Attack Victim Feedback Survey

Victim: Complete this form and present it to your attacker. Or else.

We value your opinion! 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.

The attack on me was, in my opinion, [check all that apply]

 surprising /  frightening /  appalling /  disgusting /  incomprehensible /  malicious /  enlightening

I considered my attackers to be
 fearsome /  skillful /  focused /  amoral /  cunning /  vicious or cruel /  brutish or thuggish

If I could change anything about the attack on me, it would be the

 time /  place /  number of attackers /  weapons used /  language used /  hostility level /  bloodloss

Ratings
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 2 3 4 5 6 7 8 9 10
This attack was effective in securing my cooperation with, or aid to, the attacker(s) goal(s):
1 2 3 4 5 6 7 8 9 10
Make it stop oh please make it stop:
1 2 3 4 5 6 7 8 9 10
Note: If you have no opinion, inform your attacker, who will quickly help you develop an opinion.

True / False
For office use only
Indicate the truth or falsity of the following statements:
Your name __________________________________________
True False
Target(s) ___________________________________________
Location was used creatively   Attack tracking # ____________________________________

Weapon(s) was/were used well   Specified severity of attack: [check all that apply]
 verbal
Injuries were efficient  
 physical:
 bruises  burns/scars  breakage  mutilation
Compared well w/ other attacks on me  
 emotional:
Witnesses were impressed    passive-aggressive  annoying  poisonous
 existential:
Witnesses were eliminated    troubling  grave  midlife crisis  self-destructive

Saw my life pass before my eyes   Associated property damage? [check all that apply]
 personal
Attack left cool-looking scars  
 room:
 small items  furnishings  paint/wiring/plumbing
Correct number of holes in body  
 building:
Want my mommy    vandalism  arson  destruction
 neighborhood/campus / district/city:
Would be attacked this way again    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