Microsoft Word - HURT FEELINGS REPORT.docx
HURT FEELINGS REPORTFor use of this form, see ASC 00-210; the proponent agency is NSB DATA REQUIRED BY THE PRIVACY ACT OF 1947AUTHORITY:9 USAP 895, Departmental Regulations; 99 ASC 2211, United States Antarctic ProgramPRINCIPAL PURPOSE:To assist whiners in documenting hurt feelings, and to provide leaders with a list of contractors who require additional counseling, leadership, and extra duty.ROUTINE USES:For subordinate leader development PAE 47-255687. Leaders & whiners should use this form as necessary.DISCLOSURE:Disclosure is voluntary, but repeated disclosure may result in a FF Form 2908-DF, Report of Wall To Wall CounselingPART I – ADMINISTRATIVE DATAA. WHINER’S NAME (Last, First, MI)B. POSITION TITLEC. SOCIAL SECURITY NUMBERD. DATE OF REPORTE. ORGANIZATIONF. NAME & TITLE OF THE PERSON FILLING OUT THIS FORMPART II – INCIDENT REPORTA. DATE FEELINGS WERE HURTB. TIME OF HURTFULNESSC. LOCATION OF HURTFUL INCIDENTD. TITLE OF FOREMAN SYMPATHETIC TO WHINERE. NAME OF REAL MAN/WOMAN WHO HURT YOUR SENSITIVEFEELINGSF. POSITION TITLEG. ORGANIZATION (if different from 1e above)E. INJURY (Mark all that apply)1. WHICH EAR WERE THE WORDS OF HURTFULNESS SPOKEN INTO?? LEFT ? RIGHT ? BOTH2. IS THERE PERMANENT FEELING DAMAGE?? YES ? NO ? MAYBE3. DID YOU REQUIRE A “TISSUE” FOR TEARS?? YES ? NO ? MULTIPLE 4. HAS THIS RESULTED IN A TRAUMATIC BRAIN INJURY?? YES ? NO ? MAYBEF. REASON FOR FILING THIS REPORT (Mark all that apply)I am thin skinnedIt hurts when I get called on my shitI got cut off at Gallagher’sI am from Colorado or TexasI was not offered a boondoggleI got cut off at SouthernI have no sense of humorI consider myself “outdoorsy”I got cut off at the Coffee HouseI am a big fucking crybabyI am a self-centered D-bagI was forced to attend an ALL HANDSI am not all that brightThe weather is too coldAll of the above and moreG. NARRATIVE (Tell us in your own sissy words how your feelings were hurt.)PART III ‐ AUTHENTICATIONa. PRINTED NAME OF REAL MAN/WOMANb. SIGNATUREc. PRINTED NAME OF WHINERd. SIGNATUREWe, as the USAP, take hurt feelings seriously. If you don't have someone who can give you a hug and make things all better, please let us know and we will promptly dispatch a "hugger" to you ASAP. In the event we are unable to find a "hugger" we will notify the fire department and request that they send fire personnel to your location. If you are in need of supplemental support, upon written request, we will make every reasonable effort to provide you with a "blankey", a "binky" and/or a bottle if you so desire. ASC FORM 80085-F7PAST EDITIONS OBSELETE ................
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