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Family violence survey template

This Family violence survey is a questionnaire that can be used by organizations to conduct a survey on family violence. This template can be used to collect data on the prevalence of family violence, the types of family violence that occur, and the impact of family violence on individuals and families.

Time to complete

2 minutes

Eligibility

The survey template is available to those who have experienced family violence in the last 12 months.

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Questions for Family violence survey template

1.

What is your age?

The answer should be a number input.
2.

What is your gender?

The answer should be a single choice:
  1. Male
  2. Female
3.

Do you live with a partner?

The answer should be a single choice:
  1. Yes
  2. No
4.

Do you have any children?

The answer should be a single choice:
  1. Yes
  2. No
5.

What is your employment status?

The answer should be a single choice:
  1. Yes
  2. No
6.

What is your education level?

The answer should be a text input.
7.

What is your ethnic background?

The answer should be a text input.
8.

What is your religious affiliation?

The answer should be a text input.
9.

Have you ever experienced any form of family violence?

The answer should be a single choice:
  1. Yes
  2. No
10.

If yes, please describe the nature of the violence.

The answer should be a text input.
11.

Have you ever been a perpetrator of family violence?

The answer should be a single choice:
  1. Yes
  2. No
12.

If yes, please describe the nature of the violence.

The answer should be a text input.
13.

Do you know anyone who has been a victim or perpetrator of family violence?

The answer should be a single choice:
  1. Yes
  2. No
14.

What do you think are the main causes of family violence?

The answer should be a text input.

Similar Ideas

  • Family Violence Victim Survey Form
  • Family Violence Perpetrator Survey Form
  • Family Violence Incident Survey Form
  • Family Violence Case Survey Form

Here are some FAQs and additional information
on Family violence survey template

What is the Family Violence Survey?

The Family Violence Survey collects information from people about their experiences with spousal violence, sexual violence, and/or stalking.

What is the purpose of the Family Violence Survey?

The Family Violence Survey is used to measure the prevalence of family violence and to identify risk factors associated with victimization and perpetration. The data from the survey are used to inform policy and program development, and to help raise public awareness about family violence.

How is the Family Violence Survey conducted?

The Family Violence Survey is conducted by submitting online forms, telephone and is administered to a randomly selected sample of adults.

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