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Hurt Feelings Report

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  • October 2010
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For use of this form, see FM 22-102; the proponent agency is TRADOC  AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES: DISCLOSURE: DATA REQUIRED BY THE PRIVACY ACT OF 1974 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN) 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.. For subordinate leader development IAW FM 22-102. Leaders & whiners should use this form as necessary. Disclosure is voluntary, but repeated disclosure may result in a DA Form 779-1A, Report of Wall To Wall Counseling

HURT FEELINGS REPORT 

PART I – ADMINISTRATIVE DATA 
A. WHINER’S NAME (Last, First, MI)  B. RANK/GRADE C. SOCIAL SECURITY NUMBER D. DATE OF REPORT

E. ORGANIZATION 

F. NAME & TITLE OF THE PERSON FILLING OUT THIS FORM

PART II – INCIDENT REPORT 
A. DATE FEELINGS WERE HURT  B. TIME OF HURTFULNESS  C. LOCATION OF HURTFUL INCIDENT D. NCO OR OFFICER SYMPATHETIC TO WHINER

E. NAME OF REAL MAN/WOMAN WHO HURT YOUR SENSITIVE  FEELINGS 

F.  RANK/GRADE

G. ORGANIZATION (if different from 1e above)

E. INJURY (Mark all that apply) 
1. WHICH EAR WERE THE WORDS OF HURTFULNESS SPOKEN INTO?  2. IS THERE PERMANENT FEELING DAMAGE? 

 LEFT     RIGHT      BOTH 
3. DID YOU REQUIRE A “TISSUE” FOR TEARS? 

 YES     NO      MAYBE 
4. HAS THIS RESULTED IN A TRAUMATIC BRAIN INJURY? 

 YES     NO      MULTIPLE ________               

 YES     NO      MAYBE 

F. REASON FOR FILING THIS REPORT (Mark all that apply)    I am thin skinned  The Army 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 post brief      I am a crybaby  I was told that I am not a hero  Someone requested a post brief      I want my mommy  The weather is to cold ...

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