HITS Domestic Violence Screening

Form Template

The Domestic Violence Screening Tool mobile app can easily be conducted to investigate intimate partner violence and domestic abuse by asking these four questions:

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Language: English
Country: United States of America

• 1. Have you ever been hurt or threatened by your boyfriend/husband/partner?

• 2. Have you ever been hit, kicked, slapped, pushed, or shoved by your boyfriend/husband/partner? OR Have your ever been hit, kicked, slapped, pushed or shoved by your boyfriend/husband/partner during a pregnancy?

• 3. Have you ever been raped or forced to engage in sexual activity against your will?

• 4. Are you currently or have you ever been in a relationship where you were physically hurt, threatened, or made to feel afraid?

You can document potential domestic violence and/or sexual assault quickly and accurately using this screening tools app on your iPhone, iPad, or Android device. All reports are securely saved in the GoCanvas Cloud. They can be emailed or printed as a PDF if they need to be shared with members of law enforcement, domestic violence services, or health care providers. "

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