From: Jacquelyn C. Campbell, Ph.D., R.N. Copyright, 2003; update 2019; www.dangerassessment.org
A lethality assessment is an evaluation that predicts the likelihood of serious injuries or death. It provides an easy and effective method to identify victims of domestic violence who are at the highest risk of being seriously injured or killed by their intimate partners.
Several risk factors have been associated with increased risk of homicides (murders) of women and men in violent relationships. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide in situations of abuse and for you to see how many of the risk factors apply to your situation.
Mark Yes or No for each of the following.
Top of Form
Has the physical violence increased in severity or frequency over the past year?
Yes
No
Does he own a gun?
Yes
No
Have you left him after living together during the past year?
Yes
No
Have you NEVER lived with him?
Yes
No
Is he unemployed?
Yes
No
Has he ever used a weapon against you or threatened you with a lethal weapon?
Yes
No
If yes to the previous question, was the weapon a gun?
Yes
No
Does he threaten to kill you?
Yes
No
Has he avoided being arrested for domestic violence?
Yes
No
Do you have a child that is not his?
Yes
No
Has he ever forced you to have sex when you did not wish to do so?
Yes
No
Does he ever try to choke/strangle you or cut off your breathing?
Yes
No
If yes to the previous question, has he done it more than once, or did it make you pass out or blackout or make you dizzy?
Yes
No
Does he use illegal drugs? By drugs, I mean “uppers” or amphetamines, “meth”, speed, angel dust, cocaine, “crack”, street drugs or mixtures.
Yes
No
Is he an alcoholic or problem drinker?
Yes
No
Does he control most or all of your daily activities? For instance, does he tell you who you can be friends with, when you can see your family, how much money you can use, or when you can take the car?
Yes
No
In reference to the previous question, do you let him control most or all of your activities?
Do not let him
Do let him
Is he violently and constantly jealous of you? (For instance, does he say: “If I can’t have you, no one can.”)
Yes
No
Have you ever been beaten by him while you were pregnant?
Yes
No
Have you ever been pregnant by him?
Yes
No
Has he ever threatened or tried to commit suicide?
Yes
No
Does he threaten to harm your children?
Yes
No
Do you believe he is capable of killing you?
Yes
No
Does he follow or spy on you, leave threatening notes or messages, destroy your property, or call you when you don’t want him to?
Yes
No
Have you ever threatened or tried to commit suicide?
Yes
No