Domestic Violence Questionnaire

Domestic violence questionnaire attempts to investigate occurrences of violence against females, minors or any other individual by members of the subject’s  family but in most cases it is used in the cases where women have been tortured or bullied by their husband and/or in-laws.  This is done by police, investigation agencies or human rights, feminist groups to ensure protection of women inside households.

Domestic Violence Questionnaire Sample

Name:               __________________________________________________________________

Address:        __________________________________________________________________

Phone:               _______________________          Email:               ________________________

Answer the following. Cite examples where you can

Has your partner has done the following in the course of your relationship

  1. Monitor your time and asks for explanations on being late from work, away from home etc
  2. Discourages you to make new friends.
  3. Humiliates you by saying mean things in the presence of your/his friends.
  4. Discourage you to make new friends.
  5. Misbehaves with his in laws.
  6. Pressure you to have sex more often than you’d like?
  7. Bothers you excessively on how you spend money.
  8. Hurt you physically by-

a)    Punching , slapping, grabbing your hair or kicking you

b)    Pushing , holding you tight or twisting your arm

c)     Throw some object at you

d)    Attack you with knife or sharp objects

  1. Leave visible injuries on your body requiring you to seek medical help?
  2. Does your partner have a police record for criminal activities
  3. How does he behave with your children?
  4. What kind of people/friends does your partner mingle with?
  5. Are your friends/relatives aware of your partner’s misconduct?
  6. Had ever anyone of your friends/relatives tried to resolve conflict between you and your partner? If yes then what were his response?

Category: Personality Questionnaire

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