School Safety Survey Form

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Name___________________________________ Date_________________ Student Safety Survey At this school:|Always|Sometimes|Never|Don’t| ||||Know| ||||| They take good care of the school grounds.||||| ||||| They keep the building clean.||||| ||||| My classrooms look nice.||||| ||||| Students help make decisions.||||| ||||| Students can be in many different groups and activities.||||| ||||| Teachers here are nice people.||||| ||||| My teachers respect me.||||| ||||| At this school:|Always|Sometimes|Never|Don’t| ||||Know| ||||| Teachers let me know when I’m doing a good job.||||| ||||| I have good relationships with my teachers.||||| ||||| Students respect the teachers.||||| ||||| I’m comfortable talking to a teacher about my problems.||||| ||||| I feel very safe.||||| ||||| I feel safe on the way to school and on the way home.||||| ||||| When students have an emergency, they can get help.||||| ||||| You can trust most people.||||| ||||| Adults care about students.||||| ||||| Even people who are different are respected.||||| ||||| Have any of these things happened to you at your school? Yes No Have you been grabbed or shoved by someone being mean? Have you been punched or kicked? Have you been cut by another student with something sharp? Have you seen a student with a gun on campus? Have you been hit by a rock or something else thrown by a student? Have you seen a student with a knife on campus? Have you had your property stolen? Have you had your property damaged? Has someone threatened to hurt you? Has someone cursed at you? Has someone made fun of you? Have you been bullied? Has someone sexually harassed you? Has someone made unwanted sexual advances to you? Has someone been mean to you because of your color or race? Has someone been

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