Student Bullying Survey

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0

Gender:
Male

Female

Prefer not to say

Other (Please specify)
0

Do you feel safe going to school?
Yes

No
0

Are you afraid of going to school, for any reason?
Yes

No
0

Please specify why

0 / 5000
0

Have you witnessed bullying in school?
Yes

No
0

Please specify
0

Have you been teased inside or outside of school?
No

Yes
0

Please specify how
0

Have you been threatened in any way?
Yes

No
0

Please specify how

0 / 5000
0

Have you been physically hurt in any way? (punching, kicking, pinching etc.)
No

Yes
0

please specify how:

0 / 5000
0

Rate how affected you are by these aspects of bullying:
(Unaffected) 1 - - 2 - - 3 - - 4 - - 5 (Very affected)

Verbal abuse

1

2

3

4

5

Physical abuse

1

2

3

4

5

Social abuse

1

2

3

4

5

Internet bullying

1

2

3

4

5

Racial bullying

1

2

3

4

5