The SAFE questionnaire is based on a mnemonic for screening a patient for domestic violence. This can help identify patients who may require further evaluation.



(1) S = stress and safety (items 1 and 2)

(2) A = afraid or abused (items 3 and 4)

(3) F = friends and family (items 5 and 6)

(4) E = emergency escape (items 7 and 8)


Questions to identify possible abuse: 1 to 4


Questions about resources and support: 5 to 8



• I rephrased the second questions for implementation to: "Do you feel safe when you disagree or argue with your significant other?"

• I split the seventh question into 2: "Are you in danger now?" and "Would you like to go to a shelter or talk with someone?"



• One or more affirmative answers in the first group should prompt further questions.


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