Tell us about bullying
Please do not put your name on this form anywhere. You are allowed to tell us anything you want to.
We would like to know what you think about bullying in your school or organisation. Your answers to the questions below will help us to stop bullying. If the answer you want to give is not given, use the space provided to write in your own.
Tell us about yourself
1.
Have you ever been bullied ?
(please tick one box)
No, I have never been bullied
Yes, I have been bullied a little bit
Yes, I have been bullied a lot
a. I am a
Boy
Girl
b. I am
years old.
c. I am in class
ChildLine 0800 1111 ChildLine 0800 1111 ChildLine 0800 1111 ChildLine 0800 1111 ChildLine 0800 1111
2.
When were you bullied ?
(you can tick more than one box)
I have never been bullied
A long time ago
Last year
Last term
Last month
Last week
3.
What kind of bullying was it ?
Called names
Left out or excluded by other children
Punched or pushed
Nasty stories told about me
Asked to give up money or belongings
Being sent nasty text messages or emails
Forced to do something I didn't want to do
Teased about the way I look
Called gay (whether or not it's true)
Because of my religion
Because of my ethnicity or race
Other
4.
Where did the bullying happen ?
In a classroom
In the corridors
In the dinner hall
In the playground
On the way to or from school
5.
Who did you tell that you were being bullied ?
I told no-one
An adult at school
Another adult
A friend
An older boy or girl
My parent or carer
My brother/sister
A peer supporter
I phoned a helpline
6.
What happened then ?
(you can ticked more than one box)
Something was done that stopped the bullying
Something was done but it didn't stop the bullying
Something was done but it made the bullying worse
Nothing was done but the bullying stopped anyway
Nothing was done and the bullying carried on
8.
If you were bullied and you told someone...
What did they do that was helpful?
What would you like them to have done differently?
7.
What else did you do about being bullied ?
I fought back
I stuck up for myself without fighting
I took no notice
I tried to keep away from the bullies
I stayed away from school
I dealt with it myself
I made new friends
I did nothing
9.
Do you know about your school's anti-bullying policy ?
10.
Do you think what your school does about bullying is working ?
11.
What else do you think your school could do to stop bullying ?
12.
Is there anything else you want to tell us about bullying ?
Thank you for answering these questions.
If you are being bullied, whether in school or somewhere else,
try to find someone you trust to talk to about it, or phone ChildLine on 0800 1111.
Published by the National Children s Bureau on behalf of the Anti-Bullying Alliance
8 Wakley Street, London EC1V 7QE
Telephone: +44 (0)20 7843 1901 Fax: +44 (0)20 7843 6053
Website: www.anti-bullyingalliance.org. Email: aba@ncb.org.uk
NCB Registered Charity No: 258825
® NCB, 2005
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