A domestic violence research questionnaire, as the name describes, is a set of specific questions and queries framed by the experts to measure the level of domestic violence faced by an individual. These types of questionnaires are also framed so as to assess the knowledge of the people regarding domestic violence.

Sample Of Domestic Violence Research Questionnaire:

Participant’s Contact Details:

Name: _______________

Age: _____ Sex: _____

Address: ______________ Pin Code: __________

E-mail id: _____________

Phone Number: _________________-

Q1. You are participating in this questionnaire as a:

  • Abuse Survivor
  • Abuse Victim
  • Abuser
  • Family member/ friend
  • Student
  • Professional (police, wife)
  • Others, please mention: ________________

Q2. How long have you been facing domestic violence?

  • From the last two year
  • From the last 5 years
  • From the last seven years
  • Others, please mention the duration: ______________

Q3. What kind of abuse you have experienced during the past turbulent years?

  • Shoving & pushing causing painful injuries
  • Pulling hair
  • Kicking
  • Burning and consistent beating
  • Using sharp objective to make cuts on your body
  • Stubbing you with cigarette
  • Hitting you body and head against the wall

Q4. Kindly choose an appropriate option to expose the person who was harming you:

  • Husband
  • Husband & in- laws
  • In- Laws
  • Step father of step mother
  • Others, please provide the details: ________________

Q5. Have you sustained any type of serious injury while you were being harmed?

  • Yes.
  • No

Q7. Do you have any sort of injurious cuts and scars on your body?

  • Yes
  • No

Q8. Have you ever tried to raise your voice to protect yourself from domestic violence?

  • Yes. Many times
  • I was too afraid to raise voice
  • Never tried