Peterborough County, ON

Screening Tool: Domestic Violence

This survey is designed to provide a quick assessment of whether you might be in an abusive relationship. However, no test is 100% accurate. No matter what your score is, you should seek help from a health professional if you have any concerns about yourself or your loved ones.

 

This questionnaire is the 4-item HITS (Hurt, Insulted, Threatened, Screamed) screening tool, developed by Dr. Kevin Sherin. 

1. How often does your partner physically scream or curse at you?
2. How often does your partner insult or talk down to you?
3. How often does your partner threaten you with harm?
4. How often does your partner physically hurt you?

HITS is copyrighted in 2003 by Kevin Sherin MD, MPH. Sincere thanks to Dr. Kevin Sherin of the Florida Department of Health for permission to use the HITS screening tool. 

 

For more information about this survey

  • Sherin KM, Sinacore JM, Li Q, Zitter RE, Shkil A: HITS, a short domestic violence screening tool for use in a family practice setting. Family Medicine. 1998 Jul-Aug; 30(7): 508-12.
  • Libschutz JM, Rothman EF: The HITS Screening Tool for Domestic Violence, New England Journal of Medicine 2012;367:2071-2073.