Safety and Sobriety Manual
Best Practices in Domestic Violence and Substance Abuse

January 2005


Sample Screening Questions

(Note:  The form can be found on page 15 of the Appendix Resource (pdf))

Answer YES or NO for each question as it applies.

(Victim)

  1. Within the past few years, have you been hit, slapped, kicked, pushed, shoved, or otherwise physically hurt by a family member, a person with whom you were in a relationship, or a care giver?
  2. Within the past year, has anyone in your family, or anyone you have been in a relationship with forced you to participate in sexual activities against your will?
  3. (If yes to either above): Are you afraid that the person who harmed you may do it again?

(Perpetrator)

  1. Within the past few years, have you hit, slapped, kicked, pushed, shoved, or otherwise physically hurt a family member, a person with whom you were in a relationship, or a person to whom you were a care giver?
  2. Within the past year, have you forced anyone in your family, or anyone with whom you have been in a relationship, to participate in sexual activities against their will?
  3. (If yes to either above): Do you think that you may do it again?

NOTE:  A YES to any of the questions would indicate that a more formal assessment be completed by a qualified professional.


Red Flags of Abusive Partners

A list of warning signs to indicate a possible abuser:

(Note:  The list can be found on page 16 of the Appendix Resource(pdf))

  • Jealous
  • Watching the amount of time you are away
  • Wanting to keep you away from friends
  • Asks "Who are you talking to?" when you are on the phone
  • Asks too many questions
  • Sulks when he doesn't get his way
  • Seems childish and/or insecure
  • When something is important to you, he tunes you out
  • He talks louder until he gets your undivided attention
  • He physically restrains you until you listen to him
  • Yells in your ear (sometimes until it is painful)
  • He follows you around endlessly, repeating things over and over again
  • Makes you repeat what he said back to him to be sure you were listening
  • Makes you stop what you are doing to listen to him
  • He makes all the rules. There is no flexibility
  • What you think and feel are not important
  • What he thinks and feels is very important
  • He says, "We will get along fine as long as it goes my way."
  • He won't admit it when he's wrong
  • He pesters you about it until you admit it
  • He tells you what your feelings are and then punishes you with the silent treatment or violence
  • He acts as if he found a clue and makes a big issue of it
  • He makes frequent accusations
  • He acts as if any attention to another human being is flirting
  • He says things like, "You belong to me", I got papers on you", and "You're my wife."
  • He tells you how to dress or whether or not to wear make-up.
  • He criticizes frequently
  • He uses what you have told him against you
  • He doesn't like anybody you like or he criticizes your friends
  • He is controlling
  • He is possessive of you
  • He is bossy
  • He is jobless
  • He is a drug/alcohol user and uses that as an excuse for his behavior
  • He was abusive in a previous relationship
  • He has to know about your business but is secretive about his own
  • He smiles too much (sneaky)
  • He is always argumentative
  • He has an uncontrollable temper