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Safe Families Routine Enquiry


  • We know that family violence is common and affects people’s health so we are asking women routinely about family violence.
  • You don’t have to answer if you don’t want to.
  • Any information you wish to tell me will be kept secure and not disclosed to anyone without your permission, unless I judge that somebody’s life or safety may be in danger.
  • I am concerned that someone hurting you may have caused some of your symptoms.


  • Have you been hurt or frightened by someone close to you in the past year?

    By that I mean hit, kicked, pushed, slapped, attempted to strangle or choke or otherwise physically hurt by your partner, ex-partner or someone else close to you.
  • Is there someone close to you who makes you feel you are no good or worthless?

    By that I mean, swears or shouts at you, threatens you or puts you down.
  • Have you been made to do anything sexually in a way, or at a time you didn’t want to by your partner, ex-partner or anyone else?
  • Are you afraid of the abuser?
    • Is the abuser here now?
    • Are you afraid to go home?
    • Would you like some assistance?


Use the patient's own words:
Has the patient disclosed abuse:
Are there signs and symptoms of abuse?
Is the abuse current?
Is the patient in immediate danger - is their safety at risk:
  1. Has the physical violence increased in severity or frequency?
  2. Have you separated (or tried to) from (the abuser) in the last year?
  3. Has the abuser:
    • Threatened to harm/kill you or your child(ren)?
    • Threatened you or your child(ren) with a weapon?
    • Got access to a gun?
    • Attempted to strangle or choke you?
    • Threatened to commit suicide?
  4. Does (the abuser) use alcohol or drugs?
  5. Have you:
    • Thought about hurting yourself because of the abuse?
    • Thought about/tried to commit suicide?
  6. Is anyone else in the household at risk, older people or people with disabilities?
Is the nature of the abuse sexual?
Are there children at home?
Is the patient pregnant?

Patient is in immediate danger:

If there is a serious threat to health and safety, call police on 111. You do not need the patient's permission.

In consultation with the patient:

Signs and symptoms present:

If you have concerns, for example in the case of any children in the home:

  • Review old notes, previous presentations.
  • If appropriate the patient should be questioned sensitively about this.
  • If necessary arrange a follow up appointment.
  • Consider recording a FV Alert for patient and/or children.
Action taken today:

No signs and symptoms present:

“We give all women this information about domestic violence, no matter how they answered the questions. You might be interested to read it or you might know someone who could use it”. “If for any reason you think it is unwise or unsafe to take this information home, please dispose of it in the bin provided on the way out”

Patient has disclosed historical abuse:


Patient has disclosed sexual assault:


Children at home:

Some questions to consider:
  • "Where were the child(ren) when the abuse was happening?”
  • “Have the child(ren) heard or seen the abuse?”
  • “Have the child(ren) attempted to intervene in the abuse? Have they been hurt?”
  • “Do you feel unable to protect them from the abuse?”
  • "Has the abuser ever removed or threatened to remove the children from your care?"
  • "Where are the children at the moment?"
Record name, DOB and relationship to the patient/abuser of all children at risk:


  • anybody has physically abused the children, or
  • children have current injuries due to the abuse, or
  • patient is in immediate danger and there are children aged 2 and under in the home.

Patient is pregnant

  • “Have you been assaulted while pregnant?”
  • “Have you been prevented from accessing medical care?”
  • “Has the abuser threatened to hurt your baby during your pregnancy?”

Encourage information to be shared with the Lead Maternity Carer given the increased vulnerability of patient and unborn child.


Patient is not in immediate danger

Safety plan has 3 Stages:

  1. Avoiding injury, escaping violence
  2. Preparing for Separation
  3. Long-term safety after separation

To do:

  • Discuss with patient safe contact details.
  • Review ongoing safety.
  • Offer follow up appointment.
Information on Safety Planning (from Women's Refuge)

Reason for accessing form:
Risk assessment:

Children At Home:

Other people at risk:

Additional notes: