Free Hurt Feelings Report Form in PDF

Free Hurt Feelings Report Form in PDF

The Hurt Feelings Report form, devised as a tongue-in-cheek approach to addressing complaints and grievances within certain organizational environments, such as the military, serves a dual purpose. Initially, it seeks to document instances where individuals feel their emotions have been negatively impacted, guiding those in leadership to address and possibly remedy the situation. To ensure those feelings are acknowledged and managed appropriately, consider filling out the form by clicking the button below.

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In today's fast-paced and often high-pressure environments, the concept of addressing emotional distress with sensitivity and understanding is more important than ever. This is evident in the unique approach taken by the military through the creation of the "Hurt Feelings Report" form. This document, humorously designed, purports to offer a structured way for individuals, humorously referred to as "whiners," to report instances where their feelings were hurt. As stated within the form, it aims to assist these individuals in documenting such instances while also providing leaders with information on who might need further counseling or leadership guidance. The form requires personal data, details of the incident causing hurt feelings, and even asks whether the emotional damage is permanent, amongst other seemingly facetious questions. Interestingly, it also suggests providing "huggers," "blankies," and other forms of comfort to those in distress if required, wading into the territory of emotional support with a blend of satire. This document straddles the complex line between addressing genuine concerns around emotional well-being and mocking the perceived over-sensitivity in professional settings, suggesting a need for a careful balance between humor and the seriousness of emotional distress in the workplace.

Preview - Hurt Feelings Report Form

HURT FEELINGS REPORT

For use of this form, see FM 22-102; the proponent agency is TRADOC

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)

PRINCIPAL PURPOSE: To assist whiners in documenting hurt feelings, and to provide leaders with a list of soldiers who require additional counseling, NCO leadership, and extra duty..

ROUTINE USES: For subordinate leader development IAW FM 22-102. Leaders & whiners should use this form as necessary.

DISCLOSURE: Disclosure is voluntary, but repeated disclosure may result in a DA Form 779-1A, Report of Wall To Wall Counseling

PART I – ADMINISTRATIVE DATA

A. WHINER’S NAME (Last, First, MI)

B. RANK/GRADE

C. SOCIAL SECURITY NUMBER

D. DATE OF REPORT

E. ORGANIZATION

F. NAME & TITLE OF THE PERSON FILLING OUT THIS FORM

PART II – INCIDENT REPORT

A. DATE FEELINGS WERE HURT

 

B. TIME OF HURTFULNESS

C. LOCATION OF HURTFUL INCIDENT

 

D. NCO OR OFFICER SYMPATHETIC TO WHINER

 

 

 

 

 

 

E. NAME OF REAL MAN/WOMAN WHO HURT YOUR SENSITIVE

F. RANK/GRADE

 

G. ORGANIZATION (if different from 1e above)

FEELINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. INJURY (Mark all that apply)

 

 

 

 

1. WHICH EAR WERE THE WORDS OF HURTFULNESS SPOKEN INTO?

 

2. IS THERE PERMANENT FEELING DAMAGE?

 

LEFT

RIGHT BOTH

 

 

YES

NO

MAYBE

 

 

 

3. DID YOU REQUIRE A “TISSUE” FOR TEARS?

 

4. HAS THIS RESULTED IN A TRAUMATIC BRAIN INJURY?

YES NO MULTIPLE ________

 

 

YES

NO

MAYBE

 

 

 

 

 

 

 

 

 

F. REASON FOR FILING THIS REPORT (Mark all that apply)

I am thin skinned

I am a wimp

Ihave woman/manlike hormones

Iam a crybaby

Iwant my mommy

The Army needs to fix my problems

My feelings are easily hurt

I didn't sign up for this

I was told that I am not a hero

The weather is to cold

Two beers is not enough

My hands should be in my pockets

I was not offered a post brief

Someone requested a post brief

All of the above and more

G. NARRATIVE (Tell us in your own sissy words how your feelings were hurt.)

PART III ‐ AUTHENTICATION

a. PRINTED NAME OF REAL MAN/WOMAN

b. SIGNATURE

c. PRINTED NAME OF WHINER

d. SIGNATURE

We, as the Army, take hurt feelings seriously. If you don't have someone who can give you a hug and make things all better, please let us know and we will promptly dispatch a "hugger" to you ASAP. In the event we are unable to find a "hugger" we will notify the fire department and request that they send fire personnel to your location. If you are in need of supplemental support, upon written request, we will make every reasonable effort to provide you with a "blankey", a "binky" and/or a bottle if you so desire.

