Bully Free Survey



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Bullying Prevention Survey

For Students (Elementary)

Grades 3-5

(Copyright 2006, Allan L. Beane, Ph.D.)

INSTRUCTIONS TO TEACHERS: Ask students not to write their names on the survey. Please read the following instructions to students: “All students should feel safe, accepted and have a sense of belonging at our school. For this to happen, we need your help to prevent and stop bullying. Bullying is when a more powerful person (or persons) mistreats someone over and over on purpose. It is not hurting someone accidentally. Examples of bullying are hitting, pushing, tripping, shoving someone into his/her locker, name-calling, teasing, making fun of someone because of looks or skin color or dress, rejecting someone, spreading rumors and lies about someone, writing mean notes, turning others against someone, threatening someone, embarrassing someone, stealing or damaging things that belong to someone, etc.”

Note: Read each item of the survey to students then pause long enough for them to ask questions. Have students respond to each statement by shading in the appropriate bubble (with a no. 2 pencil) on the computer scan sheet (or some other answer sheet) which most accurately describes them.

|I am in the __________ grade. |I am a __________. |

| | |

|3rd |Female |

|4th |Male |

|5th | |

|6th | |

|I live with ____________. |My parents are ___________. |

| | |

|Both parents |Married |

|One parent |Separated |

|A relative |Divorced |

|A friend |Don’t know |

|A foster parent |Other |

|What is your ethnic group? |I feel taken care of at home. |

| | |

|African American |Yes |

|Native American |No |

|Caucasian | |

|Hispanic | |

|Other | |

Use the scale below and respond to each item by shading in the appropriate bubble (with a no. 2 pencil) on the computer scan sheet for the response which comes closest to describing what you see and experience.

|A |B |C |D |E |

|Almost Never |A Little |Sometimes |A Lot |Almost Always |

What Bullying Looks Like

|7 |I see other students hit, pinched, kicked, tripped, pushed, elbowed, touched, or grabbed in a hurtful or embarrassing way. |

|8 |I am hit, pinched, kicked, tripped, pushed, elbowed, touched, or grabbed in a hurtful or embarrassing way. |

|9 |I see other students ignored, rejected, lied about, had rumors told about them, or had hurtful and mean notes written about |

| |them. |

|10 |I am ignored, rejected, lied about, had rumors told about me, or had hurtful and mean notes written about me. |

|11 |I see other students called names, teased, made fun of the way they look or dress, or put down in a hurtful way. |

|12 |I am called names, teased, made fun of the way I look or dress, or put down in a hurtful way. |

|13 |I see other students forced to do things they don’t want to do. |

|14 |I am forced to do things I don’t want to do. |

|15 |I see other students have things damaged or stolen from them. |

|16 |I have things damaged or stolen from me. |

|17 |I see other students bullied in other ways. |

|18 |I am bullied in other ways. |

Bullied in the School

| 19 |I am bullied in the classroom. |

|20 |I am bullied in the hall. |

|21 |I am bullied in the lunchroom. |

|22 |I am bullied in the gym or locker room. |

|23 |I am bullied in the bathroom. |

|24 |I am bullied in other places in the school. |

Bullied Outside School Building

|25 |I am bullied in the parking lot. |

|26 |I am bullied during recess. |

|27 |I am bullied outside the school building before school starts. |

|A |B |C |D |E |

|Almost Never |A Little |Sometimes |A Lot |Almost Always |

Who is Bullying?

|28 |I am bullied by one student. |

|29 |I am bullied by more than one student. |

Bystanders

|30 |Most students try to help other students who are bullied. |

|31 |When students see someone bullied, most of them ignore it. |

|32 |When students see someone bullied, most of them join in by laughing or other ways. |

How I Feel

|33 |I feel safe at school. |

|34 |I feel safe at home. |

|35 |I feel safe in my neighborhood. |

|36 |I feel unhappy at school because I am being bullied. |

|37 |I feel angry at school because I am being bullied. |

|38 |I feel lonely at school because no one likes me. |

|39 |I feel upset because I see students being bullied. |

|40 |I feel afraid because I am bullied. |

|41 |I feel afraid because I see other students bullied. |

|42 |I sometimes stay home because of bullying at school. |

Reporting Bullying

|43 |If I were bullied, I would tell an adult at school. |

|44 |If I heard about or saw someone bullied, I would tell an adult at school. |

|45 |If I were bullied at school, I would tell an adult at home. |

Friends at School

|46 |If I were mistreated by other students, my friends would help me. |

|47 |I am able to make friends at school. |

|A |B |C |D |E |

|Almost Never |A Little |Sometimes |A Lot |Almost Always |

Adults as Models and Helpers

|48 |If an adult at school saw bullying, he/she would try to stop the bullying without making it worse for the student being bullied.|

|49 |If an adult at my house reported that I am being bullied at school, someone at my school would try to stop it without making it |

| |worse for me. |

|50 |My principal and/or assistant principal try to stop students from bullying. |

|51 |I am bullied by one or more adults at school. |

|52 |There are some adults at school who bully students. |

|53 |There are some adults at school who bully other adults. |

Rules and Instruction

|54 |My teacher(s) have classroom rules against bullying. |

|55 |The punishment for breaking classroom rules about bullying is clear. |

|56 |Some adults at school talk to us about bullying. |

|57 |Some adults at school talk to us about the Golden Rule – treating others the way we want to be treated. |

Riding the Bus (Answer these questions only if you ride the bus to school and/or ride the bus home from school.)

|58 |I am bullied while waiting for the bus to arrive to take me to school. |

|59 |I am bullied on the bus going to school. |

|60 |I am bullied while waiting for the bus to arrive to take me home. |

|61 |I am bullied while riding the bus home from school. |

Walking to and from School

(Answer these questions only if you walk to and/or from school)

|62 |I am bullied while walking to school. |

|63 |I am bullied while walking home from school. |

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