Bully Free Survey



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Bullying Prevention Survey

For Students (Middle School and High School)

(Copyright 2006, Allan L. Beane, Ph.D., Allan L. Beane Bullying Prevention Program, )

INSTRUCTIONS: Do not write your name anywhere on this questionnaire or on the bubble sheet (or other answer sheets). 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. Respond to each statement by shading in the appropriate bubble (with a no. 2 pencil) on the computer scan sheet which most accurately describes them.

|1. I am in the _________ grade. |

|A. 6th grade |B. 7th grade |C. 8th grade | | |

| |

|2. I am in the _________ grade. |

|A. 9th grade |B. 10th grade |C. 11th grade |D. 12th grade | |

| |

|3. I live with _________. |

|A. Both parents |B. One parent |C. A relative |D. A friend |E. A foster parent |

| |

|4. My parents are _________. |

|A. Married |B. Separated |C. Divorced |D. Don’t know |E. Other |

| |

|5. What is your ethnic group? (Check one.) |

|A. African |B. Native American |C. Caucasian |D. Hispanic |E. Other |

|American | | | | |

|6. I feel taken care of at home. |

|A. No |B. Yes | | | |

| |

|7. I am a _________. |

|A. Female |B. Male | | | |

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 your opinion about what you see and experience.

|A |B |C |D |E |

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

What Bullying Looks Like

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

|9 |I am hit, pinched, kicked, tripped, pushed, elbowed, touched, or grabbed in a hurtful or embarrassing way. |

|10 |I see other students ignored, rejected, lied about, had rumors told about them, or had hurtful and mean notes written about |

| |them. |

|11 |I am ignored, rejected, lied about, had rumors told about me, or have had hurtful and mean notes written about me. |

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

|13 |I am called names, teased, made fun of the way I look or dress, or put down in a hurtful way. |

|14 |I see other students forced to do things they don’t want to do. |

|15 |I am forced to do things I don’t want to do. |

|16 |I see other students’ things damaged or stolen from them. |

|17 |I have had things damaged or stolen from me. |

|18 |I see other students bullied in other ways. |

|19 |I am bullied in other ways. |

Bullied in the School

| 20 |I am bullied in the classroom. |

|21 |I am bullied in the hall. |

|22 |I am bullied in the lunchroom. |

|23 |I am bullied in the gym or locker room. |

|24 |I am bullied in the bathroom. |

|25 |I am bullied in other places in the school. |

Bullied Outside the School Building

| 26 |I am bullied in the parking lot. |

|27 |I am bullied outside during physical education classes. |

|28 |I am bullied outside the school building before school starts. |

|29 |I am bullied on an athletic field. |

|A |B |C |D |E |

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

Who is Bullying?

|30 |I am bullied by one student. |

|31 |I am bullied by more than one student. |

Bystanders

|32 |Most students try to help other students who are being bullied. |

|33 |When students see someone bullied, most of them ignore it. |

|34 |When students see someone bullied, most of them join in by laughing, or other ways. |

How I Feel

|35 |I feel safe at school. |

|36 |I feel safe at home. |

|37 |I feel safe in my neighborhood. |

|38 |I feel unhappy at school because I am being bullied. |

|39 |I feel angry at school because I am being bullied. |

|40 |I feel lonely at school because no one likes me. |

|41 |I feel upset because I see students being bullied. |

|42 |I feel afraid because I am bullied. |

|43 |I feel afraid because I see other students bullied. |

|44 |I sometimes stay home because of bullying at school. |

Reporting Bullying

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

|46 |If I heard about or saw someone bullied at school, I would tell an adult at school. |

|47 |If I were bullied at school, I would tell an adult at home. |

Friends at School

|48 |If I were mistreated by other students, my friends would help me. |

|49 |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

|50 |If an adult at school saw bullying, he/she would try to stop the bullying without making it worse for the student being bullied.|

|51 |If an adult at my house reported that I am being bullied, someone at my school would try to stop it without making it worse for |

| |me. |

|52 |My principal and/or assistant principal try to stop students from bullying. |

|53 |I am bullied by one or more adults at school. |

|54 |There are some adults at school who bully students. |

|55 |There are some adults at school who bully other adults. |

Rules and Instruction

|56 |My teacher(s) have classroom rules against bullying. |

|57 |The punishment for breaking classroom rules about bullying is clear. |

|58 |Some adults at school talk to us about bullying. |

|59 |Some adults at school talk to us about the Golden Rule – treating others the way we want to be treated. |

Walking to and from School (Answer these questions only if you walk to and/or from school. If you ride the bus, go to item 62.)

|60 |I am bullied while walking to school. |

|61 |I am bullied while walking home from school. |

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

|62 |I am bullied while waiting for the bus to arrive to take me to school. |

|63 |I am bullied on the bus going to school. |

|64 |I am bullied while waiting for the bus to arrive to take me home. |

|65 |I am bullied while riding the bus home from school. |

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