# Attachment 1 **– Survey Instrument**  Fast Response Survey System (FRSS) 106: School Safety and Discipline: 2013– 14 OMB# 1850 - 0733 v. 29

November 2 7 , 2013 National Center for Education Statistics U.S. Department of EducationU.S. DEPARTMENT OF EDUCATION NATIONAL CENTER FOR EDUCATION STATISTICS

WASHINGTON, D.C. 20006–5651 **SCHOOL SA** **FETY A ND**  **DISCIPLINE : 2013** **– 14**  FAST RESPONSE SURVEY SYSTEM FORM APPROVED O.M.B. No.: 1850–0733 EXPIRATION DATE: 05/2015 **Draft 1 1**  **- 25**  **- 13**  This survey is authorized b y law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9543). Wh ile participation in this survey is voluntary, your cooperation is critical to make the results of this survey comprehensive, accurate, and timely. Your answers may

be used only for stati stical purposes and may not be disclosed, or used, in identifiable form for any other purpose unless otherwise compelled by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9573).



###  **This survey**  **is designed**  **to be**  **completed by**  **the person(s)**  **most k**  **nowledgeable about**  **safety and**  **discipline at your school.**  **Please respond for the current**  **2013 –**  **14 school year to date**  **.**  **Please use**  **the definitions**  **on the**  **Instructions and**  **Definitions Page**  **for words**  **that appear**  **in the**  **questionnaire bolded and marked by an ast** **erisk .**  

### NA**ME AND**  **ADDRESS OF**  **SA MPLED**  **SCHOOL HERE** 

IF ABOVE **SCHOOL** INFORMATION IS INCORRECT, PLEASE UPDATE DIRECTLY ON LABEL. 

### Grades taught at this school: Low grade taught ________ High grade taught ________ Name of person completing this form:

________________________________ ________________________________ ___ Title/position:

________________________________ ________________________________ ______________________ Telephone number:

________________________________ ___ E - ma il:

________________________________ ______ Best days and times to reach you (in case of questions):

________________________________ ___________________ **THA NK YOU. PLEA** **SE KEEP A COPY OF THIS SURVEY FOR YOUR RECORDS.**  **PLEASE RETURN COMPLETED FORM TO: IF YOU HAVE ANY QUESTIONS OR COMMENTS, CONT** **ACT: Ma**  **il:** Cind y Gra y (6197.01.02.02) Cind y Gra y at W estat Westat 80 0 - 937 - 8281, Ext. 4336 or 301 -251 -4336 1600 Research Boulevard E - ma il: SafetyS urvey@westat.com Rockville, Maryland 20850 - 3195 **Fax:** 800 -254 - 0984 According to the Paperwork Re duction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850–0733. The time required to complete this information collection is estimated to average 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for im proving this form, please write to: U.S. Department of Education, Washington, DC 20202–4537. If you have any comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Education Statistics, 1990 K Street, NW, Washington, DC 20006. FRSS Form No. 106, 02/2014

## I **nstructions and D**  **efinitions Page** 

 Please respond for the current 2013– 14 school year to date .  The following words are bolded and marked by a n asterisk (*) wherever they appear in the questionnaire. Please use these definitions as you respond. **At school/a** **t your school** – activities happening in school buildings, on school grounds, on school buses, and at places that hold school -sponsored events or activities. Unless otherwise specified, this refers to normal school hours or to times when school activities/events were in session. **Physical attack or fight** – an actual and intentional touching or striking of another person against his or her will, o r the intentional causing of bodily harm to an individual. **Rape** – forced sexual intercourse (vaginal, anal, or oral penetration). This includes penetration from a foreign object. Both male and female students can be victims of rape. **Robbery** (taking things by force) – the taking or attempting to take anything of value that is owned by another person or organization, under confrontational circumstances by force or threat of force or violence and/or by putting the victim in fear. A key difference between robb ery and theft/larceny is that robbery involves a threat or battery. **For this survey, you will be asked to report incidents of robbery, but not**  **theft/larceny). Sexual battery**  – an incident that includes threatened rape, fondling, indecent liberties, child m olestation, or sodom y. Both male and female students can be victims of sexual battery. Classification of these incidents should take into consideration the age and developmentally appropriate behavior of the offender(s). **Sexual harassment** – conduct that i s unwelcome, sexual in nature, and denies or limits a student’s ability to participate in or benefit from a school’s education program. The conduct can be carried out by school employees, other students, and non - employee third parties. Both male and female students can be victims of sexual harassment, and the harasser and the victim can be of the same sex. The conduct can be verbal, nonverbal, or physical. **Theft/larceny** (taking things worth over $10 without personal confrontation) – the unlawful taking of another person’s property without personal confrontation, threat, violence, or bodily harm. **(For this survey, you will be asked to report incidents of robbery, but not**  **theft/larceny). Violence**  – actual, attempted, or threatened fight or assault. **Weapon** – a ny

instrument or object used with the intent to threaten, injure, or kill. This includes look- alikes if they are used to threaten others.1 . During the 2013– 14 school year, was it a practice of your school to do the following? ( If your school changed its

practices during the school year, please answer regarding your most recent practice. Indicate yes or no for each item.) **Yes No**  a. Require visitors to sign or check in ................................ ................................ ................................ .... b. Control access to school buildings during school hours (e.g., locked or monitored doors) ............... c. Control access to school grounds during school hours (e.g., locked or monitored gates) ................ d. Require students to pass through metal detectors each day ................................ ............................. e. Perform one or more random metal detector checks on students ................................ ..................... f. Require that all or most students stay on campus during lunch ................................ ........................ g. Use one or more random dog sniffs to check for drugs ................................ ................................ ..... h. Perform one or mo re random sweeps for contraband (e.g., drugs or **weapons*** ), but not including dog sniffs ................................ ................................ ................................ ............................. i. Require drug te sting for athletes ................................ ................................ ................................ ........ j. Require drug testing for students in extra - curricular activities other than athletics ........................... k. Require drug testing for any other students ................................ ................................ ....................... l. Require students to wear uniforms ................................ ................................ ................................ .... m. Enforce a strict dress code ................................ ................................ ................................ ................. n. Provide school lockers to students ................................ ................................ ................................ .... o. Require clear book bags or ban book bags on school grounds ................................ ......................... p. Provide an electronic notification system that automatically notifies parents in case of a school -wide emergency ................................ ................................ ................................ ..................... q. Provide a structured anonymo us threat reporting system (e.g., online submission, telephone hotline, or written submission via drop box) ................................ ................................ ...... r. Require students to wear badges or picture IDs ................................ ................................ ................ s. Require faculty and staff to wear badges or picture IDs ................................ ................................ .... t. Use one or more security cameras to monitor the school ................................ ................................ . u. Provide telephones in most classrooms ................................ ................................ ............................ v. Provide two-way radios to any staff ................................ ................................ ................................ ... w. Lim it access to social networking websites (e.g. , Facebook, Twitter) from school com puters ................................ ................................ ................................ ................................ .......... x. Prohibit use of cell phones and text messaging devices during school hours ................................ ... 2 . During the 2013– 14 school year, did your school or school district provide any of the following for classroom teachers or aides? (

Indicate yes or no for each item.) **Yes No**  a. Training in classroom ma nagem ent for teachers ................................ ................................ ............... b. Training in school -wide discipline policies and practices related to **violence*** ................................ .. c. Training in school -wide discipline policies and practices related to bul lying ................................ ..... d. Training in school -wide discipline policies and practices related to alcohol and/or drug use ............ e. Training in safety procedures (e.g., how to handle emergencies) ................................ .................... f. Training in recognizing early warning signs of students likely to exhibit violent behavior ................. g. Training in recognizing physical, social, and verbal bullying behaviors ................................ ............. h. Training in recognizing signs of students using/abusing alcohol and/or drugs ................................ .. i. Training in positive behavioral intervention strategies ................................ ................................ ....... j. Training in crisis preventio n and intervention ................................ ................................ .....................3. Please indicate in **part 1** whether yo ur school has a written plan that describes procedures to be pe rformed in the

following crises. For items a–e, if your school has a written plan, please indicate in **part 2** whether yo ur school drilled students on the use of this plan during the 2013– 14 school year. **Crisis Part 1.**  **Have a wr** **itten plan? Part 2**  **. If “** **Yes ,”**  **have yo**  **u drilled students**  **o n the plan**  **this school y** 

**ear?** a. Shootings/Active shooters Yes No Ye s No b. Natural disasters (e.g. , earthquakes or tornadoes) Yes No Yes No c. Hostages Yes No Yes No d. Bom b threats or incidents Yes No Yes No e. Chemical, biological, or radiological threats or incidents (e.g., release of mustard gas, anthrax, smallpox , or radioactive materials) Yes No Yes No f. Suicide threat or incident Yes No g. An “imminent threat a lert” is issued by the Department of Homeland Security’s National Terrorism Advisory System Yes No h. Pandemic flu Yes No 4 . During the 2013– 14 school year, did you have any security guards, se curity personnel, or sworn law enforcement officers present **at your school*** at least once a week? Yes (Continue with question 5.) No ( Skip to question 7.) 5. How ma ny

of the following were present in your school at least once a week? ( If an officer works full time across various schools in the district, count this officer as “ part time **at your school**  **.** *****” Please answer all items. If none, check the “None” box.)

**Ty pe of**  **personnel** (A nswer all items. If none, check the “None” box) **Number at**  **yo ur**  **school*** a . Security guards or security personnel (not law enforcement) i. Full tim e **at your school*** ................................ ................................ ................................ ______ or None ii. Part time **at your school*** ................................ ................................ ................................ ______ or None b . School Resource Officers ( Include all career law enforcement officers with arrest authority, specialized training , and are assigned to work with school organizations . ) i. Full tim e **at your school*** ................................ ................................ ................................ ______ or None ii. Part time **at your school*** ................................ ................................ ................................ ______ or None c . Sworn law enforcement officers who are not School Resource Officers i. Full tim e **at your school*** ................................ ................................ ................................ ______ or None ii. Part time **at your school*** ................................ ................................ ................................ ______ or None 6 . Did these security guards, security personnel, or sworn law enforcement officers participate in the following activities **at your school*?** (

Indicate yes or no for each item.) **Yes No**  a. Security enforcement and patrol ................................ ................................ ................................ ....... b. Mainta ining school discipline ................................ ................................ ................................ ............ c. Coordinating with local police and emergency team(s) ................................ ................................ .... d. Identifying problems in the school and proactively seeking solutions to those problems .................. e. Training teachers and staff in school safety or crime prevention ................................ ....................... f. Mentoring students ................................ ................................ ................................ ............................. g. Teaching a law- related education course or training students ( e.g., drug - related education, crim inal law, or crime prevention courses) ................................ ................................ .........................

### Please refer to the **Instructions and Definitions Page for words in bold and marked by an asterisk.** 7. To the best of your knowledge, how often do the following types of problems occur **at your school*** ? (Check one box on each line.)

**Problem Happens**  **daily Happens** 

**at least once a**  **week Happens** 

**at least once a**  **month Happens** 

**on occasion**  **Never**

**happens** a. Student racial/ethnic tensions ................................ ... b. Student bullying ................................ ........................ c. Student **sexual harassment*** of other students ....... d. Student harassment of other students based on sexual orientation or gender identity (i.e., lesbian, gay, bisexual, transgender, questioning) .................. e. Wi despread disorder in classrooms .......................... f. Student verbal abuse of teachers ............................. g. Student acts of disrespect for teachers other than verbal abuse ................................ ............................ 8. During the 2013– 14 school year, have any of yo ur school’s students, faculty, or staff died as a result of a homicide committed **at your school** ***** ? Yes No 9. Record the number of incidents that occurred **at school** ***** during the 2013– 14 school year for the offenses l isted below. Please provide information on:  T he number of incidents, not the number of victims or offenders.  Recorded incidents, regardless of whether any disciplinary action was taken.  Recorded incidents, regardless of whether student s or non -students were involved.  Incidents occurring before, during, or after normal school hours. Please answer all items. If none, check the “None” box. **Ty pe of incident**  **Total number of recorded incidents**  a. **Rape*** or attempted **rape*** ................................ ................................ ................................ ______ or None b. **Sexual battery** * other than **rape*** (include threatened **rape*)** ................................ ______ or None c. **Robbery*** (

Report **r obbery**  **,** ***** which is taking things by force or threat. Do not report **theft**

**,** ***** which is taking things without personal confrontation .) i. With a **weapon*** ................................ ................................ ................................ ______ or None ii. Without a **weapon*** ................................ ................................ ................................ ______ or None d. **Physical attack or fight*** i. With a **weapon*** ................................ ................................ ................................ ______ or None ii. Without a **weapon*** ................................ ................................ ................................ ______ or None e. Threats of **physical attack*** i. With a **weapon*** ................................ ................................ ................................ ______ or None ii. Without a **weapon*** ................................ ................................ ................................ ______ or None