Posttest - Intimate Partner Checklist - Women's Research Center

Intimate Partner Violence Checklist

Below are listed various forms of behavior. Please rate if your partner (or ex-partner) has had some of these behaviors with you and with what frequency? Please indicate frequency from 0 to 7: 0 = never happened to me to 7 = happened to me every day.

Please put your identifier code here:

Intimately touched you when you did not want to?

Verbally forced you to have sexual intercourse when you did not want to?

Physically forced you to have sexual intercourse when you did not want to

Slapped you or hit you with a fist

Used a knife or fired a gun against you

Pushed, grabbed, or shoved you

Kick, bit, choked or burned you

Hit or tried to hit you with some object

Took money from your purse, wallet, or bank account without your permission and/or knowledge

Restricted your access to personal money

Refused to get a job so you had to support your family alone

Demanded to know how your money was spent

Forbid you to have a job or to study

Ignored you, refused completely to talk or discuss an issue with you

Insulted or was offensive to you (said that you are worthless, dumb, ugly etc.)

Screamed and yelled at you

Tried to restrict contact with your family or friends

Was overly jealous without a reason

Damaged your personal belongings

Threatened to hurt you physically

ThreatenStalked you, bothered you with phone call, messages, e-mail's etc.ed to hurt you physically

Please indicate frequency from 0 (never happened to me) to 7 (happened to me every day)