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Victim: Complete this form and present it to your attacker. Or else.
Please describe your assailant(s) and their attack on you using the following metrics, either during or immediately after the attack. Your feedback will help us improve our future attacks on others.
We value your opinion!
The attack on me was, in my opinion, [check all that apply]
surprising / frightening / appalling / disgusting / fearsome / skillful / focused / amoral /
incomprehensible / malicious / enlightening
I considered my attackers to be
cunning / vicious or cruel / brutish or thuggish language used / hostility level / bloodloss
If I could change anything about the attack on me, it would be the
time / place / number of attackers / weapons used /
Rate these aspects of your attack and attackers on a numerical scale from 1 (disagree strongly) to 10 (agree strongly).
My attacker(s) made it clear what he/she/it/they wished to accomplish by attacking me:
1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 10 10 10
This attack was effective in securing my cooperation with, or aid to, the attacker(s) goal(s): Make it stop oh please make it stop:
Note: If you have no opinion, inform your attacker, who will quickly help you develop an opinion.
True / False
Indicate the truth or falsity of the following statements:
For office use only
Your name __________________________________________ Target(s) ___________________________________________ Attack tracking # ____________________________________ Specified severity of attack: [check all that apply]
verbal physical: bruises burns/scars breakage mutilation emotional: passive-aggressive annoying poisonous existential: troubling grave midlife crisis self-destructive
Location was used creatively Weapon(s) was/were used well Injuries were efficient Compared well w/ other attacks on me Witnesses were impressed Witnesses were eliminated Saw my life pass before my eyes Attack left cool-looking scars Correct number of holes in body Want my mommy Would be attacked this way again
Associated property damage? [check all that apply]
personal room: small items furnishings paint/wiring/plumbing building: vandalism arson destruction neighborhood/campus / district/city: panic riot destruction annihilation
Copyright ©2009 Ninjalistics. Written by Allen Varney. Answer further invasive personal questions on the many forms available free at www.ninjalistics.com