Violence
  1. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club?
    0 days
    1 day
    2 to 4 days
    5 to 6 days
  2. During the past 30 days, on how many days did you carry a gun?
    0 days
    1 day
    2 to 4 days
    5 to 6 days
  3. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on school property?
    0 days
    1 day
    2 to 4 days
    5 to 6 days
  4. During the past 30 days, on how many days did you not go to school because you felt you would be unsafe at school or on your way to or from school?
    0 days
    1 day
    2 to 4 days
    5 to 6 days
  5. During the past 12 months, how many times has someone threatened or injured you with a weapon such as a gun, knife, or club on school property?
    0 times
    1 to 3 times
    4 to 9 times
    10 or more times
  6. During the past 12 months, how many times were you in a physical fight?
    0 times
    1 to 3 times
    4 to 9 times
    10 or more times
  7. During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?
    0 times
    1 time
    2 to 5 times
    6 or more times
  8. During the past 12 months, how many times were you in a physical fight on school property?
    0 times
    1 to 3 times
    4 to 9 times
    10 or more times
  9. During the past 12 months, did your boyfriend or girlfiiend ever hit, slap, or physically hurt you on purpose?
    No
    Yes
  10. Have you ever been forced to have sexual intercourse when you did not want to?
    No
    Yes

Text provided by the Centers for Disease Control.

Copyright © 1999 University of Colorado Health Sciences Center. All rights reserved.