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Prevention: PEAK

Play Kit I: "No Bullying Allowed!"

Outcomes Assessment: Pre-Kit Use Survey

Recently, you agreed to participate in our survey research about bullying in your school and your use of the No Bullying Allowed! Play Kit. Complete this survey before you have implemented the program with your students.

The Second Mile is conducting this assessment solely to determine the effectiveness of this program. The following identifying information will be used to match your responses with those you give to the follow-up questionnaire. No individual or school names or identifying information will be used by The Second Mile in reporting the results.

All boxes denoted with an asterisk (*) must be filled out. Thank you.

Date:

Name:*

Job Title:*

School:*

Address:*

 

City:*

State:*

ZIP:*

E-mail:*

School Phone:*

 

The Second Mile Bullying Questionnaire

Please consider the current state of bullying in your classroom or school and respond to the following items:

 

Not At All

0

 

1

To a Moderate Degree

2

 

3

To an Extremely High Degree

4

1. Teachers and administrators perceive bullying as a problem in this school.

2. Students perceive bullying as a problem in this school.

3. Parents perceive bullying as a problem in this school.

4. All parties are willing to discuss the problem of bullying.

5. Most bullying incidents are reported to adults.

6. Teachers actively intervene in bullying incidents.

7. Administrators actively intervene in bullying incidents.

8. Parents actively intervene in bullying incidents.

9. The number of bullying incidents has decreased over the past six months.

10. The severity of bullying incidents has decreased over the past six months.

11. Students can define bullying and provide examples of bullying behavior.

12. Students can identify appropriate strategies to use in bullying situations.

13. Students utilize anti-bullying strategies in school and non-school settings.

 

  
 

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