Domestic Violence Risk Assessment Checklist
Victim Information
Name:
Date:
Risk Factors
History of physical harm or threats
Access to weapons in the home
Recent escalation in violence or threats
Controlling or jealous behavior
Attempt to isolate the victim
Children present or at risk
Substance use or abuse
Mental health concerns
Threats to kill or severely injure
History of sexual violence
Stalking behavior
Recent separation or attempt to leave
Financial abuse/control
Notes / Observations