Lethality Assessment May 12, 2020 Has the physical violence increased in severity or frequency over the past year? Yes No None Does he own a gun? Yes No None Have you left him after living together during the past year? Yes No None Have you NEVER lived with him? Yes No None Is he unemployed? Yes No None Has he ever used a weapon against you or threatened you with a lethal weapon? Yes No None If yes to the previous question, was the weapon a gun? Yes No None Does he threaten to kill you? Yes No None Has he avoided being arrested for domestic violence? Yes No None Do you have a child that is not his? Yes No None Has he ever forced you to have sex when you did not wish to do so? Yes No None Does he ever try to choke/strangle you or cut off your breathing? Yes No None If yes to the previous question, has he done it more than once, or did it make you pass out or blackout or make you dizzy? Yes No None Does he use illegal drugs? By drugs, I mean “uppers” or amphetamines, “meth”, speed, angel dust, cocaine, “crack”, street drugs or mixtures. Yes No None Is he an alcoholic or problem drinker? Yes No None Does he control most or all of your daily activities? For instance, does he tell you who you can be friends with, when you can see your family, how much money you can use, or when you can take the car? Yes No None In reference to the previous question, do you let him control most or all of your activities? Do not let him Do let him None Is he violently and constantly jealous of you? (For instance, does he say: “If I can’t have you, no one can.”) Yes No None Have you ever been beaten by him while you were pregnant? Yes No None Have you ever been pregnant by him? Yes No None Has he ever threatened or tried to commit suicide? Yes No None Does he threaten to harm your children? Yes No None Do you believe he is capable of killing you? Yes No None Does he follow or spy on you, leave threatening notes or messages, destroy your property, or call you when you don’t want him to? Yes No None Have you ever threatened or tried to commit suicide? Yes No None Time's up