DA FORM IMT WF1, APRIL 2009

EDITION OF APRIL 1989 IS OBSELETE

Document Specs

Fact Name Description
Form Title Hurt Feelings Report
Referenced Manual For use of this form, see FM 22-102
Proponent Agency TRADOC
Authority 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)
Principal Purpose To assist whiners in documenting hurt feelings and to provide leaders with a list of soldiers who require additional counseling, NCO leadership, and extra duty.
Routine Uses For subordinate leader development IAW FM 22-102. Leaders & whiners should use this form as necessary.
Disclosure Disclosure is voluntary, but repeated disclosure may result in a DA Form 779-1A, Report of Wall To Wall Counseling
Content Humor The form contains humorously stated options to report hurt feelings, promoting a light-hearted approach to the impracticality of formally documenting such complaints.

Instructions on Writing Hurt Feelings Report

Filling out the Hurt Feelings Report form is a straightforward process designed to document instances of hurt feelings in a structured manner. The purpose of this form is to identify those in need of additional support or counseling. Whether the feelings have been hurt due to exchanges with colleagues or as part of a team dynamic, this form serves as a foundation for addressing and resolving such issues. Below are the necessary steps to accurately complete the Hurt Feelings Report form.

  1. Part I – Administrative Data:
    • Enter the whiner's full name including last, first, and middle initial in the designated space.
    • Indicate the whiner's rank/grade.
    • Provide the whiner's social security number as required.
    • Fill out the date on which the report is being made.
    • Specify the organization to which the whiner belongs.
    • Record the name and title of the person completing the form.
  2. Part II – Incident Report:
    • Document the date when the feelings were hurt.
    • Indicate the exact time of the hurtful incident.
    • Specify the location where the incident occurred.
    • Name any NCO or officer sympathetic to the whiner, if applicable.
    • Enter the full name and rank/grade of the individual who caused the hurt feelings.
    • If different, mention the organization of the person who hurt the whiner's feelings.
    • Mark applicable boxes to indicate which ear heard the hurtful words, if there is permanent feeling damage, the requirement of a "tissue" for tears, and if the incident resulted in a traumatic brain injury.
    • Check all reasons that apply for filing the report, such as being thin-skinned, a crybaby, or feeling unprepared for Army challenges.
    • In the narrative section, describe in detail how the incident occurred and how it made the whiner feel, using their own words.
  3. Part III – Authentication:
    • Print the name of the person considered a "real man/woman" involved in the incident.
    • Secure the signature of the above-mentioned individual.
    • Lastly, the whiner must print their name and sign the form to authenticate the report.

Once the form is completed, it serves as a record of the incident and initiates a pathway to address and resolve the emotional distress encountered. It is a tool to foster understanding and support within the organization, ensuring that everyone feels valued and heard.

Understanding Hurt Feelings Report

What is the "Hurt Feelings Report" form?

The "Hurt Feelings Report" form appears to be a satirical document that pretends to offer a formal process for reporting instances where an individual's feelings were hurt. Despite its official-looking nature, complete with references to U.S. military and Department of the Army regulations, it is not a genuine or officially endorsed document. The form includes humorous sections where one can report on the nature of their emotional injury, who caused it, and even suggests remedies such as dispatching a "hugger" or providing a "blankey" to the offended party. It is designed to mock or downplay complaints about emotional distress, likely targeting individuals in a military context where toughness is often valued.

Is the "Hurt Feelings Report" legally binding?

No, the "Hurt Feelings Report" is not legally binding. It is a mock form meant for humorous or satirical purposes and has no legal standing in any jurisdiction. It references real laws and military regulations in jest, but it does not function under any legal authority or framework. Individuals should not consider it an appropriate or effective way to address genuine concerns about harassment, bullying, or emotional distress.

Can someone get in trouble for using the "Hurt Feelings Report" in a workplace?

Using the "Hurt Feelings Report" in a workplace, especially in a professional or military setting, can potentially lead to disciplinary action or be considered harassment. If the form is used to mock or belittle someone's genuine grievances, it could be viewed as creating a hostile work environment. In today's workplace culture, which increasingly recognizes the importance of mental health and emotional well-being, such actions are taken seriously. Employers and military leaders often have strict policies against harassment and bullying, designed to protect individuals from demeaning and hurtful behavior.

What should you do if you receive or find a "Hurt Feelings Report" at your place of work or within a military unit?

If you encounter the "Hurt Feelings Report" in a professional or military setting, it is important to approach the situation with sensitivity. Recognize that it was likely shared as a joke, but be mindful of how it could affect others or reflect the workplace culture. If you feel comfortable, you may choose to discuss with those involved about why the document is inappropriate and could be hurtful. If the situation does not improve, or you believe the document is part of a larger issue of harassment or bullying, it would be prudent to bring this to the attention of a supervisor, human resources representative, or another appropriate authority. They can provide guidance and take action if necessary to address the issue in line with organizational policies and regulations.

