Results Are In: Hurt Feeling Report

Hurt Feelings Report

For use of this form, see FM 22– 102; the proponent agency is TRADOC
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DATA REQUIRED BY THE PRIVACY ACT OF 1974
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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 and 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 Counseling

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PART ONE — ADMINISTRATIVE DATA
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Whiner’s Name: (Last, First, MI)

Rank/Grade:

Social Security Number:

Date of Report:

Organization:

Name and Title of the Person Filling Out This Form:

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PART TWO — INCIDENT REPORT
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Date Feelings Were Hurt:

Time of Hurtfulness:

Location of Hurtful Incident:

NCO or Officer Sympathetic to Whiner:

Name of Real Man/Woman Who Hurt Your Sensitive Feelings:

Rank/Grade:

Organization (If different from above) :

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INJURY (Mark All That Apply)
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Which Ear Were the Words of Hurtfulness Spoken Into?

Left
Right
Both

Is There Permanent Feeling Damage?

Yes
No
Maybe

Did You Require A “Tissue” For Tears?

Yes
No
Multiple

Has This Resulted In a Traumatic Brain Injury?

Yes
No
Maybe

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I am thin-skinned
I am a wimp
I have woman/man-like hormones
I am a crybaby
I want my mommy
The Army need to fix my problems
My feelings are easily hurt
I didn’t sign up for this
I was told that I am not a hero
The weather is too cold
Two beers are not enough
My hands should be in my pockets
I was not offered a post brief
Someone requested a post brief
All of the Above and More

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NARRATIVE (Tell us in your own sissy words how your feelings were hurt.)
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PART THREE — AUTHENICATION
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Printed Name of Real Man/Woman:

Signature:

Printed Name of Whiner:

Signature:

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We, as the Army, take hurt feelings very 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 we are unable to find a “hugger” we will notify the fire department and request that they send fire personnel to your location. If you are in need of supplemental support, upon written request, we will make every reasonable effort to provide you with a “blankey”, a “binky”, and/or a bottle if you so desire.

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DA FORM IMT WF1, MAY 2009

EDITION OF APRIL 1989 IS OBSELETE

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