Hurt Feelings Report
Date:
Time of Hurtfulness:
1) In which ear were the words of hurtfulness spoken into:
Left
Right
Both
2) Is there any permanent feelings damage?
Yes
No
3) Do you need a tissue for the tears?
Yes
No
4) Reason for filing this report: (check correct responses)
I am thin skinned
I am a pussy
I have a woman with hormones
I am a fag
I am a little bitch
I am a cry baby
I need a sex change
All of the above
5) Girly man who filed this report:
6) Name of real man that hurt your feelings:
Supervisor receiving report:
Submit Report