Common mistakes

One common mistake made when filling out the Hurt Feelings Report form is not providing detailed administrative data. The section labeled "Administrative Data" is crucial for accurately documenting the incident and for further reference. However, individuals often overlook the importance of filling in fields such as the "Whiner's Name," "Rank/Grade," and "Social Security Number" with accurate information. This detail is essential for maintaining a record of the incident and ensuring that the report can be appropriately addressed. Without this information, the effectiveness of the Hurt Feelings Report as a tool for addressing grievances may be significantly diminished.

Another frequent error is the incomplete reporting of the incident itself. Part II of the form, "Incident Report," demands specifics about when and where the hurtful incident occurred, alongside the identity of the person causing the discomfort. Many people submit vague accounts, neglecting details like the "Time of Hurtfulness" or the exact "Location of Hurtful Incident." This omission of critical information can hinder the understanding of the context and severity of the incident, making it challenging for leaders or counselors to provide the necessary support or intervention.

Additionally, individuals often fail to accurately mark the injury section, thus not clearly communicating the nature of their distress. The options provided, such as "Which ear were the words of hurtfulness spoken into?" and whether there is "Permanent feeling damage," are designed to gauge the impact of the incident. However, responses are frequently marked in jest or left blank. This oversight can minimize the perceived validity of the claim, potentially leading to the undervaluing of genuine emotional distress.

Lastly, an error frequently seen is in the narrative section, where individuals must describe in their own words how their feelings were hurt. Many reports contain narratives that are either overly succinct or overly dramatic, failing to accurately convey the gravity of the situation. This crucial part of the form is an opportunity to provide context and elaborate on the emotional damage incurred. When not utilized effectively, it diminishes the ability of the reviewing personnel to fully understand and appropriately address the complaint.

Documents used along the form

When handling sensitive situations that may involve emotions or grievances within a workplace or organization, several forms and documents, in addition to the Hurt Feelings Report, can be useful. These documents are designed to ensure all issues are addressed properly, providing a structured manner for communication, documentation, and resolution of various personal and professional concerns. Below is a list of other forms and documents often used to manage and address personal grievances, workplace conflicts, or emotional distress.

  • Incident Report Form: Used to document any event that may have led to injuries or emotional distress, detailing what happened, when, and where, along with any witnesses.
  • Employee Complaint Form: Allows employees to formally lodge a complaint about workplace issues, including harassment, discrimination, or conflicts with co-workers or management.
  • Conflict Resolution Form: Provides a structured approach for two parties to outline their perspectives on a conflict and suggests possible resolutions.
  • Mediation Request Form: Used when parties involved in a conflict seek the assistance of a neutral third party to help mediate their dispute.
  • Counseling Referral Form: For recommending professional counseling for individuals experiencing emotional distress, this form may be filled out by supervisors, HR, or the individual themselves.
  • Performance Improvement Plan (PIP): Utilized for employees whose performance may be affected by personal issues or conflicts, outlining specific goals and actions required to improve their performance.
  • Compliment or Feedback Form: Allows individuals to provide positive feedback or compliments about colleagues, helping to boost morale and recognize good work.
  • Exit Interview Questionnaire: Used for gathering feedback from employees who are leaving the organization, which can include questions about workplace environment, culture, and personal experiences.
  • Wellness Program Signup Form: Offers employees the opportunity to participate in wellness programs aimed at improving their physical, mental, and emotional health.
  • Employee Assistance Program (EAP) Access Form: For employees seeking confidential services provided by EAPs, such as counseling, work-life balance resources, and legal assistance.

Each document plays a crucial role in the framework for addressing and managing issues within any organization or workplace. They help to ensure that every individual's concerns and needs are taken into consideration, promoting a healthy and supportive environment for all. It's important for organizations to make these documents easily accessible and ensure that their use is understood by all members, enhancing the overall well-being and productivity of the team.

Similar forms

The "Hurt Feelings Report" bears a resemblance to the official "Incident Report Form" that is commonly used across various organizations to document any incidents or events that deviate from standard operating procedures or expectations. Both documents serve the purpose of officially recording specific details about an event, including who was involved, the date and time it occurred, and a narrative description of the incident. While the "Hurt Feelings Report" approaches the matter with a satirical tone, focusing on emotional distress, the "Incident Report Form" treats all incidents with a serious and formal approach, regardless if they are related to safety violations, procedural non-compliance, or interpersonal conflicts.

Similarly, "Employee Feedback Forms" are designed to capture feedback, concerns, or suggestions from employees within an organization, akin to how the "Hurt Feelings Report" aims to document emotional grievances. Both types of forms provide a structured means for individuals to express their viewpoints or experiences, albeit the latter does so mockingly. "Employee Feedback Forms" typically encourage constructive feedback aimed at improving the workplace, highlighting a stark contrast in intent and application despite the superficial similarity in gathering individual sentiments.

