Bullying Survey—Student

Read the following statements concerning bullying at school, and respond based on your
direct knowledge as a student. In addition, please provide the personal information Date Administered
regarding gender and grade level. _____________________
Male ___________ Female ___________ Grade Level ___________

Please answer the questions using the following definition for bullying.

Bullying is the repeated, negative behaviors between one or more individuals together with aggression or
intentional harm (physical or emotional). Incidents of bullying include an imbalance of power between
perpetrator (the bully) and the victim. The imbalance of power may be in one or more of the following areas:
• Social power • Athletic power
• Financial power • Intellectual power
• Physical power
1. I have observed classmates being bullied at school during the past 12 months.
Agree Unsure Disagree
If the answer to #1 is Agree, on average, how many times have you observed this behavior?
a. Once a day
b. Several times a day
c. Once a week
d. Several times a week
e. Only a few times in the 12 months

2. I have been the victim of bullying by another student during the 12 months.
Agree Unsure Disagree
If the answer to #2 is Agree, on average, how many times have you been victimized?
a. Once a day
b. Several times a day
c. Once a week
d. Several times a week
e. Only a few times in the past 12 months
3. I have observed one or more of my friends being bullied during the past 12 months.
Agree Unsure Disagree

4. The teachers at this school try to reduce bullying.

Agree Unsure Disagree

5. The administrators at this school try to reduce bullying.

Agree Unsure Disagree
6. The counselors at this school try to reduce bullying.
Agree Unsure Disagree
 7. If I were bullied at school, I would tell a teacher or other staff member.
Agree Unsure Disagree

8. If I were bullied at school, I would tell my parents.

Agree Unsure Disagree

9. I believe there is a need for a bullying prevention program at my school.

Agree Unsure Disagree

10. Bullying is addressed in the student handbook.

Agree Unsure Disagree

11. I believe there is adequate adult supervision of students at school.

Agree Unsure Disagree

12. Counselors at my school are involved in bullying prevention.

Agree Unsure Disagree

13. I believe teachers in this school are consistent and fair in their approach when bullying is observed or reported.
Agree Unsure Disagree

14. I believe the principal or other administrators in this school are fair and consistent in their approach when
bullying is observed or reported.
Agree Unsure Disagree

15. I have personally observed students participating in bullying behaviors in the following locations.
Please circle all that apply. Extracurricular Activities School Bus
Student Commons/Hallways Cafeteria
Restrooms Locker Rooms

Playground/Recess Physical Education Class

Classroom On the Way to or From School

16. I have observed classmates being bullied or harassed online.

Agree Unsure Disagree

If the answer to #16 is Agree, I told (circle all that apply):

a. No one
b. My parent
c. Another student
d. A teacher or other adult at school
17. I have been harassed or bullied online.
Agree Unsure Disagree

If the answer to #17 is Agree, I told (circle all that apply):

a. No one
 b. My parent
c. Another student
d. A teacher or other adult at school

18. If you have observed bullying at school, or if you have been bullied, please use the space below to describe what
you have seen or experienced. Please be as specific as possible.

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19. What suggestions do you have for the prevention of bullying at this school?

________________________________________________________________________________________

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