Bullying Questionnaire

Help stop bullying in your community with better-informed programs and interventions using this questionnaire.




What is your gender?

Male
Female
Other (Please specify):

What is your age?

Please check your response.

Yes No
Have you ever been bullied?
Have you experienced bullying in the past 12 months?
Have you experienced cyber bullying in the past 12 months?

If yes, where were you bullied? (Select all that apply)

Workplace
Neighborhood
In the Home
Recreation Facilities
Parks
School Bus
School
Online / internet
Group text messages / chats
Smart phone or tablet apps

Do you know of someone in our community who has been bullied in the last 12 months?

Yes
No

If you have answered 'Yes', please select all that apply:

Parent
Step Parent
Guardian
Brother or Sister
Friend
Co-worker
Stranger
Classmate / schoolmate
Acquaintance / stranger
Other (Please specify):

Where did the bullying take place? (Select all that apply)

Workplace
Neighborhood
In the Home
Recreation Facilities
Parks
School Bus
School
Online / internet
Group text messages / chats
Smart phone or tablet apps
Other (Please specify):

How should bullying be dealt with? (Select all that apply)

Teach those being bullied how to get help.
Teach peers and bystanders to stop others from bullying.
Teach the community the signs of bullying and strategies to address them.
Teach bullies awareness
Teach parents of bullies and victims how to prevent/help
Other (Please specify):

I would like to learn more about… (Select all that apply)

Community workshops that may prevent bullying such as: bullying education, communication, inclusion and empathy.
Teaching the bullied to stand up for them-self.
Teaching peers and bystanders to get involved.
Identifying the signs of bullying.
Cyberbullying.
Other (Please specify):

Other Comments you might like to make:

Please describe how the bullying has affected you, or changed what you do.