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Form Name:   Hurt Feelings Report
Tags:   Hurt Feelings Report, HURTFEELINGSREPORTF
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Date:   5/6/2010
Size:   88KB
Type:   .PDF
     
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HURTFEELINGSREPORTFor use of this form, see FM 22-102; the proponent agency is TRADOCDATA 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 CounselingPARTI–ADMINISTRATIVEDATAA.WHINER’SNAME(Last,First,MI)B.RANK/GRADEC.SOCIALSECURITYNUMBERD.DATEOFREPORTE.ORGANIZATIONF.NAME&TITLEOFTHEPERSONFILLINGOUTTHISFORMPARTII–INCIDENTREPORTA.DATEFEELINGSWEREHURTB.TIMEOFHURTFULNESSC.LOCATIONOFHURTFULINCIDENTD.NCOOROFFICERSYMPATHETICTOWHINERE.NAMEOFREALMAN/WOMANWHOHURTYOURSENSITIVEFEELINGSF.RANK/GRADEG.ORGANIZATION(ifdifferentfrom1eabove)E.INJURY(Markallthatapply)1.WHICHEARWERETHEWORDSOFHURTFULNESSSPOKENINTO?‰LEFT‰RIGHT‰BOTH2.ISTHEREPERMANENTFEELINGDAMAGE?‰YES‰NO‰MAYBE3.DIDYOUREQUIREA“TISSUE”FORTEARS?‰YES‰NO‰MULTIPLE________4.HASTHISRESULTEDINATRAUMATICBRAININJURY?‰YES‰NO‰MAYBEF.REASONFORFILINGTHISREPORT(Markallthatapply)IamthinskinnedTheArmyneedstofixmyproblemsTwobeersisnotenoughIamawimpMyfeelingsareeasilyhurtMyhandsshouldbeinmypocketsIhavewoman/manrlikehormonesIdidn'tsignupforthisIwasnotofferedapostbriefIamacrybabyIwastoldthatIamnotaheroSomeonerequestedapostbriefIwantmymommyTheweatheristocoldAlloftheaboveandmoreG.NARRATIVE(Tellusinyourownsissywordshowyourfeelingswerehurt.)PARTIIIrAUTHENTICATIONa.PRINTEDNAMEOFREALMAN/WOMANb.SIGNATUREc.PRINTEDNAMEOFWHINERd.SIGNATUREWe,astheArmy,takehurtfeelingsseriously.Ifyoudon'thavesomeonewhocangiveyouahugandmakethingsallbetter,pleaseletusknowandwewillpromptlydispatcha"hugger"toyouASAP.Intheeventweareunabletofinda"hugger"wewillnotifythefiredepartmentandrequestthattheysendfirepersonneltoyourlocation.Ifyouareinneedofsupplementalsupport,uponwrittenrequest,wewillmakeeveryreasonableefforttoprovideyouwitha"blankey",a"binky"and/orabottleifyousodesire.DAFORMIMTWF1,APRIL2009EDITIONOFAPRIL1989ISOBSELETE