HURT FEELINGS REPORT
Date:________________ Time of hurtfulness:________________ am/pm
Which ear were the words of hurtfulness spoken into? (circle one)
Left Right Both
Is there permanent feeling damage? Yes No
Did you need a tissue for the tears? Yes No
Reason for filing this report (circle Yes or No)
a. I am thin-skinned Yes No
b. I am a pussy Yes No
c. I have woman-like hormones Yes No
d. I am a queer Yes No
e. I am a little bitch Yes No
f. I am a cry-baby Yes No
g. I want my Mommy Yes No
h. All the above Yes No
(just circle this one since all most likely apply)
If you feel that you need someone to hug, go home to Mommy and let her change your diaper.
If you feel as though you must speak to someone immediately to soothe you, please call: 1-800-CRY-BABY or 1-800-SIS-GIRL.
Girly-man who filed this report:_____________________________________________
Signature of girly-man:___________________________________________________
Name of “Real Man” who hurt your feelings:_________________________________
(person who is being brought up on charges):
Signature of real man:___________________________________________________
Supervisor’s signature:__________________________________________________
(person who is obligated by policy to listen to this drivel)
Use additional pages if whining & bitching requires more space
FORM PC-101
Date:________________ Time of hurtfulness:________________ am/pm
Which ear were the words of hurtfulness spoken into? (circle one)
Left Right Both
Is there permanent feeling damage? Yes No
Did you need a tissue for the tears? Yes No
Reason for filing this report (circle Yes or No)
a. I am thin-skinned Yes No
b. I am a pussy Yes No
c. I have woman-like hormones Yes No
d. I am a queer Yes No
e. I am a little bitch Yes No
f. I am a cry-baby Yes No
g. I want my Mommy Yes No
h. All the above Yes No
(just circle this one since all most likely apply)
If you feel that you need someone to hug, go home to Mommy and let her change your diaper.
If you feel as though you must speak to someone immediately to soothe you, please call: 1-800-CRY-BABY or 1-800-SIS-GIRL.
Girly-man who filed this report:_____________________________________________
Signature of girly-man:___________________________________________________
Name of “Real Man” who hurt your feelings:_________________________________
(person who is being brought up on charges):
Signature of real man:___________________________________________________
Supervisor’s signature:__________________________________________________
(person who is obligated by policy to listen to this drivel)
Use additional pages if whining & bitching requires more space
FORM PC-101