Danger Assessment
(480) 442-4816
DANGER ASSESSMENT
How serious is/was your abuse?
Circle the response that best describes your current or past relationship:
| 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).
Domestic Violence Hotline: 1-800-799-SAFE (7233) You can also visit: http://www.thehotline.org where help is one click away.
If you are NOT in imminent Danger and would like more information on resources, referrals or counseling – you can contact R3 Christian Domestic Violence Services by filling out the form below. None of information will not be shared with anyone.
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Holly T. Ashley 