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Fill Out a Valid Hurt Feelings Report Template

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Content Overview

Guide to Writing Hurt Feelings Report

After completing the Hurt Feelings Report form, it should be submitted directly to a Law Enforcement Officer. This ensures that your concerns are officially documented and addressed. Follow the steps below carefully to fill out the form accurately.

  1. Begin with Part I - Administrative Data. Fill in your name in the format of Last, First, Middle Initial.
  2. Provide your age in the designated space.
  3. Indicate your sex by selecting the appropriate option.
  4. Write the date when you are filling out the report.
  5. Specify the type of whine you are using.
  6. Include the name of the person filling out the form, if different from you.
  1. Move to Part II - Incident Report. Record the date when your feelings were hurt.
  2. Document the time when the hurtful comments were made.
  3. Describe the location where the comments occurred.
  4. Note if anyone was sympathetic to you, including any paid witnesses.
  5. Provide the name of the person who hurt your feelings.
  6. Indicate how long you felt the need to whine.
  7. Specify which feelings were hurt.
  1. Proceed to Part III - Injury. Circle the ear into which the hurtful words were spoken.
  2. Indicate if there is any permanent feeling damage by selecting Yes, No, or Maybe.
  3. State whether you required a tissue for tears.
  4. Answer if this incident has resulted in a traumatic brain injury by selecting Yes, No, Multiple, or Maybe.
  1. In Part IV - Reason for Filing This Report, mark all reasons that apply to your situation.
  2. Provide a narrative in your own words explaining how your feelings were hurt.
  1. Finally, complete Part V - Authentication. Print your name if you wish to be identified.
  2. Sign the form to confirm your submission.
  3. Print your name again if you are the whiner.
  4. Sign again as the whiner to finalize the report.

Once the form is completed, ensure it is handed directly to a Law Enforcement Officer. Your concerns will be taken seriously, and support will be provided as needed.

Document Breakdown

Fact Name Description
Purpose of the Form This form is designed to help individuals document their hurt feelings and seek sympathy from others.
Submission Requirements The form must be physically handed to any Law Enforcement Officer to be considered valid.
Governing Laws It is governed by the Privacy Act of 1974, along with various Departmental Regulations and Title 10 of the U.S. Code.
Voluntary Disclosure While disclosure of information is voluntary, repeated submissions may result in a humorous label on the file.
Incident Reporting The form includes sections to detail the incident, such as the date, time, location, and any witnesses present.
Support Services If needed, the department offers supplemental support, including a "hugger" or other comfort items like a "blankie" or "binky."

FAQ

What is the purpose of the Hurt Feelings Report form?

The Hurt Feelings Report form is designed to assist individuals in documenting instances where they feel their feelings have been hurt. The form allows individuals, referred to as "whiners," to seek sympathy and support from others. While the completion of the form is voluntary, it serves as a means to express grievances related to emotional distress.

Who should fill out the Hurt Feelings Report form?

Any individual who believes their feelings have been hurt can fill out this form. The form requires personal information such as the whiner's name, age, and the details of the incident that caused emotional distress. It is important to note that the form must be physically presented to a law enforcement officer to be considered valid.

What information is required on the form?

The form consists of several parts that gather information about the incident. Key sections include:

  1. Administrative Data: This includes the whiner's name, age, sex, and date of the report.
  2. Incident Report: Details about the date, time, and location of the hurtful comments, as well as information about any sympathetic responses received.
  3. Injury: Questions about the nature of the hurtful words and any emotional or physical impact.
  4. Reason for Filing: A checklist of reasons why the individual is submitting the report.
  5. Authentication: A section for the reporter and whiner to provide their printed names and signatures.

Is there any confidentiality regarding the information provided?

The disclosure of information on the Hurt Feelings Report form is voluntary. However, it is important to understand that repeated submissions may lead to informal labels being assigned to the individual. While the form is intended for humor, the information provided is treated with a degree of seriousness by the department.

What happens after the form is submitted?

Once the form is submitted to a law enforcement officer, the department acknowledges the hurt feelings expressed. If necessary, the department may dispatch a "hugger" to provide emotional support. In the absence of a "hugger," an EMS team may be sent to assist further. Additionally, supplemental support items, such as a "blankie" or "binky," can be requested to help soothe the individual.

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Hurt Feelings Report Example

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.