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Safe School Survey Forms
Safe Schools Parent/Community Survey
This survey asks about your views on safety and crime on your child's campus.
Do not put your name on this survey. The answers you give will be kept private.
Choose only one answer for each question, unless you are given other instructions.
1. Sex
Male
Female
2. Race or Ethnicity
White non-Hispanic
African-American non-Hispanic
Native American or Alaskan Native
Hispanic
Asian or Pacific Islander
Other
3. Number of your children who are enrolled on the campus.
(Select the total number of you children enrolled in this school)
1
2
3
4
5
6
7
8
9
10
11
12
4. Grade(s) of you child(ren) at this school.
(Select all that apply)
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
5. How safe does your child(ren) feel at school?
Very safe
Safe
Unsafe
6. Are there particular places at school where your child(ren) don't feel safe?
(Select all that apply)
Classrooms
Lunchroom
Playground
Parking lot
Restrooms
School bus
other
7. Are there certain times of day when these places are unsafe?
(Select all that apply)
Before school
During class
During lunch
After school
Entire school day
Other
8. This school year has your child had something stolen from his/her desk, locker, or other place at school?
Never
One or two times
Three to four times
More than four times
9. This school year has someone taken money or things directly from your child by using force, weapons, or threats?
Never
One or two times
Three to four times
More than four times
Gangs
Don't know
No problem
Small problem
Serious problem
21. In your opinion, what are the three major problems at this campus right now?
(Please type in your answer below)
10. This school year has someone physcially threatened, attacked, or hurt your child at school?
Never
One or two times
Three to four times
More than four times
11. If yes, please specify where this happened to your child.
At school
To and from school
On a school bus
At a school sponsored activity
Other
12. This school year has someone verbally threatened your child at school?
Never
One or two times
Three to four times
More than four times
13. This school year has someone made sexual advances or attempted to sexually assault your child at school?
Never
One or two times
Three to four times
More than four times
14. This year has has someone sexually assaulted your child at school?
Never
One or two times
Three to four times
More than four times
15. Is there a process in place for students to report alleged physical, psychological, or sexual abuse?
Yes
No
16. Does the campus follow up on reports of alleged abuse?
Yes
No
17. If yes, please specify what kind of weapon your child saw.
(Select all that apply)
Gun
Knife
Scissors
Other
18. During this school year has your child talked about seeing a student carrying a weapon at school?
Yes
No
19. During this school year, how many fights has your child witnessed at school?
None
One to two
Three to five
More than five
20. In your opinion, how serious are the following problems on this campus?
(Each area is listed below)
Vandalism
Don't know
No problem
Small problem
Serious problem
Alcohol Use
Don't know
No problem
Small problem
Serious problem
Tobacco Use
Don't know
No problem
Small problem
Serious problem
Drug Use
Don't know
No problem
Small problem
Serious problem
Drug Selling
Don't know
No problem
Small problem
Serious problem
Carrying Weapons
Don't know
No problem
Small problem
Serious problem
Racial Conflict
Don't know
No problem
Small problem
Serious problem
Other
(Please type in your answer below)
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