Survey 1: Anti-Bullying Survey

Dáta:_____________

1. Has anyone repeatedly called you a name?_______________________

2. Has anyone told you that you can’t be friends?____________________

3. Has anyone ever hit, kicked or pushed you repeatedly?_______________

4. Has anyone ever threatened you?______________________________

5. Was someone mean to you because of how you look?________________

6. Have you felt bullied in school this year? __________

7. Did you tell anyone about any of these incidents?________

8. Why or why not?

__________________________________________________________

__________________________________________________________

9. Have you seen someone else being bullied in school this year?_________

     Give details:

__________________________________________________________

__________________________________________________________

10. Have you ever called someone else a name, hit, kicked, pushed, threatened or being mean to someone?

__________________________________________________________

__________________________________________________________

Remember that bullying behaviour is REPEATED. If you are seeing this happen or it is happening to you or you think you might be doing it to someone it is really very important that you talk to someone about it. You can write anything that bothers you about this on the back of this page: