Bully Survey Question Title * 1. I am a Boy Girl OK Question Title * 2. I am in grade: 3rd 4th 5th OK Question Title * 3. In my classroom I feel: Scared and Unsafe Kind of Safe Very Safe Scared and Unsafe Kind of Safe Very Safe OK Question Title * 4. On the playground I feel Scared and Unsafe Kind of Safe Very Safe Scared and Unsafe Kind of Safe Very Safe OK Question Title * 5. In the cafeteria I feel: Scared and Unsafe Kind of Safe Very Safe Scared and Unsafe Kind of Safe Very Safe OK Question Title * 6. Going to and from school I feel: Scared and Unsafe Kind of Safe Very Safe Scared and Unsafe Kind of Safe Very Safe OK Question Title * 7. Playing at home in my neighborhood I feel: Scared and Unsafe Kind of Safe Very Safe Scared and Unsafe Kind of Safe Very Safe OK Question Title * 8. Other kids hit, kick or push me: Every day Once or twice a week Once or twice a year Never OK Question Title * 9. On social media like messenger and musically other kids say mean things to me: Every day Once or twice a week Once or twice a year Never OK Question Title * 10. Other kids say mean things to me: Every day Once or twice a week Once or twice a year Never OK Question Title * 11. I use social media (snap chat, musically, messenger) Every day Once or twice a week Once or twice a month Never OK Question Title * 12. Other kids say nice things to me or help me: Every day Once or twice a week Once or twice a year Never OK Question Title * 13. Who has bullied you, said mean things to you, teased you, called you names, or tried to hurt you at school? Boys and girls A boy A girl Several boys Several girls Nobody OK Question Title * 14. In what grade is the student or students who bully you? I haven't been bullied In the same grade as me, but in a different class In a lower grade In a higher grade In my class OK Question Title * 15. If you have been bullied this year, who have you told? My mother or father My sister or brother A teacher or other adult at school Another kid at school Nobody OK Question Title * 16. If you have been bullied this year, who has tried to help you? My mother or father My sister or brother A teacher or other adult at school Another kid at school Nobody I haven't been bullied OK Question Title * 17. How often do you hit, kick or push other kids? Every day Once or twice a week Once or twice a month Once or twice a year Never OK Question Title * 18. How often do you say mean things, tease or call other kids names? Every day Once or twice a week Once or twice a month Once or twice a year Never OK Question Title * 19. How often do you spend recess alone because nobody wants to play with you? Every day Once or twice a week Once or twice a month Once or twice a year Never OK Question Title * 20. List the three kids in your grade whom you most like to do things with: OK Question Title * 21. List the three kids in your grade whom you don’t like to spend time with: OK Question Title * 22. List the three kids in your grade who you think most need a friend: OK Question Title * 23. Is there anyone you feel is a bully? OK DONE