Kindergarten-2nd Grade Survey on Bullying

1. Student Section

Dear Parents: Please help you Kindergartener, 1st grader, or 2nd grader complete the following survey. Click on the box that best describes YOUR child.

Question Title

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

Very happy and good

Sometimes happy and good

So-so

Sometimes sad and unhappy

Very sad and unhappy

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

	Very Safe	Kind of Safe	So So	Unsafe	Very Unsafe
a. in my classroom	a. in my classroom Very Safe	a. in my classroom Kind of Safe	a. in my classroom So So	a. in my classroom Unsafe	a. in my classroom Very Unsafe
b. on the playground	b. on the playground Very Safe	b. on the playground Kind of Safe	b. on the playground So So	b. on the playground Unsafe	b. on the playground Very Unsafe
c. in the lunch room	c. in the lunch room Very Safe	c. in the lunch room Kind of Safe	c. in the lunch room So So	c. in the lunch room Unsafe	c. in the lunch room Very Unsafe
d. walking to/from school	d. walking to/from school Very Safe	d. walking to/from school Kind of Safe	d. walking to/from school So So	d. walking to/from school Unsafe	d. walking to/from school Very Unsafe
e. in the bathroom	e. in the bathroom Very Safe	e. in the bathroom Kind of Safe	e. in the bathroom So So	e. in the bathroom Unsafe	e. in the bathroom Very Unsafe
f. in the hall	f. in the hall Very Safe	f. in the hall Kind of Safe	f. in the hall So So	f. in the hall Unsafe	f. in the hall Very Unsafe

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

	Everyday	1 or 2 times a week	1 or 2 times a month	1 or 2 times a year	Never
a. teased in a mean way	a. teased in a mean way Everyday	a. teased in a mean way 1 or 2 times a week	a. teased in a mean way 1 or 2 times a month	a. teased in a mean way 1 or 2 times a year	a. teased in a mean way Never
b. called hurtful names	b. called hurtful names Everyday	b. called hurtful names 1 or 2 times a week	b. called hurtful names 1 or 2 times a month	b. called hurtful names 1 or 2 times a year	b. called hurtful names Never
c. left out of things on purpose	c. left out of things on purpose Everyday	c. left out of things on purpose 1 or 2 times a week	c. left out of things on purpose 1 or 2 times a month	c. left out of things on purpose 1 or 2 times a year	c. left out of things on purpose Never
d. threatened	d. threatened Everyday	d. threatened 1 or 2 times a week	d. threatened 1 or 2 times a month	d. threatened 1 or 2 times a year	d. threatened Never
e. hit, kicked, or pushed	e. hit, kicked, or pushed Everyday	e. hit, kicked, or pushed 1 or 2 times a week	e. hit, kicked, or pushed 1 or 2 times a month	e. hit, kicked, or pushed 1 or 2 times a year	e. hit, kicked, or pushed Never

Bullying Defined: There are lots of ways to bully, but in all cases students who bully other students intend to hurt or upset them (it’s not an accident). Usually they hurt or upset them repeatedly and have an advantage over them, such as being bigger, older, more popular. Sometimes a group of students will bully a student (Adapted from the Safe School Project, Ontario, Canada).

For Questions 4-8, mark all that apply.

Question Title

* 4. At school, who has:

	Both boys and girls	A group of girls	A group of boys	A boy	A girl	Nobody
a. left you out of things on purpose	a. left you out of things on purpose Both boys and girls	a. left you out of things on purpose A group of girls	a. left you out of things on purpose A group of boys	a. left you out of things on purpose A boy	a. left you out of things on purpose A girl	a. left you out of things on purpose Nobody
b. said mean things to you	b. said mean things to you Both boys and girls	b. said mean things to you A group of girls	b. said mean things to you A group of boys	b. said mean things to you A boy	b. said mean things to you A girl	b. said mean things to you Nobody
c. teased you	c. teased you Both boys and girls	c. teased you A group of girls	c. teased you A group of boys	c. teased you A boy	c. teased you A girl	c. teased you Nobody
d. called you names	d. called you names Both boys and girls	d. called you names A group of girls	d. called you names A group of boys	d. called you names A boy	d. called you names A girl	d. called you names Nobody
e. tried to hurt you at school	e. tried to hurt you at school Both boys and girls	e. tried to hurt you at school A group of girls	e. tried to hurt you at school A group of boys	e. tried to hurt you at school A boy	e. tried to hurt you at school A girl	e. tried to hurt you at school Nobody

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

In my classroom

In the same grade, but different class

In a lower grade

In a higher grade

I haven’t been bullied

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* 6. When I am bullied, I:

