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Domestic Violence
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Safety Assessment

Several risk factors have been associated with homicides (murders) of both batterers and battered women in research conducted after the murders have taken place. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide in situations of severe battering and for you to see how many of the risk factors apply to your situation.

Mark Yes or No for each of the following.

  1. Are you in immediate danger?
  2. Where is your partner now?
  3. How safe do you feel being at home or returning home today?
  4. Do you have a plan for when you don’t feel safe?
  5. Do you have somewhere safe to go?
  6. Has the violence gotten worse or is it getting scarier? Is it happening more often?
  7. Has your partner ever choked you, or injured you while you were pregnant?
  8. Have there been threats or direct abuse of the children (if s/he has children?)
  9. Has your partner ever injured someone outside the home?
  10. Has your partner ever injured a pet or destroyed items you cared about?
  11. Has your partner used weapons, alcohol or drugs?
  12. Has your partner ever held you or your children against your will?
  13. Does your partner ever watch you closely, follow you or stalk you?
  14. Has your partner ever threatened to kill you/him/herself or your children?

Please note your total "Yes" answers.

If your answers concern you, please consider making a SAFETY PLAN and/or go to GETTING HELP to get connected to helpful resources.

(Adapted from The National Consensus Guidelines for improving healthcare response to domestic violence and was produced by: The Family Violence Prevention Fund, 383 Rhode Island Street, Suite 304 San Francisco, CA 94103-5133. 415-252-8900. TTY 800-595-4889. First Printing: September, 2002. Updated 2004). Jacquelyn C. Campbell, Ph.D., R.N. Copyright 1985,1988)

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