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Blank Hurt Feelings Report Form

The Hurt Feelings Report form serves as a tongue-in-cheek tool designed for individuals to document their emotional distress. This lighthearted approach highlights the importance of addressing feelings, even if the circumstances seem trivial. If you find yourself needing to express your grievances, consider filling out the form by clicking the button below.

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Table of Contents

The Hurt Feelings Report form serves a unique purpose within the realm of emotional expression and documentation. Designed to assist individuals in articulating their feelings of distress, this form requires submission to a law enforcement officer. It encompasses various sections, including personal data about the individual filing the report, details of the incident that caused the hurt feelings, and a narrative section for elaborating on the emotional impact. The form also inquires about the nature of the incident and whether any witnesses were present to offer sympathy. Additionally, it prompts users to specify the type of emotional injury sustained, and even asks if any physical manifestations, such as tears, occurred. Importantly, the form includes a light-hearted acknowledgment of the sensitivity surrounding hurt feelings, aiming to create an atmosphere where individuals feel comfortable expressing their grievances. While the completion of this report is voluntary, it humorously notes that excessive complaints may lead to a less-than-flattering label. Ultimately, this document reflects a blend of seriousness and levity, encouraging individuals to seek support while navigating their emotional experiences.

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Dos and Don'ts

When filling out the Hurt Feelings Report form, there are several important guidelines to keep in mind. Here is a list of things you should and shouldn't do:

Do provide accurate personal information, including your name and age.
Do clearly describe the incident that hurt your feelings.
Do include any witnesses who may have seen or heard the incident.
Do be honest about your feelings and the impact of the incident on you.

Don't exaggerate your feelings or the incident; stick to the facts.
Don't use offensive language or insults in your report.
Don't forget to sign the report; your signature is important.
Don't take the process too lightly; it is intended to address genuine concerns.

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.

Listed Questions and Answers

What is the purpose of the Hurt Feelings Report form?
The Hurt Feelings Report form is designed to assist individuals in documenting their feelings of hurt. This form allows individuals, referred to as "whiners," to seek sympathy and support from law enforcement officers or others who may care about their emotional distress.
Who should fill out this form?
This form should be filled out by anyone who feels their feelings have been hurt. The person completing the form must provide their name, age, sex, and details about the incident that caused the hurt feelings. It is important that the form is physically handed to a law enforcement officer.
What information is required on the form?
The form requires several pieces of information:
- Name of the individual reporting the hurt feelings
- Age and sex of the individual
- Date and time of the incident
- Location where the hurtful comments were made
- Name of the person who caused the hurt feelings
- Details about the emotional injury
Is disclosure of information on the form mandatory?
Disclosure of information on the Hurt Feelings Report form is voluntary. However, individuals should be aware that repeated submissions may lead to a negative label, such as being referred to as a "candy ass." This serves as a reminder to be mindful of how often one chooses to report hurt feelings.
What support is available after submitting the form?
The department takes hurt feelings seriously. If an individual feels they need additional support, they can request a "hugger" to provide comfort. If a hugger is unavailable, an EMS team may be dispatched to assist. The department also offers supplemental support items, such as a "blankie," "binky," or a bottle, upon written request.

Form Overview

Fact Name	Description
Form Purpose	This form is designed to help individuals document their hurt feelings and seek sympathy from others.
Submission Requirement	The form must be physically handed to a Law Enforcement Officer to be considered valid.
Privacy Act Compliance	Data collected on this form is governed by the Privacy Act of 1974, ensuring personal information is handled appropriately.
Voluntary Disclosure	While providing information is voluntary, repeated use of the form may lead to humorous labeling by authorities.
Incident Reporting	The form includes sections for detailing the incident, including the date, time, and nature of the hurtful comments.
Support Options	If needed, the department offers supplemental support such as "huggers" and comfort items for those filing the report.