OUR LADY OF FATIMA UNIVERSITY

SENIOR HIGH SCHOOL DEPARTMENT

Assessing Bullying Victimization, Perpetration and Bystanders Experiences

PART I: PERSONAL INFORMATION

Name: ________________ (optional) Gender: _______________

Age: ______ Section/Strand: ____________

PART II: DIRECTIONS: Read the items below. For each item, indicate if you personally experienced, only witnessed, penetrated
the behavior to others or both experienced, witnessed and penetrated the behavior. Circle the appropriate response that best
represents your experience. (With Filipino translation)

1- NEVER 2- SOMETIME 3-FREQUENTLY

Have you experienced, witnessed or/and penetrated these behavior? Experienced Witnessed Penetrated

1. Being mocked (With Filipino translation) 1 2 3 1 2 3 1 2 3

2. Being made incompetent(With Filipino translation) 1 2 3 1 2 3 1 2 3
3. Receiving threats (With Filipino translation) 1 2 3 1 2 3 1 2 3
4. Being the target of gossips or false rumor (With Filipino translation) 1 2 3 1 2 3 1 2 3
5. Receiving uneven task or workload during group activity (With Filipino 1 2 3 1 2 3 1 2 3
translation)
6. Being repeatedly reminded of your mistakes (With Filipino translation) 1 2 3 1 2 3 1 2 3
7. Being micromanaged(With Filipino translation) 1 2 3 1 2 3 1 2 3
8. Being yelled in front of others (With Filipino translation) 1 2 3 1 2 3 1 2 3
9. Being criticized in front of others (With Filipino translation) 1 2 3 1 2 3 1 2 3
10. Being cursed in front of others (With Filipino translation) 1 2 3 1 2 3 1 2 3
11. Being excluded from routine lunches (With Filipino translation) 1 2 3 1 2 3 1 2 3
12. Being the target of gossip because of others shared your personal /private 1 2 3 1 2 3 1 2 3
information (With Filipino translation)
13. Being excluded or retaliated because of speaking up (With Filipino 1 2 3 1 2 3 1 2 3
translation)
14. Being made to feel stupid (With Filipino translation) 1 2 3 1 2 3 1 2 3
15. Being insulted behind your back (With Filipino translation) 1 2 3 1 2 3 1 2 3