Coping Mechanism Survey
Coping Mechanism Survey
Demographic Information:
1. Age: _________
2. Gender: ☐ Male ☐ Female
3. Grade Section: _________
Section 1: Experiences of Physical and Mental Violence
4. Have you ever experienced any form of physical or mental violence at school?
☐ Yes ☐ No
5. If yes, can you describe the types of physical or mental violence you have experienced?
_________________________________________________________________
_________________________________________________________________
6. How frequently have you experienced these forms of violence? ☐ Occasionally (once in a
while)
☐ Regularly (a few times a month)
☐ Often (almost every week)
☐ Rarely (once or twice) ☐ Never
7. Who do you usually experience this violence from?
☐ Classmates
☐ Teachers
☐ Other students (e.g., upperclassmen)
☐ Other (please specify) _________