Questionnaire on Traumatic Situations, LEQ Test - the question form
Questions: 38 · 7 minutes
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1. Has anyone tried to take your property by using force or threats (for example, robbery or a group attack)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
2. Has anyone broken into your home, or attempted to do so, while you were there?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
3. Has anyone broken into your home, or attempted to do so, while you were away?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
4. Has anyone ever tried to rob you (excluding situations covered in the two previous items), or actually robbed you (i.e., stolen your personal belongings)?
1 - Never
2 - Not at all
3 - Very little
4 - Moderately
5 - Very much
6 - Extremely
5. Have you experienced an accident at work, in a motor vehicle, or elsewhere?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
6. Have you experienced a natural disaster (e.g., tornado, hurricane, flood, severe earthquake)?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
7. Have you experienced human-caused disasters, such as a train crash, a building collapse, a bank robbery, a fire, etc.?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
8. Have you been at risk of chemical or radioactive contamination that could have threatened your health at work, at home, or elsewhere?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
9. Have you ever been in any other situation in which you sustained a serious injury?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Exceptionally strongly
10. Have you ever been in any other situation where you feared you might be killed or seriously injured?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
11. Have you ever witnessed someone being seriously injured or killed?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
12. Have you ever seen a dead body (not at a funeral)? Have you ever, for any reason, had to touch the body of a deceased person?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
13. Has a close friend or family member been seriously injured or killed after being hit by a vehicle driven by an intoxicated (drunk) driver?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
14. Have you ever learned that someone close to you had a serious injury, a life-threatening illness, or died unexpectedly?
1 – Never
2 – No impact
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
15. Have you ever experienced the death of your spouse, partner, or child?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
16. Have you ever had a serious or life-threatening illness?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
17. Have you ever served in the military in a combat zone?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
18. Have you ever killed someone?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
19. Have you ever been a victim of or witness to torture?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
20. Before age 18, did any member of your household (someone you lived with) spend time in jail or prison?
1 – Never
2 – No impact
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
21. Were you, when you were young (before age 18), placed in someone else's care to be raised or adopted?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
22. Were your parents divorced or living separately at any time while you were living with them?
1 – Never
2 – Did not affect me
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
23. Have you ever been divorced or separated from a spouse or partner?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
24. Have you experienced severe financial hardship (for example, homelessness, bankruptcy, or a prolonged period of unemployment)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
25. Have you had a close person with severe emotional problems (for example, major depression or a chronic addiction to alcohol, drugs, etc.)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
26. Have you experienced emotional abuse or neglect (for example, frequent humiliation or being made to feel embarrassed, being regularly ignored, or being repeatedly told you were “worthless”)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
27. Have you ever experienced severe physical deprivation (for example, not enough food, very poor or seasonally inappropriate clothing, or lack of necessary care during a serious illness or when you were too young)?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
28. Have you ever had a miscarriage or an abortion?
1 – Never
2 – Did not affect me
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
29. Have you ever been separated from your children for a long period or on an ongoing basis (for example, because you were unable to have contact with them or due to a child abduction)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
30. Has your infant or child had serious physical or medical injuries (including birth defects)?
1 - Never
2 - Not at all
3 - Very little
4 - Moderately
5 - Very strongly
6 - Extremely strongly
31. Has anyone ever forced you to have sexual intercourse, oral sex, or anal sex against your will?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
32. Has anyone ever touched your intimate body parts using force or threats, or forced you to touch their intimate body parts?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
33. Aside from the situations described in the previous two items, have there been any other situations in which another person tried to have sexual contact with you against your will?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
34. Has anyone, including family members or friends, ever attacked you with a gun, a knife, or any other type of weapon?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
35. Has anyone, including a family member or friend, assaulted you without a weapon and caused you a serious injury?
1 - Never
2 - Not at all
3 - Very little
4 - Moderately
5 - Very much
6 - Extremely
36. Has anyone in your family ever hit, slapped, or pushed you so hard that you were injured?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
37. Have you experienced any other extraordinary stressful situation or event that was not listed above?
1 – Never
2 – Did not affect me
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
38. Aside from the events and situations listed above, have you experienced any other potentially stressful events or situations?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
1. Has anyone tried to take your property by using force or threats (for example, a robbery or a group attack)?
1 - Never
2 - Not at all
3 - Very little
4 - Moderately
5 - Very much
6 - Extremely
2. Has anyone broken into your home, or attempted to do so, while you were there?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
3. Has anyone broken into your home, or attempted to do so, while you were away?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
4. Has anyone ever tried to rob you (excluding the situations described in the two previous items) or actually robbed you (i.e., stole your personal belongings)?
