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1. Do you think that some people ask to be harassed or deserve to be harassed, for example because of their attitudes or how they dress?
No, no one deserves to be sexually harassed or brings it upon themselves.
Yes, some people bring harassment upon themselves
2. Do you think that most charges of sexual harassment are true, false, or exaggerated?
Most complaints are false.
Most complaints are true, but exaggerated.
Most complaints are true.
3. Do you think men experience sexual harassment, or do they enjoy this kind of attention?
Men enjoy this kind of attention, so it is not harassment.
Yes, men experience sexual harassment, they do not enjoy this type of attention.
4. Do you believe that someone can be harassed by a person of the same gender?
No, you can only be sexually harassed by a person of the opposite gender.
Yes, a woman can harass a woman, and a man can harass a man.
5. Do you believe you have been sexually harassed or stalked at some point in your life?
No, I have never been sexually harassed or stalked. Please go to question 22
Yes, I have been sexually harassed or stalked.
6. When did the harassment occur? Check any that apply.
I am currently being harassed. Two years ago
More than two years ago.
Within the last year.
7. Where were you harassed? Check all that apply.
At work or while doing your job (such as while traveling for your job)
At school
At a doctor's office, a hospital, or a clinic.
At a public assistance office or human services office.
Somewhere else:
8. Who harassed you? Check any that apply.
A stranger or group of
A teacher or professor (or several)
A friend or group of friends
A coworker or group of
A doctor or other health care
My supervisor or employer.
Someone else:
A client
9. Was your harasser/s male or female? (If you have been harassed by both, check both selections.)
Male Female
10. What kind of sexually harassing behavior was involved? Check any that apply.
Unwelcome sexual relations or demands for sexual relations
Unwelcome physical contact (e.g. touching, pinching)
Graphic commentary on your body
Harassing mail or emails
Propositions of a sexual nature
Sexually suggestive objects, posters, or graffiti displayed
Harassing phone calls or text messages
Stalking or cyberstalking
Sexual comments
Other behaviors:
11. How did the sexual harassment make you feel? Check any that apply.
It did not affect me at all I took it as a joke
I was flattered I was mildly embarrassed
I felt very embarrassed I felt apprehensive
I felt confused I felt humiliated
I felt powerless I felt angry
I felt violated I felt ashamed
I felt guilty I felt scared/frightened
I felt degraded I felt devalued
I blamed myself Other feelings/
12. Were you threatened that your failure to submit to the harassment would adversely affect you? (e.g. were you told you would be fired from your job, be denied a promotion, be given a poor grade, etc.)
No
Yes => if Yes, then what was the threat?
13. Was there any retaliation--adverse actions--against you because you rejected the harasser/s attention or because did not submit to the harassment? (e.g. were you fired from your job, denied training or a promotion, given a poor evaluation, a poor grade, etc.) Note: This does NOT include retaliation for your reporting the behavior.
No
Yes => if Yes, then what happened?
14. Did you talk to anyone about the harassment? (i.e. supervisor, coworkers, human resources, school counselor, family members, friends, etc.)
No => If no, then why not? Please share below:
Yes => If yes, who did you talk to?
If you did NOT talk to anyone about the harassment, skip down to question 19 .
14a. What was the overall response when you talked about the harassment? (e.g. were people supportive overall? Were they disbelieving, or did they blame you?) Please explain below:
15. Did you make a formal report or file a grievance, say to human resources or the school administration?
No => If no, why not? Please share below:
Yes, I made a formal report.
=> If yes, were you satisfied with the outcome?
No, I was not satisfied
I have mixed feelings
Yes, I was satisfied
Please share your opinion about the outcome after you made the
If the harassment was at your job, was your supervisor supportive
No => What was her/his reaction?:
Yes, my supervisor was supportive.
16. Did you experience any retaliation--adverse actions--from the harasser or others in the harassment environment after you talked about or reported the harassment?
No, there was no retaliation
Yes, there was retaliation after I talked about or reported the harassment.
=> If yes, what happened? Please share below:
17. Did people change towards you after they learned of the harassment, or that you had reported it? (For example, did co-workers or fellow students shun you, or become hostile?)
No, no one changed towards me.
Yes, people changed towards me
=> Who changed and how?
18. Were your family and friends supportive of you?
My family was supportive My friends were supportive
Some of my family members were Some of my friends were supportive
None of my friends were supportive
None of my family was supportive
Comments about the support you received (or lack of support.):
19. Were there any psychological or physiological effects because of the situation?
No
Yes => If yes, then what? Check all that apply.
Depression Anxiety and/or panic attacks
Traumatic stress; Sleeplessness and/or
Difficulty concentrating Headaches
Fatigue Stomach problems (e.g.
Eating problems (weight loss
Loss of motivation
Decreased work or school Feeling powerless, helpless,
Feeling violent Increased blood pressure
Withdrawal or isolation
Loss of confidence or self-esteem
Loss of trust in other people Dizziness
Difficulties with time (e.g.
Suicidal thoughts or attempts
Other symptoms/changes:
20. Have there been any long term consequences to your being harassed?
It's too soon to tell
No
Yes
=> If yes, then what?
Professional consequences , such as job loss, having to change jobs or careers.
Economic consequences , such as loss of income or benefits. Please explain
Academic consequences , such as a weakened transcript, having to drop course,
Personal consequences , such as divorce, losing friends, or having to move to
Long term health consequences , such as chronic anxiety, PTSD, or depression.
21. Regarding the harassment and the surrounding events, what has had the greatest negative impact on your environment and life, overall? PLEASE CHECK ONLY ONE
The harassment itself
The response of my friends
The response of my family
The reactions of others in the
Please tell us why?
22. Do you think sexual harassment is a real problem, or is it blown out of proportion?
Sexual harassment is not a real problem.
Sexual harassment is somewhat of a problem.
Sexual harassment is a serious problem.
23. Do you think people should confront sexual harassment, or report if they are being harassed? Or should they keep quiet about it?
They should just ignore it and not say anything to anyone, not even the harasser.
They should confront it on their own, but not say anything to about it to anyone but the
It depends on the situation. (e.g. depends on who is doing it, or how "extreme" it is.)
Sexual harassment should always be confronted or reported.
24. What do you think are the causes of sexual harassment?
25. Do you have any suggestions on ways we can improve how we deal with sexual harassment as a society?
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