Southern Luzon State University

College of Allied Medicine

Lucban, Quezon

Questionnaire

Dear Respondents,

The information provided will assist the University in assessing the prevalence of
bullying among their student and their level of knowledge regarding the Anti-Bullying Law.
Results of the study will only be presented in summary form and individual responses will be
kept strictly confidential. We would like encourage you to answer it honestly and with full
disclosure as we want to provide assistance to those needing help and support.

Thank you and God bless.

A. Personal Information

Name :_______________________________________(Optional)
Age:____
Sex: _____Male _____Female

B. Please check your corresponding answer on the box provided.

QUESTIONS I YES NO
Have you ever been bullied at school?
Have you ever been bullied someone at school?
Have you ever saw someone being bullied at school?
4 3 2 1
Often Sometimes Seldom Never
 Types of Bullying
 Physical Bullying - using one’s body and physical bodily acts to exert power over peers. Punching, kicking and other physical
attacks are all types of physical bullying.
a) Punching
b) Pushing
c) Slapping
d) Shoving
e) Kicking
f) Fighting
g) Other (Please Specify)
 Verbal Bullying - is when an individual uses verbal language (e.g., insults, teasing, etc) to gain power over his or her peers.
a) Foul Language or Profanity (mura)
b) Name-calling
c) Tormenting
d) Teasing
e) Criticizing
f) Threatening
g) Spreading Rumors
h) Put-down or Insult
i) Other (Please Specify)
 Cyber bullying - takes place over digital devices like cell phones, computers, and tablets; can occur through SMS, Text, and
apps, or online in social media, forums, or gaming where people can view, participate in, or share content.
a) Flaming: Online fights using electronic messages with angry `
and vulgar language

b) Harrassment and Stalking: Repeatedly sending cruel,

vicious and/or thretening messages

c) Denigration: Sending or posting Gossip or rumors.

d) Impersonation: Breaking into someone’s account and

using it to send vicious or embarassing material to others.

e) Outing and Trickery: Engaging someone in instant

messaging, tricking him or her into revealing sensitive
information, and forwarding that information to others

f) Exclusion: Intentionally excluding someone from an online

group

g) Cyberstalking: Repeated, intense harassment and

denigration that includes threats or creates significant fear.

 Social Bullying - sometimes referred to as relational bullying, involves hurting someone’s reputation or relationships.
a) Leaving someone out on purpose – telling others that
they are not included or to exclude someone from a group.
b) Telling other students not to be friends with someone
– telling others that you or others do not want to be friends
with them.
c) Spreading rumors about someone - Telling others
negative things about a particular person in order to damage
or sabotage that person’s close relationships or social
reputation
d) Embarrassing someone in public - Embarrassing or
insulting other students or making embarrassing comments
about others when they attempt to approach the group
 Reasons for Bullying
a) Stress and Trauma (Coping Mechanism) - The
research shows that some people simply do not know how to
positively respond to stress and so default to bullying others
as a coping mechanism.
b) Aggressive behaviors - learned behavior that is actively
taught by society using dysfunctional gender norms and roles.
c) Low Self-esteem - In order to mask how they actually feel
about themselves, some people who bully focus attention on
someone else.
d) Bullied in the past - research shows that those who have
experienced bullying are twice as likely to go on and bully
others. Maybe they were bullied as kids in the past, or maybe
they are being bullied now. Often it’s used as a defense
mechanism and people tend to believe that by bullying
others, they will become immune to being bullied themselves.
e) Difficult Home life/situation at home - 1 in 3 of those
who bully people daily told that they feel like their
parents/guardians don’t have enough time to spend with
them. Often feelings of rejection from the very people who
should love them unconditionally. They are also much more
likely to come from violent households with lots of arguments
 and hostility.
f) Peer Pressure - pressure from others to conform to the
behaviors, attitudes and personal habits of a group or clique.
Sometimes kids within a clique will pressure other kids to
participate in bullying.
RA. 10627 (Anti-Bullying Law) YES NO
The Respondent:
1. know about the Anti-Bullying Law of 2013, its policies,
regulation, and etc.
2. Know that the Anti-Bullying Law can help anyone that is
involved in a Bullying incidence. Such as support to the
victim and disciplinary action toward the bully.
3. think the school has a appropriate and effective policies
related to Bullying.
4. Think there is a decrease of bullying incidence because
of the Anti-Bullying policies of the school and the Anti-
Bullying Law.

Thank you for answering the question.

May God bless you always.