1 – Never
2 – No effect
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
5. Have you experienced an accident at work, in a car, or elsewhere?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
6. Have you experienced a natural disaster (for example, a tornado, hurricane, flood, severe earthquake, etc.)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
7. Have you experienced a man-made disaster, such as a train crash, a building collapse, a bank robbery, a fire, etc.?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
8. Have you been at risk of chemical or radioactive contamination that could have threatened your health at work, at home, or elsewhere?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
9. Have you ever been in any other situation in which you were seriously injured?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
10. Have you ever been in any other situation where you feared you might be killed or seriously injured?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
11. Have you ever witnessed someone being seriously injured or killed?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
12. Have you ever seen the body of a deceased person (not at a funeral)? Have you ever, for any reason, had to touch the body of a deceased person?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
13. Has a close friend or family member been seriously injured or killed after being hit by a vehicle driven by someone who was drunk?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
14. Have you ever been notified of a close person’s serious injury, life-threatening illness, or unexpected death?
Never
Not at all
Very little
Moderately
Very strongly
Extremely strongly
15. Have you ever experienced the death of a spouse, partner, or child?
1 - Never
2 - Not at all
3 - Very little
4 - Moderately
5 - Very much
6 - Extremely
16. Have you ever had a serious or life-threatening illness?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
17. Have you served in the military in an area where there was active combat?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
18. Have you ever killed someone?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
19. Have you ever been a victim of, or witnessed, torture?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
20. Before age 18, did any member of your household (someone you lived with) serve time in prison?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
21. Before age 18, were you placed in someone else’s care to be raised or adopted?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
22. Were your parents divorced or living separately while you were living with them?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
23. Have you ever been divorced or separated from a partner?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
24. Have you experienced serious financial hardship (for example, homelessness, bankruptcy, or being unemployed for a long period of time)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
25. Have you had a close person with severe emotional problems (for example, major depression or a chronic addiction to alcohol, drugs, etc.)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
26. Have you experienced emotional abuse or neglect (for example, frequent humiliation or being put in an embarrassing situation, being regularly ignored, or being repeatedly told that you are “worthless”)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
27. Have you ever experienced severe physical deprivation (e.g., inadequate food, very poor or seasonally inappropriate clothing, or not receiving needed care during a serious illness, or when you were very young)?
1 – Never
2 – Not affected
3 – Very little affected
4 – Moderately affected
5 – Very strongly affected
6 – Extremely affected
28. Have you ever had a miscarriage or an abortion?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very much
6 – Extremely
29. Have you ever been in a prolonged or ongoing separation from your children (for example, due to no contact or as a result of a child abduction)?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
30. Has your infant or child had a serious physical injury or serious medical trauma (including birth defects)?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
31. Has anyone forced you to have sexual intercourse, oral sex, or anal sex against your will?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely
32. Has anyone touched your intimate body parts using force or threats, or forced you to touch theirs?
1 – Never
2 – Not at all
3 – A little
4 – Moderately
5 – Very much
6 – Extremely
33. Aside from the situations described in the previous two items, have there been any other situations in which another person tried to have sexual contact with you against your will?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
34. Has anyone, including family members or friends, ever attacked you with a gun, knife, or any other type of weapon?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
35. Has anyone, including family members or friends, ever attacked you without a weapon and caused you serious injury?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
36. Has anyone in your family ever hit, slapped, or shoved you so hard that you were injured?
1 – Never
2 – Not affected
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
37. Have you experienced any other extraordinary stressful situation or event not listed above?
1 – Never
2 – Did not affect me
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly
38. Aside from the events and situations listed above, have you experienced any other stressful situations or events?
1 – Never
2 – Not at all
3 – Very little
4 – Moderately
5 – Very strongly
6 – Extremely strongly