DOMESTIC VIOLENCE QUESTIONNAIRE
c. Persons who are the parents of a child or
are persons who have or had parental responsibility for that child
d. Persons who are family members related
by consanguinity, affinity or marriage
e. Persons who are domestic child carers or
domestic workers
f. Persons who are in an intimate relationship
g. RF
h. DK/NA
Knowledge
79.
Are you aware that you can apply for a
Protection Order if you become a victim
of domestic violence?
a.
b.
c.
d.
80.
Please name at least 5 (you may name
more than 5) acts which you consider as
acts of domestic violence?
a.
b.
c.
d.
e.
f.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
81.
Yes
No
RF
DK/NA
Physical abuse
Verbal abuse / psychological abuse
Sexual abuse
Economic / Financial abuse
Impregnating the spouse, without concern to her health condition and against
any medical advice to refrain from impregnation for a specified period of time
Impregnating a women, who is trying to
remove herself from a harmful marriage,
against her will;
Deliberately withholding the property of
a person;
intimidation;
harassment;
stalking;
damage to property;
entry into, and being present thereafter
at the victim’s residence without consent,
where the parties do not share the same
residence;
any other act which may be described as
controlling or abusive behavior towards
the victim;
coercing, intimidating or forcing the victim to commit an act which such person
would not have consented to or committed by their own volition;
confining the victim to a place or restricting their movement against their will;
attempting to commit any of the foregoing acts or causing apprehension of such
acts; or
Causing a minor to witness or hear an
act of domestic violence or presenting or
placing a minor in such situation where
such minor may witness or hear an act of
domestic violence.
Other…………………………………
RF
DK/NA
82.
a.
b.
c.
d.
83.
Yes
No [Skip to Qu 85]
RF [Skip to Qu 85]
DK/NA [Skip to Qu 85]
If yes, what institution(s) should you report it to?
a.
b.
c.
d.
e.
f.
g.
h.
Police
Ministry of Gender and Family
Family Protection Authority
Hospital / Health center
HRCM
Others
RF
DK/NA
Perception
84.
Considering the works that the institutions responsible for prevention of domestic violence are doing, how well [how
good a job] are they doing?
a.
b.
c.
d.
e.
f.
g.
85.
An excellent job
A good job
A satisfactory job
Not that good a job
A poor job
RF
DK/NA
In relation to the institutions working towards prevention of domestic violence
in what way(s) do you think they can improve their services? (you may give more
than one answer)
Create public awareness
Capacity building of staff
Rehabilitation of perpetrators
Adequate, timely and convenient assistance to survivors
e. Other……………………………………
f. RF
g. DK/NA
a.
b.
c.
d.
Please name up to 5 relationships which
you consider as a domestic relationship?
a. Persons who are or were married to each
other
b. Persons who share or have recently
shared the same residence
If you have reason to believe that an act of
domestic violence has been, or is being,
committed, do you know what institution(s) to report it to?
86.
In your opinion, what factors contribute to domestic violence? (you may give
81