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Domestic Violence Screening Test

The HITS domestic violence screening test is used primary in doctors offices and asks respondents how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them.

Instructions: Please read each of the following activities and fill in the circle that best indicates the frequency in the last 12 months with which you partner acts in the way depicted.


1 ) How often does your partner physically hurt you?
  Never
Rarely
Sometimes
Fairly often
Frequently

2 ) How often does your partner insult or talk down to you?
  Never
Rarely
Sometimes
Fairly often
Frequently

3 ) How often does your partner threaten you with harm?
  Never
Rarely
Sometimes
Fairly often
Frequently

4 ) How often does your partner physically scream or curse at you?
  Never
Rarely
Sometimes
Fairly often
Frequently