1. Does he/she check up on you and want to know where you are at all times? Calling, texting; you, your friends or family?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


2. Is he/she jealous, and does he/she accuse you of having affairs with other men or women?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


3. Does he/she tell you that you are stupid, lazy, ugly, a rotten cook, a failure as a mother, wife or no good in bed, etc.?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


4. Does he/she call you obscene names?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


5. Does he/she tell you that no one else could ever love you?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


6. Does he/she try to keep you from seeing your family or friends?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


7. Do they control the family money so that you have to account for every penny or beg or do favors for money?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


8. Do they forbid or demand that you work or if you want to work, do they make it difficult for you?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


9. Do they tell you that no one would ever hire you?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


10 Do they keep you from driving the car (hiding car keys, etc.?)
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


11. Do they have dramatic mood swings?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


12. Do they become angrier when they drink?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


13. Do they try to make you have sex when you don’t want to?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


14. Do they force you to pressure you to commit sexual acts that are unholy, immoral or illegal (homosexual or otherwise)
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


15. Have they ever broken or damaged your home, possessions, or property?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


16. Have they ever threatened to harm a pet?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


17. Have they ever killed a pet?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


18. Have they ever intentionally harmed a pet?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


19. Have they ever locked you out of the house?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


20. Do they force you to stay awake?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


21. Do they slap, punch, kick, bite, choke, pull your hair or burn you?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


22. Have they ever hurt you with an object or weapon?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


23. Have they threatened you with an object or a weapon?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


24. Do they endanger you or your children with reckless driving?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


25. Do they neglect you or the children when you need medical attention?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4

26. Have they ever threatened to kill themselves, you, the children or other family members or friends?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


27. Have they ever been violent toward your children?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


28. Have they ever molested your children sexually?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


29. Are they violent towards anyone else in the family?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


30. Have you ever had to call the police or wanted to because you feared them?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


31. Have they ever been arrested for violence?
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4


32. When you tell them you are leaving – do they try to stop you? Either by force or intimidation or even coercion (crying, saying they will change or that they are sorry?)
Never – 0 Once or twice  - 2 Frequently – 3 All the time – 4
   
To learn how serious your abuse is/has been, please total your points.

(0 – Healthy Relationship)    (1-14 – Unhealthy)    (15-36 – Abusive)   (37-93 – Seriously Abusive)  

(94+ - Dangerously Abusive - Make a Safety Plan and get help now).

Call or Text us at: (480) 442-4816

DANGER ASSESSMENT
How serious is/was your abuse?
Circle the response that best describes your current or past relationship:

Domestic Violence Hotline: 1-800-799-SAFE (7233) You can also visit: http://www.thehotline.org where help is one click away.