Form 24 ATTACHMENT C25: Olweus Bullying Quesstionnaire (High Sch

OMB No:: 0920-0747: Exp Date: ???

The Olweus Scale

1. How do you like school? O Dislike school very much O Dislike O Neither like nor dislike O Like school O Like school very much 2. How many good friends do you have in your class(es)? O None O 1 good friend O 2-3 good friends O 4-5 good friends O 6+ good friends 3. How often have you been bullied at school in the past couple of months? O Haven’t been bullied O Once or twice O 2-3 times a month O About once a week O Several times/week 4. I was called mean names, was made fun of, or teased in a hurtful way. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week

5. Other students left me out of things on purpose, excluded me from their group of friends, or completely ignored me. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 6. I was hit, kicked, pushed, shoved around, or locked indoors. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 7. Other students told lies or spread false rumors about me and tried to make others dislike me. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 8. I had money or other things taken away from me or damaged. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week

Public reporting burden of this collection of information is estimated to average 7 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Clearance Officer; 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (???).

9. I was threatened or forced to do things I did not want to do. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 10. I was bullied with mean names or comments about my race or color. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 11. I was bullied with mean names, comments, or gestures with a sexual meaning. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 11A) I was bullied with mean or hurtful messages, calls or pictures, or in other ways on my cell phone or over the Internet (computer). O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 11B). If you were bullied on your cell phone or over the Internet, how was it done? O Only on cell phone O Only over the Internet O In both ways

12. I was bullied in another way. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 13. In which class(es) is the student or students who bully you? O In my class O Diff. class, same grade O In a higher grade O In a lower grade O In different grades 14. Have you been bullied by boys or girls? O Mainly by 1 girl O By several girls O Mainly by 1 boy O By several boys O Both boys and girls 15. By how many students have you usually been bullied? O Mainly by 1 student O By 2-3 students O By 4-9 students O By more than 9 O Different students/grades 16. How long has the bullying lasted? O 1 or 2 weeks O About a month O About 6 months O About a year O Several years

17. Where have you been bullied? O Playground/athletic field O Hallways/stairwells O Class (teacher in room) O Class (teacher NOT in room) O Bathroom O Gym class O Lunchroom O Way to and from school O Bus stop O School bus O Somewhere else in school 18. Have you told anyone that you have been bullied in the past couple months? O Been bullied/not told O Been bullied/told somebody Who have you told? O Your class teacher O Another adult at school O Your parent(s) guardian(s) O Your brother(s)/sister(s) O Your friend(s) O Somebody else 19. How often do the teachers or other adults at school try to put a stop to it when a student is being bullied at school? O Almost never O Once in a while O Sometimes O Often O Almost always 20. How often do other students try to put a stop to it when a student is being bullied at school? O Almost never O Once in a while O Sometimes O Often O Almost always

21. Has any adult at home contacted the school to try to stop your being bullied at school in the past couple of months? Haven’t been bullied No, not contacted school Yes, once Yes, several times 22. When you see a student your age being bullied at school, what do you feel or think? Probably deserves it Don’t feel much Feel a bit sorry Feel sorry and want to help 23. How often have you taken part in bullying another student(s) at school in the past couple months? Not bullied others Once or twice 2-3 times a month About once a week Several times/week 24. I called another student(s) mean names and made fun of or teased him or her in a hurtful way. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 25. I kept him or her out of things on purpose, excluded him or her from my group of friends, or completely ignored him or her. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week

26. I hit, kicked, pushed, and shoved him or her around, or locked him or her indoors. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 27. I spread false rumors about him or her and tried to make others dislike him or her. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 28. I took money or other things from her or her or damaged his or her belongings. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 29. I threatened or forced him or her to do things he or she did not want to do. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 30. I bullied him or her with mean names or comments about his or her race or color. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week

31. I bullied him or her with mean names, comments, or gestures with a sexual meaning. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 31A) I bullied him or her with mean or hurtful messages, calls or pictures, or in other ways on my cell phone or over the Internet (computer). O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 31B) If you bullied another student(s) on your cell phone or over the Internet (computer), how was it done? O Only on cell phone O Only over the Internet O In both ways 32. I bullied him or her in another way. O Hasn’t happened O Once or twice O 2-3 times a month O About once a week O Several times/week 33. Has your class or homeroom teacher or any other teacher talked with you about your bullying another student(s) at school in the past couple of months? O Not bullied others O No, haven’t talked with me O Yes, they have once O Yes, several times

34. Has any adult at home talked with you about your bullying another student(s) at school in the past couple of months? O Not bullied others O No, haven’t talked with me O Yes, they have once O Yes, several times 35. Do you think you could join in bullying a student whom you do not like? O Yes O Yes, maybe O I don’t know O No, I don’t think so O No O Definitely no 36. How do you usually react if you see or learn that a student your age is being bullied by another student(s)? O I have never noticed it O I take part in the bullying. O I don’t do it, but find it OK O I just watch what goes on O I ought to help O I try to help

37. How often are you afraid of being bullied by other students in your school? O Never O Seldom O Sometimes O Fairly often O Often O Very often 38. Overall, how much do you think your class or homeroom teacher has done to cut down on bullying in your classroom in the past couple of months? O Little or nothing O Fairly little O Somewhat O A good deal O Much

FOR STUDY USE ONLY
Date Interviewed	Month Day Year	Interviewed by