Free Hurt Feelings Report PDF Form

The Hurt Feelings Report form is designed to help individuals document instances where they feel their emotions have been hurt. This form must be physically handed to a law enforcement officer to be processed. While the intent is to provide a means for expressing feelings, the language used in the form may raise eyebrows and provoke discussion about the seriousness of emotional well-being.

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The Hurt Feelings Report form is an unconventional tool designed for individuals who feel emotionally wounded and seek validation for their experiences. This form serves a specific purpose: to assist those who may be struggling with their feelings by providing a structured way to document their grievances. It requires the individual, referred to humorously as a "whiner," to fill out various sections that capture personal information, details about the incident, and the perceived emotional injury. The form includes sections for administrative data, incident reports, and even a narrative space for individuals to express how their feelings were hurt. While the tone of the form is light-hearted, it addresses the serious nature of emotional well-being. Individuals are encouraged to share their experiences, and the report is treated with a degree of levity, acknowledging the sometimes trivial nature of the complaints while still validating the feelings of those involved. Importantly, the form emphasizes that the disclosure of information is voluntary, though it humorously warns that repeated submissions may lead to certain labels. Ultimately, the Hurt Feelings Report form aims to offer a unique outlet for emotional expression, providing a pathway for individuals to seek support in a manner that is both engaging and somewhat tongue-in-cheek.

Hurt Feelings Report Sample

HURT FEELINGS REPORT

To use this form, it must be physically placed in the hands of any Law Enforcement Officer

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

S USC 301, Departmental Regulation, 10 USC 3013 and a log of other regulations too To assist whiners in documenting hurt feelings

Whiners should use this form to seek sympathy from someone who cares

Disclosure is voluntary, however, repeated whining may lead to your file being stamped "candy ass" or some other appropriate term

PART I - ADMINISTRATIVE DATA

A. WHINER'S NAME (Last, First, MI)

B. WHINER'S AGE

C. WHINER'S SEX

D. DATE OF REPORT

E. TYPE OF WHINE USED

F. NAME OF THE PERSON FILLING OUT THIS FORM

PART II - INCIDENT REPORT

A. DATE FEELINGS WERE HURT

B. TIME OF HURTFULNESS

C. LOCATION OF HURTFUL COMMENTS

D. WAS ANYONE SYMPATHETIC TO WHINER (Please include paid witnesses)

E. NAME OF PERSON WHO HURT YOUR PANSY ASS FEELINGS

F. HOW LONG DID YOU WHINE

G. WHICH FEELINGS WERE HURT

PART III - INJURY

(Circle all that apply)


1. WHICH EAR WERE THE HURTFULL WORDS 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
		PART IV - REASON FOR			FILING THIS REPORT
				(Mark all that apply)
	I am thin skinned			The Dept needs to fix my problems		Two beers is not enough
	I am a wimp			My feelings are easily hurt		My hands should be in my pockets
	I have woman / man-like hormones			I didn't sign up for this		I was not offered a tissue
	I am a crybaby			I was told that I am not a hero		Someone requested a tissue
	I want my mommy			The weather is too cold		All of the above and more

NARRATIVE (Tell us in your own sissy words how your feelings were hurt, as if anyone cared)

PART V - AUTHENTICATION

A. PRINTED REPORTER NAME (if you wish to be labeled too)

B. SIGNATURE (are you sure about this?)

C. PRINTED WHINER NAME (you really are going out on a limb here) D. SIGNATURE OF WHINER (you have got to be shitting me!)

We, as the Dept, 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 a "hugger cannot be found, an EMS Team will be dispatched to soak your socks in coal oil to prevent ants from crawling up your leg and eating their way up your candy ass. If you are in need of supplemental support, upon written request, we will make every reasonable effort to prvide you with a "blankie", a "binky" and/or a bottle if you so desire.

Documents used along the form

The Hurt Feelings Report form is often accompanied by several other documents that help to provide context or additional information regarding the incident. Here are some commonly used forms that might be relevant:

Incident Report Form: This document captures detailed accounts of the event that led to the hurt feelings. It includes specifics such as the date, time, and location of the incident, as well as the names of those involved. This form helps to create a clear narrative of the situation.
Witness Statement Form: If there were any witnesses to the incident, this form allows them to provide their perspective. Witness statements can offer valuable insights and corroborate the details presented in the Hurt Feelings Report.
Emotional Impact Assessment: This form is designed to evaluate the emotional effects of the incident on the individual. It may include questions about feelings of distress, anxiety, or other emotional responses, helping to gauge the overall impact on the person's well-being.
Notice to Quit Form: Understanding the legal implications of eviction is critical. Landlords can access the Illinois Templates PDF to obtain the necessary documentation for notifying tenants to vacate a rental property.
Support Request Form: If the individual feels they need additional support, this form can be used to request resources such as counseling or peer support. It ensures that the person receives the help they need to process their feelings and recover from the incident.

These documents work together to create a comprehensive understanding of the situation and provide the necessary support for individuals who may be struggling with their emotions. Each form plays a unique role in addressing the concerns raised in the Hurt Feelings Report, ensuring that no one feels alone in their experience.

