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Choose how many times you did this activity or task in the last 30 days. In the last 30 days,

I pushed, shoved, slapped, or kicked other students.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I teased other students.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I was grouchy or irritable, or in a bad mood, so even little things made me mad.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I called other students names.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I threatened to hit or hurt another student.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I frequently got angryDeselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I said things about other students to make other students laugh.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I was angry most of the day.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

I took my anger out on an innocent person.Deselect Answer

Never = 0

Seldom (1 or 2 times)

Sometimes (3 or 4 times)

often (5 or more times)

Victimization Survey

Think about what happened During the LAST 7 Days, when you answer these questions.
A student teased me to make me angry.
Deselect Answer

0

1

2

3

4

5

6

A student said things about me to make other students laugh (made fun of me).Deselect Answer

0

1

2

3

4

5

6

A student pushed or shoved me.Deselect Answer

0

1

2

3

4

5

6

A student slapped or kicked me.Deselect Answer

0

1

2

3

4

5

6

A student threatened to hurt or to hit me.Deselect Answer

0

1

2

3

4

5

6

A student beat me up.Deselect Answer

0

1

2

3

4

5

6

Other students encouraged me to fight.Deselect Answer

0

1

2

3

5

6

A student asked me to fight.Deselect Answer

0

1

2

3

4

5

6

A student called me (or my family) bad names.Deselect Answer

0

1

2

3

4

5

6

A student tried to hurt my feeling.Deselect Answer

0

1

2

3

4

5

6

ByStander Survey

Scoring Instruction:
Possibly range is 0 to 60. Higher score indicates a greater frequency of being victim of overt and relational aggregation.

What types of bullying did you observe? Please check.
Deselect Answer

Physical (hitting, kicking, pushing, taking someone’s belongings, etc)

Social (spreading rumor, rejecting someone, telling secret to manipulate relationships, etc)

Vertabl(name calling, swearing, threatening, making others stop talking, etc

Others: (Please type what)

What do you think is the best thing you should have done in the bullying event described in the box? Please check Yes or No.Deselect Answer

I should have told the bully to stop it.

I should have pretend not to notice what was happening.

I should have asked the bully why he/she is doing.

I should have threatened or sworn at the bully.

I should have stayed away from the situation.

I should have reported someone else such as teachers.

I should have spread rumors, told secrets, or gotten the bully rejected by others afterwards.

I should have hit or pushed the bully back.

What did you do when you witnessed the bullying event desibed above? Check the one that is in the closest.Deselect Answer

I joined in the bullying when the bully(ies) had started it.

I giggled, laughed, shouting, or similar reactions.

Nothing, I pretended not to notice what was happening.

I tried to help in someway and was successful.

I assisted the bullying by doing something for the bully(ies).

I kept looking at the bullying and enjoying the situation.

Noting, I went away from the situation.

Name

Email

Phone

Brain Bullying Research

Brain Studies about Bullying

Bullying and ByStander Survey

Who is a Bystander?

Be An Upstander

Bullying scenarios

Who to Call

UpStander Organization

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