Domestic Violence
Safety Assessment
Tool
DOMESTIC VIOLENCE SAFETY ASSESSMENT TOOL NSW GOVERNMENT
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Domestic Violence Safety Assessment Tool (DVSAT)
For use by non-government service providers and government agencies other than NSW Police
Force.
The DVSAT has primarily been designed for use in intimate partner violence situations. Service
providers who decide to use the DVSAT in other situations should be mindful that some of
the questions in Part A might not be relevant. Service providers should use their professional
judgement about the appropriateness of individual questions.
The DVSAT does not change or replace existing child protection obligations and procedures.
Client’s name:
Client’s date of birth:
Completed by:
Signature:
Date:
| PART A: Risk identifcation checklist | |||||
| Violence toward client | |||||
| Risk indicator | Yes | No | Unknown | Refused to answer |
Source of information if not client (e.g. Police) |
| 1. Has your partner ever threatened to harm or kill you? |
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| 2. Has your partner ever used physical violence against you? |
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| 3. Has your partner ever choked, strangled or suffocated you or attempted to do any of these things? |
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| 4. Has your partner ever threatened or assaulted you with any weapon (including knives and/or other objects)? |
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| 5. Has your partner ever harmed or killed a family pet or threatened to do so? |
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| 6. Has your partner ever been charged with breaching an apprehended domestic violence order? |
DOMESTIC VIOLENCE SAFETY ASSESSMENT TOOL NSW GOVERNMENT
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| Relationship between client and partner | |||||
| Risk indicator | Yes | No | Unknown | Refused to answer |
Source of information if not client (e.g. Police) |
| 7. Is your partner jealous towards you or controlling of you? |
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| 8. Is the violence or controlling behaviour becoming worse or more frequent? |
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| 9. Has your partner stalked, constantly harassed or texted/ emailed you? |
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| 10. Does your partner control your access to money? |
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| 11. Has there been a recent separation (in the last 12 months) or is one imminent? |
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| Background of partner | |||||
| 12. Does your partner or the relationship have fnancial diffculties? 13. Is your partner unemployed? |
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| 14. Does your partner have mental health problems (including undiagnosed conditions) and/or depression? |
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| 15. Does your partner have a problem with substance abuse such as alcohol or other drugs? |
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| 16. Has your partner ever threatened or attempted suicide? |
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| 17. Is your partner currently on bail or parole, or has served a time of imprisonment or has recently been released from custody in relation to offences of violence? |
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| 18. Does your partner have access to frearms or prohibited weapons? |
DOMESTIC VIOLENCE SAFETY ASSESSMENT TOOL NSW GOVERNMENT
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| Children | |||||
| Risk indicator | Yes | No | Unknown | Refused to answer |
Source of information if not client (e.g. Police) |
| 19. Are you pregnant and/or do you have children who are less than 12 months apart in age? |
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| 20. Has your partner ever threatened or used physical violence toward you while you were pregnant? |
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| 21. Has your partner ever harmed or threatened to harm your children? |
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| 22. Is there any conflict between you and your partner regarding child contact or residency issues and/or current Family Court proceedings? |
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| 23. Are there children from a previous relationship present in the household? |
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| Sexual assault | |||||
| 24. Has your partner ever done things to you, of a sexual nature, that made you feel bad or physically hurt you? |
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| 25. Has your partner ever been arrested for sexual assault? |
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| Total number of indicators | |||||
| 1 or more ‘yes’ answers = at threat 12 or more ‘yes’ answers = at serious threat |
DOMESTIC VIOLENCE SAFETY ASSESSMENT TOOL NSW GOVERNMENT
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| PART B: Professional judgement | ||||
| How fearful is the client of their partner? (Select one) |
Not afraid | Afraid | Terrifed | Unable/ unwilling to answer |
| What concerns did the client express? What did the client think the partner might do and to whom? |
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| Do you believe any children in the household are at risk of harm? If yes, what action have you taken? Confrm that you have met your mandatory reporting obligations. |
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| Are you aware of any other additional factors, circumstances or details which make you believe overall there is a threat or serious threat to the safety of the client and/or children? |
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| Consider issues such as the client’s situation in relation to disability, substance misuse, mental health issues, cultural/ language barriers; whether they are willing to engage with a support service; whether the perpetrator’s occupation or interests has given them unique access to weapons, or if there is involvement with Community Services (FACS). |
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| Threat Level | Select appropriate level based on Part A result and/or Part B result At threat At serious threat |
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| Action Required | ■■ Make referrals and provide support as required. ■■ For clients at serious threat, address immediate safety needs and make a referral to a Safety Action Meeting where available. |
NOTE: Clients’ answers to the DVSAT may differ over time depending on a number of factors. In the context of
domestic violence, different responses do not necessarily indicate decreased threat or unreliable reporting by clients.
JUNE 2015