The "Hurt Feelings Report" also parallels "Customer Complaint Forms" used by businesses to address and resolve issues faced by customers. These forms are integral to customer service departments, facilitating the documentation and follow-up of customer dissatisfaction or problems with products or services. Just as the "Hurt Feelings Report" collects data on individuals who feel wronged, albeit facetiously, "Customer Complaint Forms" perform a crucial function in capturing legitimate grievances for the purpose of improving business operations and customer satisfaction.

Lastly, the "Medical Screening Questionnaires" used in healthcare settings share a superficial procedural similarity with the "Hurt Feelings Report." These questionnaires are vital for capturing patient health information, symptoms, and concerns before consultations, paralleling the way the satirical form seeks to document 'emotional injuries.' However, "Medical Screening Questionnaires" are employed with the utmost seriousness and confidentiality under healthcare laws and practices to ensure patient care and safety, emphasizing the vast difference in the purpose and dignity of the process compared to the mock form designed for humor.

Dos and Don'ts

Completing any form related to personal feelings and grievances, particularly in professional or organizational environments, mandates a thoughtful approach. Regardless of the form’s intent, here are several recommendations to ensure the process is handled with care and respect.

Do:

  • Read the form completely before filling it out, to understand its purpose and the kind of information it seeks.
  • Provide honest and factual information. Even if the form seems informal or nontraditional, maintaining integrity in your responses is crucial.
  • Consider the implications of submitting the form. Think about what you hope to achieve and whether this is the best way to address your concerns.
  • Seek advice if you’re unsure about completing the form. Talking to a trusted colleague, friend, or counselor can provide perspective.
  • Review your completed form before submission. Check for any errors or miscommunications that might obscure your message.

Don't:

  • Use the form to target or malign others unnecessarily. Focus on the facts of the incident and your feelings without resorting to personal attacks.
  • Dismiss your emotions. If you are choosing to complete a form about hurt feelings, it’s valid to seek resolution or acknowledgment of your feelings.
  • Forget to consider other avenues for resolution. Sometimes, direct communication or mediation can be more effective in resolving interpersonal issues.
  • Ignore the potential for humor or satire in the form. Understanding the tone and context of the form is essential in determining how seriously it will be taken by others.

Each individual’s experience and feelings are valid and warrant appropriate attention and respect. When documentation is deemed necessary, employing a thorough and considerate approach ensures the integrity of the process and fosters a productive pathway towards resolution.

Misconceptions

Understanding the Hurt Feelings Report form requires unpacking several misconceptions that have arisen around its use. This form, often misunderstood, serves a specific purpose within structured environments like the military. Let’s address some common misconceptions:

  • It’s an official military document: The Hurt Feelings Report is not a genuine military form. It's a spoof that aims to mock overly sensitive complaints, suggesting that the military environment should be tough.

  • It’s meant to be taken seriously: This form is satirical. Its purpose is to evoke laughter through exaggerated phrases and options, not to formally report incidents of hurt feelings.

  • It encourages reporting of genuine emotional distress: The form, in fact, does the opposite. It discourages sharing genuine emotional concerns by framing them as trivial, which can be harmful in environments where emotional well-being should be taken seriously.

  • It’s a helpful tool for leaders: Contrary to supporting leadership, the form may undermine trust within a team. It implies that leaders should not be bothered with their team members' emotional well-being, potentially eroding morale.

  • It complies with privacy regulations: Despite its misleading header that references the Privacy Act of 1974, this form is not compliant with official practices for handling personal information, especially sensitive data like social security numbers.

  • It’s widely accepted and used: While some might find humor in the form, its use is generally considered inappropriate and unprofessional in official settings. Humor that belittles genuine feelings or concerns can create a hostile environment.

Understanding the Hurt Feelings Report within its intended context of satire is crucial. It serves as a reminder that humor about emotional distress can undermine the importance of addressing genuine issues of well-being and morale in any environment.

Key takeaways

The "Hurt Feelings Report" form is designed with a satirical tone, aiming to address complaints in a humorous manner rather than as an official or formal process for grievance resolution.

Key points to be aware of when considering this form include:

  • The form leverages humor to highlight the perception of over-sensitivity or minor complaints within a group, notably in a military context.
  • Disclosure of information is voluntary, as stated in the form, but it humorously notes that repeated disclosure may lead to further humorous or satirical actions.
  • It collects information on the incident that led to hurt feelings, including the location, the parties involved, and the nature of the injury to feelings, albeit in a jocular manner.
  • The form mockingly offers additional "support" options, such as dispatching a "hugger" or providing a "blankey", "binky", or bottle for comfort, further emphasizing its satirical nature.

This document should not be used as a serious tool for addressing legitimate grievances or concerns within any professional setting. Its purpose is primarily comedic, aiming to poke fun at perceived minor or insignificant complaints.

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