Never

Once

Twice

3–5 Times

6–10 Times

11–20 Times

More Than 20 Times

14.

A.

Have you thrown, smashed, hit, kicked something

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

15.

A.

Have you hit or tried to hit your spouse with something

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

16.

A.

Have you thrown something at your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

17.

A.

Have you pushed, grabbed, or shoved your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

18.

A.

Have you slapped your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

19.

A.

Have you kicked, bit, or hit your spouse/ partner with a fist

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

22.

A.

Have you beat up your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

23.

A.

Have you threatened spouse/partner with a knife or gun

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

24.

A.

Have you used a knife or gun on your spouse/ partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement