Bullying Prevention Survey

Instructions
Dear Students,
We need your help to learn how safe you feel in school. Please answer the questions below as honestly as you can. This is not a test. There are no right or wrong answers. You will not include your name, so you don't need to worry about anyone knowing how you answered the questions. Please do not talk with other students as you take this survey. If you have a question please raise your hand and ask your teacher or another adult who may be helping. Thank you for your help.

Answer questions as they relate to you. For most answers, check the circle(s) most applicable to you or fill in the blanks. Check the board for the correct spelling of your teacher's name.

Student Descriptors


1.I am a
girl
boy

2.I am in grade
3
4
5

3.The school I now attend is
Brown
Kaler
Marsh
Skillin
Small

4.Most of the time, in school, I feel
happy
sad
angry

5.My teacher's name is (check the spelling on the board)

Student Responses


6.I like my school
not at all
a little
a lot

7.I think the children in this class like each other
not at all
a little
a lot

8.I think the children in this class respect each other
not at all
a little
a lot

9.I think the adults in this school care about me
not at all
a little
a lot

10.How often does another child tease you at school?
not at all
a little
a lot

11.How often does another child call you names at school?
not at all
a little
a lot

12.How often does another child threaten you at school?
not at all
a little
a lot

13.How often does another child try to hurt you physically at school?
not at all
a little
a lot

14.How often do you tease another child at school?
not at all
a little
a lot

15.How often do you call another child names at school?
not at all
a little
a lot

16.How often do you threaten another child at school?
not at all
a little
a lot

17.How often do you try to physically hurt another child at school?
not at all
a little
a lot

18.How much do the adults at school help when kids are being bullied?
not at all
a little
a lot

19.How safe from bullying do you feel when riding the bus to and from school or on a field trip?
not at all
a little
a lot

20.How safe from bullying do you feel when walking to and from school or the bus stop?
not at all
a little
a lot

21.How safe do you feel in the classroom?
not at all
a little
a lot

22.How safe do you feel in the hallways?
not at all
a little
a lot

23.How safe do you feel in the bathroom?
not at all
a little
a lot

24.How safe do you feel at recess?
not at all
a little
a lot

25.How safe do you feel during lunch?
not at all
a little
a lot

26.How much do you feel the bullying prevention program has improved our school?
not at all
a little
a lot

27.Please feel free to write additional comments below. When you are finished click the "submit your responses" box. Thank you.