12. Has ever threatened to hurt or kill the children/dependants? (…..) Hurt Kill Domestic Violence History Yes No 13. Is the abuse happening more often? 14. Is the abuse getting worse? 15. Does try to control everything you do and/or are they (…….) (In terms of relationships, who you see, being excessively jealous? at you what to wear for example. Consider ‘policed home’, telling honour based violence and stalking and specify the behaviour) 16. Has ever used weapons or objects to hurt you? (…..) Please give details Yes No 17. Has ever threatened to kill you or someone else and you (…..) believed them? Self Children Other (please specify) 18. Has ever attempted to: (…..) strangle? choke? suffocate? drown you? when was this? ……………… 19. Does do or say things of a sexual nature that makes you (….) feel bad or that physically hurt you or someone else? (Please specify who and what)
12. Has (…..) ever threatened to hurt or kill the children/dependants? Hurt Kill Domestic Violence History Yes No 13. Is the abuse happening more often? 14. Is the abuse getting worse? 15. Does (…….) try to control everything you do and/or are they excessively jealous? (In terms of relationships, who you see, being ‘policed at home’, telling you what to wear for example. Consider honour based violence and stalking and specify the behaviour) 16. Has (…..) ever used weapons or objects to hurt you? Please give details Yes No 17. Has (…..) ever threatened to kill you or someone else and you believed them? Self Children Other (please specify) 18. Has (…..) ever attempted to: strangle? choke? suffocate? drown you? when was this? ……………… 19. Does (….) do or say things of a sexual nature that makes you feel bad or that physically hurt you or someone else? (Please specify who and what)
EQ-LIB-172.docx