Teasing Inventory

 

During the past week I have been teased (make a mark to show how much)…

 

 

 

 

 

 

 

 

 

 

 

Terribly                                                                                                                                              not at all

 

Who did the teasing?

Describe the teasing.

 

How did you feel?  (for example angry, sad, scared, frustrated…)

What did you do?

 

How did you feel then?

Did you need adult help? No Yes   Did you receive help from an adult? No Yes  

 

During the past week I have witnessed someone else being teased…

 

 

 

 

 

 

 

 

 

 

 

Terribly                                                                                                                                              not at all

 

Who was being teased?

Who did the teasing?

Describe the teasing.

 

How did you feel? 

What did you do?

 

How did you feel then?

Was adult help needed?  No   Yes   Was help from an adult received?  No Yes   

 

During the past week I have teased someone else.

 

 

 

 

 

 

 

 

 

 

 

Terribly                                                                                                                                              not at all

 

Who did you tease?

Describe the teasing.

 

Why do you think you teased the other person?

 

How did you feel? 

 

Did you need adult help? No Yes   Did you receive help from an adult?  No Yes  

Is there any problem with the person you were teasing now?   No Yes  

Is there anything you need to do to improve things?

 

Name_________________________________________  Date_____________________

 

©2004 Constance Dugan