The purpose of this survey is to find out about student safety and bullying at your school. Your name is not required on this survey and your answers are confidential, so please try to answer the questions as honestly as you can.
What grade are you in?
How safe do you feel at school?
Safe means- feeling comfortable relaxed and not worried that someone could harm you.
(Choose one answer for each of the following questions)
1. Do you feel safe at school?
2. Do you feel safe on your way to and from school?
3. Do you feel safe on the school bus?
4. How often have you stayed away from school to avoid being bullied?
(Choose one answer)
5. Who do you talk to when you have problems at school?
When you answer the next questions, think about THE PAST FOUR MONTHS.
Have you been bullied by other students?(Bullying meaning- a repeated act or continuous act of one of the following)
(Choose one answer for each question)
1. Physically?
Examples: hit, pushed, shoved, slapped, kicked, spit at, beaten up or had property stolen
2. Verbally?
Examples: called names, taunted, insulted, humiliated or threatened
3. Socially?
Examples: excluded from a group, made to look dumb by someone or gossiped/ rumors spread
4. Electronically?
Examples: threatened, embarrassed, singled out, had your feelings hurt, been gossiped about or had secrets about you revealed through e-mail, phone text messages or pictures
5. Racially?
Examples: treated differently or badly because of your race, culture or ethnicity
When are you at risk of being bullied?
Bystanders in bullying situations
How often have you seen or heard about another student being bullied?
5.Racially?
How often have you tried to help another student who was being bullied?
Think of the last time you saw or heard another student being bullied. What did you do?
Where does bullying happen?
When you last saw bullying, how did you feel about getting involved? (Check one)
How can teachers help prevent bullying at your school?
How can students help prevent bullying at your school?
