Research Instrument:

Title:

Name:
Grade Level:
Section:
Date:

Please indicate your response by selecting the corresponding option for each question:

I. Have you ever been a victim of bullying during your time at CNHS?
Never ⬜
Rarely ⬜
Occasionally ⬜
Frequently. ⬜
Always. ⬜
II. How often do you observe or encounter bullying behaviors in your daily school life?
Never. ⬜
Rarely. ⬜
Occasionally ⬜
Frequently. ⬜
Always. ⬜
III. In the last school year, how often have you encountered or been aware of bullying affecting students at CATIGAN NATIONAL HIGH
SCHOOL?
Never. ⬜
Rarely. ⬜
Occasionally. ⬜
Frequently. ⬜
Always. ⬜
IV. How often have you felt anxious, sad, or stressed because of bullying experiences?
Never. ⬜

Rarely ⬜

Occasionally. ⬜

Frequently ⬜

Always. ⬜

V. How frequently have you felt that the school environment at CNHS is a safe and inclusive place free from bullying?
Never. ⬜

Rarely. ⬜

Occasionally. ⬜

Frequently. ⬜

Always. ⬜

Note: Please select the appropriate response for each question and indicate your name, grade level, section, and the date of the survey. Your
responses will be confidential and used for research purposes only. Thank you for your participation!