For use of this form, see FM 22-102; the proponent agency is TRADOC AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES:

DISCLOSURE: DATA REQUIRED BY THE PRIVACY ACT OF 1974 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN) To assist whiners in documenting hurt feelings, and to provide leaders with a list of soldiers who require additional counseling, NCO leadership, and extra duty.. For subordinate leader development IAW FM 22-102. Leaders & whiners should use this form as necessary. Disclosure is voluntary, but repeated disclosure may result in a DA Form 779-1A, Report of Wall To Wall Counseling

HURTFEELINGSREPORT

PARTIADMINISTRATIVEDATA
A.WHINERSNAME(Last,First,MI) B.RANK/GRADE C.SOCIALSECURITYNUMBER D.DATEOFREPORT

E.ORGANIZATION

F.NAME&TITLEOFTHEPERSONFILLINGOUTTHISFORM

PARTIIINCIDENTREPORT
A.DATEFEELINGSWEREHURT B.TIMEOFHURTFULNESS C.LOCATIONOFHURTFULINCIDENT D.NCOOROFFICERSYMPATHETICTOWHINER

E.NAMEOFREALMAN/WOMANWHOHURTYOURSENSITIVE FEELINGS

F. RANK/GRADE

G.ORGANIZATION(ifdifferentfrom1e above)

E.INJURY(Markallthatapply)
1.WHICHEARWERETHEWORDSOFHURTFULNESSSPOKENINTO? 2.ISTHEREPERMANENTFEELINGDAMAGE?

LEFTRIGHTBOTH
3.DIDYOUREQUIREATISSUEFORTEARS?

YESNOMAYBE
4.HASTHISRESULTEDINATRAUMATICBRAININJURY?

YESNOMULTIPLE________

YESNOMAYBE

F.REASONFORFILINGTHISREPORT(Markallthatapply) Iamthinskinned TheArmyneedstofixmyproblems Twobeersisnotenough Iamawimp Myfeelingsareeasilyhurt Myhandsshouldbeinmypockets Ihavewoman/manlikehormones Ididn'tsignupforthis Iwasnotofferedapostbrief Iamacrybaby IwastoldthatIamnotahero Someonerequestedapostbrief Iwantmymommy Theweatheristocold Alloftheaboveandmore G.NARRATIVE(Tellusinyourownsissywordshowyourfeelingswerehurt.)

PARTIIIAUTHENTICATION
a.PRINTEDNAMEOFREALMAN/WOMAN b.SIGNATURE c.PRINTEDNAME OFWHINER d.SIGNATURE

We,astheArmy,takehurtfeelingsseriously.Ifyoudon'thavesomeonewhocangiveyouahugandmakethingsallbetter,pleaseletusknowandwe willpromptlydispatcha"hugger"toyouASAP.Intheeventweareunabletofinda"hugger"wewillnotifythefiredepartmentandrequestthatthey sendfirepersonneltoyourlocation.Ifyouareinneedofsupplementalsupport,uponwrittenrequest,wewillmakeeveryreasonableefforttoprovide youwitha"blankey",a"binky"and/orabottleifyousodesire. DAFORMIMTWF1,APRIL2009EDITIONOFAPRIL1989ISOBSELETE