School Life Survey

PART I:
These questions are about yourself‚ during the past four weeks in school:
1. I hit or beat up other students and hurt them.
2. I teased other students and made cruel jokes about them.
3. I kept those I didn’t like from joining in play time or group activities.
4. I took things from other students and did not give them back.
5. I told other students that I would hurt them.
6. I told lies and stories about other students to make them look bad.
7. I pushed other students‚ made them fall and get hurt.
8. I said mean things about other students and called them bad names.
9. I kept other students from being friends with people I didn’t like.
PART II:
Did this happen to you‚ during the past four weeks in school? (Leave the item blank if it did not happen to you). Read the items below and put a check mark in the box  for the ones that are true for you. For each item you have checked‚ write down:
• the number of times it took place during the past four weeks
• the name of the student who did it to you – you can write a name more than once
• his/her grade
These questions are about yourself‚ during the past four weeks in school:
1. This student hurt me by hitting or beating me up.
2. This student said s/he would harm me or do bad things to me.
3. This student set me up to make others blame me.
4. This student took my things and did not give them back to me.
5. This student teased me and made fun of me in a mean way.
6. This student told lies and stories about me to make others dislike me.
7. This student broke my things on purpose.
8. This student called me bad names or made cruel jokes about me.
9. This student told others not to be my friend.
10. This student pushed me on purpose‚ made me fall and get hurt.
11. This student phoned me to give me a hard time.
12. This student said s/he would not be my friend if I didn’t do what s/he said.
13. This student locked me up in a room or closed space.
14. This student made mean jokes‚ noises‚ or faces at me when I walked by.
15. This student made others leave me out of things.
Copyright © 2005 Sage Publications‚ Ltd. Reproduced by special permission of the publisher‚ Sage Publications‚ Ltd‚ 1 Oliver’s Yard‚ 55 City Rd.‚ London‚ EC1Y 1SP‚ UK from: The efficacy of non-anonymous measures of bullying. School Psychology International‚ 26‚ 443–458 by John F. Chan‚ Rowan Myron‚ & Martin Crawshaw.
 
  • Physical Bullying
  • Verbal Bullying
  • Relational Bullying
 
This instrument can be found on pages 57-59 of Measuring Bullying Victimization‚ Perpetration‚ and BystanderExperiences:A Compendium of Assessment Tools‚ available online at: http://www.cdc.gov/violenceprevention/pdf/bullycompendiumbk-a.pdf
 
PART I
Physical Bullying: Items 1‚ 4‚ and 7
Verbal Bullying: Items 2‚ 5‚ and 8
Relational Bullying: Items 3‚ 6‚ and 9
PART II
Physical Victimization: Items 1‚ 4‚ 7‚ 10‚ and 13
Verbal Victimization: Items 2‚ 5‚ 8‚ 11‚ and 14
Relational Victimization: Items 3‚ 6‚ 9‚ 12‚ and 15
 

Chan‚ J. H. F.‚ Myron‚ R. R.‚ & Crawshaw‚ C. M. (2005). The efficacy of non-anonymous measures of bullying. School Psychology International‚ 26‚ 443–458.

Developer’s Contact Information
John H. F. Chan‚ PhD
Psychological Services
Toronto Catholic District School Board
80 Sheppard Avenue East
Toronto‚ ON‚ M2N 6E8‚ Canada
Tel: 416-222-8282