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Self Assessment

Domestic Violence Risk Assessment

Please select how often your partner did each of these things in the past 12 months?
(Number of assessment: 41)

Has your partner ever physically hurt you in the past 12 months? *
Has your partner ever insulted you in the past 12 months? *
Has your partner ever threatened to harm you in the past 12 months? *
Has your partner ever screamed or cursed at you in the past 12 months? *
Has your partner ever forced you to have sexual activities in the past 12 months? *

Basic Information

Who is the perpetrator *
Your age *
Sex *
Family Monthly Income *
No. of Children *
Verify

Source:
Chan C.C., Chan Y. C., Au A., Cheung G.O.C. (2010). Reliability and validity of the "extended - hurt, insult, threaten, scream" (e-hits) screening tool in detecting intimate partner violence in hospital emergency departments in Hong Kong. Hong Kong Journal of Emergency Medicine, 17(2), 109-117

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