Relationship Survey

Why a digital log? A digital log is easy to use and will make it simple to log incidents. The digital log creates reports and graphs that will make it easier to see the volume, patterns of behaviour and how to gather evidence.

How do is this useful?

When something has happened add a new incident and simply fill in the form. If you have a picture or screen shot you can also attach it to the incident.

We also want you go keep a folder of evidence such text messages, letters. Each time you fill in the form you are given an incident number add that number to your evidence.

Relationship Questionaire Looking back on your relationship please answer the following:

How often were they violent?
Have they pushed, punched, kicked, bite, pulled you by the hair,slap or hit you?
Have they ever strangled you?
Did they throw things or destroy your property?
Have they held you down?
Have they prevented you from leaving?
Have they ever threatened you with a weapon or used an object like a weapon?
Did they insisted you had unprotected sex?
Did they Insisted or made you feel you had to have sex even though you didn't want to?
Have they forced you to have sex/raped you?
Decision and Financial
Did they make most of decisions in the house, without asking your opinion?
Did they make most of the financia decisions?
Did they ever make major financial decisions without consulting or telling you?
Did you freely have access to money?
Where you given a weekly/monnthly budet
Where you given adequate money to buy food, children's clothing or gas
Did you have to ask for money each time you needed it
Did you have to account for any money you spent
Did he limit or choose the food you could buy
Tell us how you had to account
Did they stop or discourage you from getting a job?
If you had a job or income, did they control where it held or spent
Did they take out loans or other financial transaction in your name you didn't know about?
Did they ever refuse to take care of their debt/bill making you pay instead?
Did they ever incurr debt in your name?
Did they make it hard to be with friends/family or others?
Did they make it difficult or uncomfortable for your family to visit
Did they make it difficult or uncomfortable for YOUR friends to visit
Did they insist you socialised with only their family and friends
Did they act reasonable, charming in front of other people but change when you were alone?
Did they get jealous if you spent time with other people? children?
Did they make you tell them where you've been - account for our time
Did they hide your car keys?
Did they insist you were at home at specific times?
Did they not tell you things like phone messages, or about invitations
Would they hover when you were doing work?
Would they give your privacy to go to the toilet?
Would they give you privacy when you were on the phone
Did they give you specific tasks or chores to do?
Did they demand you to do things a certain way and if you didn't get upset?
psycological
Did they say you were crazy or mentally ill?
Did he say things like "your hysterical" or "your exaggerating" or "you don't kow what you are talking about" or " you are remembering that wrong"
Did they regularly read your letters, text, emails or social media?
Did this person tell you that your remembered something wrong or forgotten something - when you are sure you didn't?
Did this person move or hide things and then pretended they didn't or blamned you?
Did they constantly criticise you?
Did they make you feel bad about yourself?
Did they do things that made you doubt your sanity?
Did they blame for things that went wrong in their life
Did they act or feel like they were the victim?
Would he compromise?
If you raised concerns would they take you seriously?
If you raised their behaviour did they dismiss it, or say you were imagining it?
threats and intimidation
Threaten to take you to court if you left?
Did they threaten to take the children if you left
Did they threaten suicide?
Did they threaten to leave you penniless
Did they threaten to hurt the famiy pet?
Did they say or make you feel your problems were you and not him?
Did they punish you by ignoring you?
Did they engage other people to pursuade you to do what they wanted?
Did they use guilt to get you to do things?
Did they constantly need reassuring?
Did you feel suffocated?
Did he accuse you of flirting with others?
Did they embarass, or criticise you in front of others
Did they say or imply that they no one else would be able to love or care for you?
Did they make you feel that they would be better off if they weren't with you?
Did he flirt with women to try and make you jealous>
Did he have the attitude they were King of the Castel?
Did he feel that you should do the "women's work"
Did they pick a fight to stop you asking questions?
Did they insist you do all the child care?
Did they insist you cook and have dinner at specific times?
Long term implications
Are you having financial difficulties due to their actions
Has it stopped you from working
How has it stopped you from working?
Have their action left you isolated?
How have they isolated you?
Are are your primary concerns?
What outcome do you want