Elementary Student Bullying Questionaire 6th Grade B track

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1. Gender:

Gender:   Boy Girl

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

	Very unsafe	Kind of unsafe	Kind of safe	Very safe
In the hall	This is how safe I feel in each of these places: In the hall Very unsafe	In the hall Kind of unsafe	In the hall Kind of safe	In the hall Very safe
At the bus stop	At the bus stop Very unsafe	At the bus stop Kind of unsafe	At the bus stop Kind of safe	At the bus stop Very safe
On the bus	On the bus Very unsafe	On the bus Kind of unsafe	On the bus Kind of safe	On the bus Very safe
In the bathroom	In the bathroom Very unsafe	In the bathroom Kind of unsafe	In the bathroom Kind of safe	In the bathroom Very safe
On the playground	On the playground Very unsafe	On the playground Kind of unsafe	On the playground Kind of safe	On the playground Very safe
In the lunch room	In the lunch room Very unsafe	In the lunch room Kind of unsafe	In the lunch room Kind of safe	In the lunch room Very safe
Walking to or from school	Walking to or from school Very unsafe	Walking to or from school Kind of unsafe	Walking to or from school Kind of safe	Walking to or from school Very safe
In my classroom	In my classroom Very unsafe	In my classroom Kind of unsafe	In my classroom Kind of safe	In my classroom Very safe

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	How often have you noticed bullying going on in these places in the last month? In my classroom Never	In my classroom Once or twice	In my classroom A few times a week	In my classroom Almost everyday
On the playground	On the playground Never	On the playground Once or twice	On the playground A few times a week	On the playground Almost everyday
In the lunch room	In the lunch room Never	In the lunch room Once or twice	In the lunch room A few times a week	In the lunch room Almost everyday
Walking to or from school	Walking to or from school Never	Walking to or from school Once or twice	Walking to or from school A few times a week	Walking to or from school Almost everyday
In the bathroom	In the bathroom Never	In the bathroom Once or twice	In the bathroom A few times a week	In the bathroom Almost everyday
In the hall	In the hall Never	In the hall Once or twice	In the hall A few times a week	In the hall Almost everyday
On the bus	On the bus Never	On the bus Once or twice	On the bus A few times a week	On the bus Almost everyday
At the bus stop	At the bus stop Never	At the bus stop Once or twice	At the bus stop A few times a week	At the bus stop Almost everyday

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	How often have these things happened to you at school during the last month? Teased in a mean way Never	Teased in a mean way Once or twice	Teased in a mean way A few times a week	Teased in a mean way Almost everyday
Called hurtful names	Called hurtful names Never	Called hurtful names Once or twice	Called hurtful names A few times a week	Called hurtful names Almost everyday
Left out of things on purpose	Left out of things on purpose Never	Left out of things on purpose Once or twice	Left out of things on purpose A few times a week	Left out of things on purpose Almost everyday
Threatened	Threatened Never	Threatened Once or twice	Threatened A few times a week	Threatened Almost everyday
Hit or kicked or pushed	Hit or kicked or pushed Never	Hit or kicked or pushed Once or twice	Hit or kicked or pushed A few times a week	Hit or kicked or pushed Almost everyday

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	During the last month at school how often did you see someone: Left out of things on purpose Never	Left out of things on purpose Once or twice	Left out of things on purpose A few times a week	Left out of things on purpose Almost everyday
Being teased in a mean way	Being teased in a mean way Never	Being teased in a mean way Once or twice	Being teased in a mean way A few times a week	Being teased in a mean way Almost everyday
Hit or kicked or pushed	Hit or kicked or pushed Never	Hit or kicked or pushed Once or twice	Hit or kicked or pushed A few times a week	Hit or kicked or pushed Almost everyday
Called hurtful names	Called hurtful names Never	Called hurtful names Once or twice	Called hurtful names A few times a week	Called hurtful names Almost everyday
Threatened	Threatened Never	Threatened Once or twice	Threatened A few times a week	Threatened Almost everyday

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

	Never	Once or twice	A few times a week	Almost everyday
Call someone hurtful names	During the last month at school how often did you: Call someone hurtful names Never	Call someone hurtful names Once or twice	Call someone hurtful names A few times a week	Call someone hurtful names Almost everyday
Hit, kick or push someone	Hit, kick or push someone Never	Hit, kick or push someone Once or twice	Hit, kick or push someone A few times a week	Hit, kick or push someone Almost everyday
Leave somone out of things on purpose	Leave somone out of things on purpose Never	Leave somone out of things on purpose Once or twice	Leave somone out of things on purpose A few times a week	Leave somone out of things on purpose Almost everyday
Threaten someone	Threaten someone Never	Threaten someone Once or twice	Threaten someone A few times a week	Threaten someone Almost everyday
Tease someone in a mean way	Tease someone in a mean way Never	Tease someone in a mean way Once or twice	Tease someone in a mean way A few times a week	Tease someone in a mean way Almost everyday