Items:

Physical IPV
Did your (last) (husband/partner) ever do any of the following things to you?
1. Push you, shake you, or throw something at you?
2. Slap you?
3. Punch with his fist or with something that could hurt you?
4. Kick you, drag you, or beat you up?
5. Try to choke you or burn you in purpose?
6. Threaten to attack you with a knife, gun or other weapon?
7. Twist your arm or pull your hair?

Response Options:
Yes
No

Controlling Behaviour
First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last)(husband/partner)?
8. He (is/was) jealous or angry if you talk/talked to other men?
9. He frequently (accuses/accused) you of being unfaithful?
10. He (does/did) not permit you to meet your female friends?
11. He (tries/tried) to limit your contact with your family?
12. He (insists/insisted) on knowing where you are/were at all times?

Response Options:
Yes
No
Don't know