Staying Safe: These Are the Self-Assessment Questions Taken from the Staying Safe Section

Staying Safe: these are the self-assessment questions taken from the Staying Safe section.

You can print out these questions, complete them and then use the answers to describe your situation when you look for support. They will help Police or other support agencies to understand what is happening. You can complete them as often as you want but please sign and date every page so that you can monitor and show changes over time

Feelings: Think carefully and try to work out how frightened you are now.

Trust your feelings. If you are very scared please do not feel ashamed – it may save your life to realise that you are in grave danger and to take action to increase your safety.

Yes/ No What do you fear may happen Are you very scared now

Are you a bit scared now but more worried about the future Are you also scared for others close to you

What are the possible risks

Facts: Think carefully about the person who is targeting you.

Assess the risk of this unwanted behaviour YES/NO

Have they behaved like this before to you

Signed By: Date: Have they behaved like this before to anyone else

Have they ever damaged anything of yours on purpose

Have they ever damaged anything belonging to anyone else on purpose Do they try to find you at home more than 3 times per week

Do they try to find you at work more than 3 times per week

Do they hang around where they think you might be. How often

Have they made any threats of physical or sexual violence against you

Have they been violent to or threatened violence against people close to you Have they contacted anyone else to try to find information about you

Have they contacted anyone else to get them to pass messages to you

Do they use drugs

Do they use alcohol

Have they ever had treatment for mental illness

Have they ever threatened suicide or self-harm

Have they ever been emotionally abusive or violent to anyone in the past Have they ever been cruel to an animal

Are the unwanted things they are doing getting more serious or frightening Are the unwanted things they are doing becoming more frequent

Every single one of the questions above is an indicator of increased risk of harm. Any YES answer means risk is present.

Signed By: Date: Do you have additional risk factors at the moment?

Do you also have additional risk factors: YES/NO

Any Illness or disability

Impaired sight or hearing

Are you Pregnant

Are you in an isolated location of home or workplace

Do you have regular places where you have to be, at regular times – e.g. work/school or regular routines and appointments e.g. hospital, hairdresser, classes, clubs

Any other?

Now can you write down what you are afraid they might do to you or to someone else? Here is a list that might help you to get started:

Unwanted Behaviour YES / NO

Phone or text

Email, Twitter or Facebook you or your contacts

Follow you or people close to you

Spy on you

Hurt you or people close to you – your children or family

Hurt or kill your family pets

Make trouble for you at work

Use ways of tracking you

Break into your home and hurt you there

Signed By: Date: Interfere with your car so that it is unsafe

Push you to a mental breakdown

Push you to suicide

Kill you, your children or someone close to you

Who is being affected by this unwanted behaviour Clearly you are – or you would not have got this far. But think who else might come to harm. Remember on average 27 people close to someone who is being stalked are also affected or harmed by the stalking.

Write down their names Have you told then? YES / NO Someone who tries to protect you

Someone you care about, just to get at you

Your family, parents, brothers, sisters

Your children

Someone who just happens to be near you, in the wrong place at the wrong time e.g. at work

Colleagues or friends who do not cooperate by giving information or refuse to take messages Other

Signed By: Date: