Hurt Feeling Report

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HURT FEELINGS REPORT For use of this form, see FM 22- 102; the proponent agency is MOORINGS HOA DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY: 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Moorings and E.O. 9397 (SSN) PRINCIPAL PURPOSE: T o assist whiners in documenting hurt feelings, and to provide neighbors with a list of other neighbors who require additional counseling, HOA leadership, and extra duty.. R OUTINE USES: For neighborly development IAW FM 22-102. Neighbors & whiners should use this form as necessary. DISCLOSURE: Disclosure is voluntary, but repeated disclosure may result in a W AH Form 779- 1A, Report of Wall To Wall C ounseling PART I – ADMINISTRATIVE DATA A. WHINER’S NAME (Last, First, MI) B. WHINER’S PEE-MAIL E. MOORINGS ADDRESS C. WHINER’S MOMMY’S NAME (Last, First, MI) D. DATE OF REPORT F. NAME & TITLE OF THE PERSON FILLING OUT THIS FORM PART II – INCIDENT REPORT A. DATE FEELINGS WERE HURT B. TIME OF HURTFULNESS C. LOCATION OF HURTFUL INCIDENT F. WAS YOUR DOG/PETS(S)FEELINGS HURT? E. NAME OF REAL MAN/WOMAN WHO HURT YOUR SENSITIVE FEELINGS D. NEIGHBOR SYMPATHETIC TO WHINER G. HAVE YOU HAD YOUR PET RETALIATE YET?  YES NO  YES NO E. INJURY (Mark all that apply) 1. WHICH EAR WERE THE WORDS OF HURTFULNESS SPOKEN INTO? 2. IS THERE PERMANENT FEELING DAMAGE? LEFT RIGHT BOTH YES NO MAYBE 3. DID YOU REQUIRE A “TISSUE” FOR TEARS? 4. HAS THIS RESULTED IN A TRAUMATIC BRAIN INJURY? YES NO MULTIPLE ________ F. REASON FOR FILING THIS REPORT (Mark all that apply) YES NO MAYBE I am thin skinned The HOA needs to fix my problems Two beers is not enough I am a wimp My feelings are on my shoulders My diapers full and no one will change it I have hormonal issues I didn't sign up for this I was not offered

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