Do nothing

Tell the bully to stop

Get away from the bully

Hurt other kids

Stay home from school

Tell an adult

Tell a friend

Don’t get bullied

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

My mother or father

My sister or brother

A teacher or other adult at school

Another student at school

Nobody

I've never been bullied

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

My mother or father

My sister or brother

A teacher or another adult at school

Another student at school

Nobody

I’ve never been bullied

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

It got better

It got worse

Nothing changed

I never told anyone

I’ve never been bullied

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

Every day

1 or 2 times a week

1 or 2 times a month

1 or 2 times a year

Never

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* 11. How often do you:

	Every day	1 or 2 times a week	1 or 2 times a month	1 or 2 times a year	Never
a. say mean things	a. say mean things Every day	a. say mean things 1 or 2 times a week	a. say mean things 1 or 2 times a month	a. say mean things 1 or 2 times a year	a. say mean things Never
b. tease others	b. tease others Every day	b. tease others 1 or 2 times a week	b. tease others 1 or 2 times a month	b. tease others 1 or 2 times a year	b. tease others Never
c. call other children names	c. call other children names Every day	c. call other children names 1 or 2 times a week	c. call other children names 1 or 2 times a month	c. call other children names 1 or 2 times a year	c. call other children names Never

Question Title

* 12. How often have you seen someone:

	Every day	1 or 2 times a week	1 or 2 times a month	1 or 2 times a year	Never
a. being teased in a mean way	a. being teased in a mean way Every day	a. being teased in a mean way 1 or 2 times a week	a. being teased in a mean way 1 or 2 times a month	a. being teased in a mean way 1 or 2 times a year	a. being teased in a mean way Never
b. being threatened	b. being threatened Every day	b. being threatened 1 or 2 times a week	b. being threatened 1 or 2 times a month	b. being threatened 1 or 2 times a year	b. being threatened Never
c. left out of things on purpose	c. left out of things on purpose Every day	c. left out of things on purpose 1 or 2 times a week	c. left out of things on purpose 1 or 2 times a month	c. left out of things on purpose 1 or 2 times a year	c. left out of things on purpose Never
d. being called hurtful names	d. being called hurtful names Every day	d. being called hurtful names 1 or 2 times a week	d. being called hurtful names 1 or 2 times a month	d. being called hurtful names 1 or 2 times a year	d. being called hurtful names Never
e. being hit, kicked, or pushed	e. being hit, kicked, or pushed Every day	e. being hit, kicked, or pushed 1 or 2 times a week	e. being hit, kicked, or pushed 1 or 2 times a month	e. being hit, kicked, or pushed 1 or 2 times a year	e. being hit, kicked, or pushed Never

Question Title

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

	Every day	1 or 2 times a week	1 or 2 times a month	1 or 2 times a year	Never
a. in my classroom	a. in my classroom Every day	a. in my classroom 1 or 2 times a week	a. in my classroom 1 or 2 times a month	a. in my classroom 1 or 2 times a year	a. in my classroom Never
b. on the playground	b. on the playground Every day	b. on the playground 1 or 2 times a week	b. on the playground 1 or 2 times a month	b. on the playground 1 or 2 times a year	b. on the playground Never
c. in the lunchroom	c. in the lunchroom Every day	c. in the lunchroom 1 or 2 times a week	c. in the lunchroom 1 or 2 times a month	c. in the lunchroom 1 or 2 times a year	c. in the lunchroom Never
d. walking to or from school	d. walking to or from school Every day	d. walking to or from school 1 or 2 times a week	d. walking to or from school 1 or 2 times a month	d. walking to or from school 1 or 2 times a year	d. walking to or from school Never
e. in the bathroom	e. in the bathroom Every day	e. in the bathroom 1 or 2 times a week	e. in the bathroom 1 or 2 times a month	e. in the bathroom 1 or 2 times a year	e. in the bathroom Never
f. in the hall	f. in the hall Every day	f. in the hall 1 or 2 times a week	f. in the hall 1 or 2 times a month	f. in the hall 1 or 2 times a year	f. in the hall Never
g. at extended day	g. at extended day Every day	g. at extended day 1 or 2 times a week	g. at extended day 1 or 2 times a month	g. at extended day 1 or 2 times a year	g. at extended day Never
h. at car line	h. at car line Every day	h. at car line 1 or 2 times a week	h. at car line 1 or 2 times a month	h. at car line 1 or 2 times a year	h. at car line Never

Mark all that apply in 14-15.

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* 14. Who have you seen doing the bullying?

Both boys and girls

A group of boys

A boy

A group of girls

A girl

Nobody

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* 15. What grades are the children who bully in?

In my classroom

In the same grade but in a different class

In a lower grade

In a higher grade

I haven’t seen any bullying

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* 16. (Optional) What is your ethnic group?

Asian

Black

Hispanic

Native American

White

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* 17. Are you a boy or a girl?

Boy

Girl