Teasing Inventory
During the past week I have been teased (make a mark to show how much)…
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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…
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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.
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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 For AG