Have you ever participated in an activity (group session, rally, etc) in your community or workplace on violence against women?

Have you done any of these things [involving emotional intimate partner violence] in the past 12 months?

How often have you threatened to hurt your partner?

Have you ever hurt people your partner cares about as a way of hurting her, or damaged things of importance to her? If yes, did this happen once, a few times or many times?

Have you ever insulted a partner or deliberately made her feel bad about herself?

Have you ever done things to scare or intimidate a partner on purpose for example by the way you looked at her, by yelling and smashing things?

How often have you belittled or humiliated your partner in front of other people?

Have you done any of these things [involving economic intimate partner violence] in the past 12 months?

Have you ever thrown a partner out of the house?

Have you ever prohibited a partner from getting a job, going to work, trading or earning money?