Classroom Behavior Survey Survey is for research purposes only and any personal information will not be shared unless explicit permission is granted. What is your role?-Classroom teacherSpecial education teacherSpecialistOtherSpecify RoleHow many years have you been teaching?-0–34–78–1515+School type-PublicCharterPrivateVirtual/HybridGrade level(s) taught during the incident(s) Pre-K Elementary Middle High School District and school name (optional)You may note that this will not be shared publicly without consent.Please describe the specific student behavior(s) you observed.Have you observed any of the following student behavior? (Check all that apply.) Physical aggression toward teacher Physical aggression toward other students Threats of violence Throwing objects Property damage Repeated classroom disruption Sexual misconduct Weapon or object used as a weapon Other Other behaviorHow frequently did this behavior occur?-One-time incidentRepeated over daysRepeated over weeks or monthsWere other students present during these incidents? Yes No How did you report the behavior? (check all that apply) Verbal report to administrator Written referral Incident report Email Other OtherBriefly describe what happened and include whether anyone was physically injured as a result.In your view, was the response adequate to protect safety? Yes No If not adequate, why? Student returned to class without consequences Behavior continued No follow-up communication Discipline inconsistent with district policy Other OtherWere you ever instructed not to document or escalate the behavior? Yes No If yes, please explain.Was anyone physically injured as a result of the behavior? Teacher Student(s) Both No What actions, if any, did the administration take in response?Were incident reports or worker’s comp forms completed? Yes No Unsure Did other students’ learning suffer due to the disruption? Yes No Did any students express fear, anxiety, or reluctance to attend class? Yes No If yes, please explain.Were parents informed about the nature or severity of the student behavior? Yes No Unsure In your view, was parent communication accurate and complete? Yes No Were parents ever misled, kept in the dark, or given vague explanations? Yes No Please explainDid lack of communication contribute to continued safety issues? Yes No After raising concerns, did you experience: Retaliation Being ignored or sidelined Pressure to remain silent None of the above Did this experience affect your decision to stay in the profession? Yes No If yes, how?May your story be used for Legal advocacy Legislative testimony Public reports or media Internal research only May we contact you for follow-up questions? Yes No Preferred contact info (optional)
