Domestic Violence Experiences and Support Needs
Taking part is optional: answer only when safe, skip any question, and do not include names or identifying details. If you are in immediate danger, contact local emergency services when it is safe to do so.
Is it safe for you to complete this survey right now?
Consider whether someone could see your screen or check your device; if you are unsure, stop and return only if safe.
In the past 12 months, have a partner, ex-partner, or family member done any of these things to you?
Select all that apply. Choose “None of these” or “Prefer not to answer” on its own.
How often did any of these behaviors happen in the past 12 months?
Think about the behaviors listed above.
How have these experiences affected your daily life?
Select all that apply. Choose “No noticeable effect,” “Not applicable,” or “Prefer not to answer” on its own.
How safe do you currently feel at home?
Use 1 for “Not at all safe” and 5 for “Very safe.” Skip this question if you would rather not answer.
Who, if anyone, have you contacted for support?
Select all that apply for experiences in the past 12 months. Choose “I have not contacted anyone,” “Not applicable,” or “Prefer not to answer” on its own.
What has made it difficult to seek or receive support?
Select all that apply. Choose “No barriers,” “Not applicable,” or “Prefer not to answer” on its own.
What support would be most useful to you right now?
Choose the one that would help most. This question does not request a referral or contact from a service.
What would make support easier or safer to access?
Share only what you feel comfortable sharing; do not include names, contact details, locations, or other identifying information.
Thank you for taking a part in this survey.