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Key takeaways

Filling out the Hurt Feelings Report form requires attention to detail and an understanding of its purpose. Here are some key takeaways to consider:

Physical Submission: The form must be physically handed to a Law Enforcement Officer to be processed.
Privacy Act Compliance: The form collects data in accordance with the Privacy Act of 1974, ensuring that personal information is handled appropriately.
Documentation of Feelings: This form serves to help individuals document their feelings of hurt and seek sympathy from others.
Voluntary Disclosure: While filling out the form is voluntary, repeated submissions may result in informal labels being assigned to the individual.
Incident Reporting: Detailed information about the incident that caused hurt feelings is required, including dates, times, and locations.
Emotional Impact Assessment: The form includes sections to assess the emotional and physical impact of the hurtful comments.
Support Options: The department offers support for individuals who may need additional comfort, including the potential dispatch of a "hugger" or other resources.

Form Overview

Fact Name	Description
Purpose	This form assists individuals in documenting feelings of hurt and seeking sympathy.
Authority	The form is governed by the Privacy Act of 1974 and related regulations, including 5 USC 301 and 10 USC 3013.
Submission Process	The form must be physically handed to a Law Enforcement Officer to be considered valid.
Voluntary Disclosure	While disclosure of information is voluntary, repeated use may result in a derogatory label.
Incident Reporting	Section II requires details about the incident, including date, time, and location of hurtful comments.
Types of Injury	Part III allows the whiner to indicate the nature of the emotional injury, including permanent damage.
Reason for Filing	Part IV lists various reasons for filing the report, reflecting personal sensitivities and grievances.
Authentication	Part V requires signatures from both the whiner and the reporter, confirming the authenticity of the report.

Frequently Asked Questions

What is the purpose of the Hurt Feelings Report form?

The Hurt Feelings Report form is designed to help individuals document their emotional distress in a structured way. It serves as a tool for those who feel their feelings have been hurt, allowing them to seek sympathy and support from others. While the disclosure of information is voluntary, it is important to note that repeated submissions may lead to humorous labels being applied to the report.

How do I properly fill out the Hurt Feelings Report form?

To fill out the form, follow these steps:

Provide your name, age, and sex in the administrative data section.
Detail the incident by including the date, time, and location where your feelings were hurt.
Specify the person responsible for hurting your feelings and any witnesses who may have sympathized with you.
Indicate the type of injury, if applicable, and provide a narrative explaining how your feelings were affected.

Make sure to sign the report to authenticate it, as this adds a personal touch to your submission.

Who can submit a Hurt Feelings Report?

Anyone who feels their feelings have been hurt can submit this report. It is designed for individuals who wish to express their emotional distress and seek sympathy. However, it must be physically handed to a law enforcement officer to be considered valid.

What happens after I submit the form?

Once you submit the form to a law enforcement officer, it will be reviewed. The department takes hurt feelings seriously and will make every effort to provide support. If needed, a "hugger" may be dispatched to comfort you. In case a hugger is unavailable, an EMS team may be sent to assist you further. Additionally, supplemental support items like a "blankie" or "binky" can be requested.

Is there any follow-up after filing the report?

Yes, there may be follow-up actions depending on the nature of your report. The department aims to address the concerns raised in the report and provide appropriate support. If you require additional assistance or have further questions, do not hesitate to reach out for help.

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Misconceptions

Misconceptions about the Hurt Feelings Report form can lead to confusion and misunderstanding. Here are ten common misconceptions, clarified for better understanding:

The form is a serious legal document. Many believe this form holds legal weight, but it is intended more for humor and light-heartedness rather than as a formal complaint mechanism.
Submitting the form will lead to legal action. Some think that filling out the form will initiate legal proceedings. In reality, it’s more about expressing feelings than pursuing legal recourse.
Only certain people can fill it out. There’s a misconception that only specific individuals, like victims of harassment, can use the form. In truth, anyone feeling hurt can submit it.
It must be filled out in a specific way. Many feel pressured to fill out the form perfectly. However, it’s meant to be a casual way to express emotions, so there’s flexibility in how it’s completed.
Law enforcement takes it very seriously. While law enforcement acknowledges the form, it’s primarily seen as a humorous tool rather than a serious complaint to be investigated.
It’s only for children. Some believe the form is only suitable for kids. However, adults can also express their feelings through it, regardless of age.
Using the form is mandatory. There’s a myth that everyone must use the form if they feel hurt. In reality, it’s entirely voluntary and meant for those who choose to use it.
It guarantees sympathy. Many think submitting the form will ensure they receive sympathy. While it’s intended for that purpose, there’s no guarantee of a sympathetic response.
The form is confidential. Some assume that the details shared on the form are kept private. However, it’s important to remember that it may be shared with others in a light-hearted manner.
It’s a sign of weakness to use it. Many feel that filling out the form shows they are weak. In truth, expressing feelings is a healthy way to cope with hurt emotions.

Understanding these misconceptions can help individuals navigate their feelings and the use of the Hurt Feelings Report form with greater clarity and confidence.