Behaviour Checklist

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Click any of the steps below to navigate between them. You do not need to complete one step to navigate to the next, and you may move back and for the between the steps.

1Isolation

2Male Privilege

3Economic Abuse

4Intimidation

5Emotional Abuse

6Sexual Abuse

7Physical Abuse

8Copy of Results

Restricting Freedoms

a. Told you that you cannot do something.

Never

Once

Frequently

b. Monitored your time and made you account for where you were.

Never

Once

Frequently

c. Did not allow you to leave the house.

Never

Once

Frequently

d. Made it difficult for you to get a job.

Never

Once

Frequently

e. Restricted your use of the vehicle.

Never

Once

Frequently

f. Restricted your use of the telephone.

Never

Once

Frequently

g. Tried to prevent you from contacting your family and friends.

Never

Once

Frequently

h. Kept you from getting medical care.

Never

Once

Frequently

i. Others (Please explain)

Never

Once

Frequently

Others

Male Privilege

a. Demanded obedience.

Never

Once

Frequently

b. Made decisions without your input.

Never

Once

Frequently

c. Treated you like an inferior.

Never

Once

Frequently

d. Told you that you couldn’t cope without him.

Never

Once

Frequently

e. Talked about women as if they are inferior.

Never

Once

Frequently

f. Treated you like a servant.

Never

Once

Frequently

g. Others (Please explain)

Never

Once

Frequently

Others

Economic Abuse

a. Made you account for all the money you spent.

Never

Once

Frequently

b. Kept you short of money.

Never

Once

Frequently

c. Made you ask for basic necessities.

Never

Once

Frequently

d. Support payments for you and/or your children withheld or late.

Never

Once

Frequently

e. Sold your possessions or co-owned property without your knowledge.

Never

Once

Frequently

f. Built up debts, which you are jointly liable for.

Never

Once

Frequently

g. Cleaned out your joint bank account.

Never

Once

Frequently

h. Restricted you to an allowance.

Never

Once

Frequently

i. Others (Please explain)

Never

Once

Frequently

Others

Intimidation

a. Changed his mood suddenly.

Never

Once

Frequently

b. Gave you the silent treatment.

Never

Once

Frequently

c. Showed you that he/she was getting angry.

Never

Once

Frequently

d. Shouted or yelled.

Never

Once

Frequently

e. Pounded a fist on the table.

Never

Once

Frequently

f. Hit the wall.

Never

Once

Frequently

g. Threw or kicked something.

Never

Once

Frequently

h. Stomped out of the room/house.

Never

Once

Frequently

i. Killed or neglected the animals.

Never

Once

Frequently

j. Frightened you into submission. (i.e. to get own way)

Never

Once

Frequently

k. Others (Please explain)

Never

Once

Frequently

Others

Emotional Abuse

a. Said things designed to spite or insult you in front of others.

Never

Once

Frequently

b. Put down your physical appearance.

Never

Once

Frequently

c. Made out that you were stupid.

Never

Once

Frequently

d. Criticized your care of children/home.

Never

Once

Frequently

e. Criticized your family and/or friends.

Never

Once

Frequently

f. Called you names and swore at you.

Never

Once

Frequently

g. Told you that you were crazy/irrational.

Never

Once

Frequently

h. Undermined you (i.e. parenting, attempts to improve yourself)

Never

Once

Frequently

i. Changed his plans to visit children, or cancelled arranged custody visits.

Never

Once

Frequently

j. Blamed you for his/her problems.

Never

Once

Frequently

k. Others (Please explain)

Never

Once

Frequently

Others

Sexual Abuse

a. Withdrew affection.

Never

Once

Frequently

b. Was excessively jealous.

Never

Once

Frequently

c. Made birth control solely your responsibility.

Never

Once

Frequently

d. Did not allow you to use birth control.

Never

Once

Frequently

e. Nonconsensual use of objects (sexually).

Never

Once

Frequently

f. Flaunted affairs.

Never

Once

Frequently

g. Made sexual accusations that you were having affairs.

Never

Once

Frequently

h. Withheld sex to punish you.

Never

Once

Frequently

i. Pressured you to have sex when you were saying no.

Never

Once

Frequently

j. Forced you to have sex against your will.

Never

Once

Frequently

k. Pressured you to have sex after being abusive towards you.

Never

Once

Frequently

l. Pressured or forced you into unwanted sex acts.

Never

Once

Frequently

m. Treated you like a sex object.

Never

Once

Frequently

n. Purposely inflicted pain on you during sex.

Never

Once

Frequently

o. Sex accompanied by violence and/or threats.

Never

Once

Frequently

p. Sexual name calling.

Never

Once

Frequently

q. Nonconsensual use of pornography.

Never

Once

Frequently

r. Others (Please explain)

Never

Once

Frequently

Others

Physical Abuse

a. Threw you.

Never

Once

Frequently

b. Pinched you.

Never

Once

Frequently

c. Bit you.

Never

Once

Frequently

d. Tripped you.

Never

Once

Frequently

e. Pushed you.

Never

Once

Frequently

f. Grabbed you.

Never

Once

Frequently

g. Shook you.

Never

Once

Frequently

h. Pulled your hair.

Never

Once

Frequently

i. Twisted your arm.

Never

Once

Frequently

j. Pinned you to the wall, floor or bed.

Never

Once

Frequently

k. Choked or strangled you.

Never

Once

Frequently

l. Kicked you.

Never

Once

Frequently

m. Slapped you.

Never

Once

Frequently

n. Punched you.

Never

Once

Frequently

o. Scratched you.

Never

Once

Frequently

p. Covered your mouth.

Never

Once

Frequently

q. Restrained you.

Never

Once

Frequently

r. Smothered you.

Never

Once

Frequently

s. Forcefully put you out of the house.

Never

Once

Frequently

t. Hit or tried to hit you with something.

Never

Once

Frequently

u. Threatened you with a knife, gun or other weapon.

Never

Once

Frequently

v. Tried to run you down with a vehicle.

Never

Once

Frequently

w. Assaulted you when you were pregnant.

Never

Once

Frequently

x. Others (Please explain)

Never

Once

Frequently

Others

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