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
Being teased in a mean way
Left out of things on purpose
Hit or kicked or pushed
Threatened
6. During the last month at school how often did you:
NeverOnce or twiceA few times a weekAlmost everyday
Threaten someone
Tease someone in a mean way
Leave somone out of things on purpose
Hit, kick or push someone
Call someone hurtful names
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