BULLYING QUESTIONNAIRE FOR STUDENTS
Please answer these questions about your life at school.
Your age ________ Grade ________
1. How well do you get along with students at this school? (Circle one of the following.)
Always well Usually well About half the time
Usually not well Never well
We are interested in what bullying goes on in this school. We call it bullying when people deliberately and repeatedly threaten or hurt a less powerful person by what they do or say.
2. Have you ever been bullied by another student or group this year? (Circle one.)
3. If you have answered “yes”, indicate how often each of the following has happened to you this year (Circle “never”, “sometimes”, or “often” in each case.)
I have been hit or threatened. Never Sometimes Often
I have been called unpleasant names. Never Sometimes Often
I have been deliberately left out of
things by others. Never Sometimes Often
4. How have you felt about being bullied by others? (Circle one.)
I was never bullied by anyone. I was bullied but not bothered by it.
I was somewhat bothered by it. I was upset a great deal by it.
5. Do you personally feel safe from being bullied at this school? (Circle your answer.)
I always feel safe. I usually feel safe.
I feel safe about halftime.
I usually feel unsafe. I never feel safe.
6. Could you use some help to stop the bullying? (Circle your answer.)
Yes Unsure No
From Ken Rigby’s “STOP The Bullying” A Handbook For Teachers