Safety and Support at Home

This optional survey asks about experiences with a current or former partner or household member during the past 12 months; skip any question or stop at any time. Use a device you feel safe using, avoid names or identifying details, and contact local emergency services if you are in immediate danger and it is safe to do so.

Is it safe for you to answer these questions now?

If you are unsure or someone may see your answers, consider stopping and returning only when it is safe.

How often have you felt afraid of a partner or household member?

Think about the past 12 months.

Which of these have you experienced in the past 12 months?

Select all that apply to a current or former partner or household member; select “None” or “Prefer not to answer” alone.

How safe do you feel in your current living situation?

You may skip this question if you would rather not answer.

From Least to Most

How have these experiences affected your daily life?

Select all that apply; select “No effects,” “Not applicable,” or “Prefer not to answer” alone.

Who, if anyone, have you turned to for support?

Select all that apply for the past 12 months; select “No one” or “Prefer not to answer” alone.

What has made it difficult to get support?

Select all that apply; select “No barriers,” “I have not needed support,” or “Prefer not to answer” alone.

What support would be helpful to you now?

Select all that apply; choosing an option does not request a service or arrange contact.

What would make support easier or safer to access?

Please avoid names, addresses, contact details, or other identifying information.

Thank you for taking a part in this survey.

This is a HeySurvey survey template.