Having a Crisis or Traumatic Experience?

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1. Have you ever served in a war zone, or have you ever served in a noncombat job that exposed you to war-related casualties (for example, as a first aider, Fire Service man, medic or on graves registration duty?) Yes No

2. Have you ever been in a serious car accident, or a serious accident at work or somewhere else? Yes No

3. Have you ever been in a major natural or technological disaster, such as a fire, tornado, hurricane, flood, earthquake, or chemical spill? Yes No

4. Have you ever had a life-threatening illness such as COVID-19, cancer, a heart attack, leukemia, AIDS, multiple sclerosis, etc.? Yes No

5. Before age 18, were you ever physically punished or beaten by a parent, caretaker, or teacher so that: you were very frightened; or you thought you would be injured; or you received bruises, cuts, welts, lumps or other injuries? Yes No

6. Not including any punishments or beatings you already reported in Question 5, have you ever been attacked, beaten, or mugged by anyone, including friends, family members or strangers? Yes No

7. Has anyone ever made or pressured you into having some type of unwanted sexual contact? Note: By sexual contact we mean any contact between someone else and your private parts or between you and some else’s private parts Yes No

8. Have you ever been in any other situation in which you were seriously injured, or have you ever been in any other situation in which you feared you might be seriously injured or killed? Yes No

9. Has a close family member or friend died violently, for example, in a serious car crash, mugging, or attack? Yes No

10. Have you ever witnessed a situation in which someone was seriously injured or killed, or have you ever witnessed a situation in which you feared someone would be seriously injured or killed? Note: Do not answer “yes” for any event you already reported in Questions 1-9 Yes No

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