1-800-585-2686 (24/7/365) info@merrymanhouse.org

Domestic Violence Lethality Screen For First Responders

  • MM slash DD slash YYYY
  • Mark victim’s response to the following questions

  • A “Yes” response to any of questions #1-3 automatically triggers the protocol referral.
  • No responses to Questions #1-3, but “Yes” responses to at least 4 of Questions #4-11, trigger the protocol referral.
  • An officer may trigger the protocol referral, if not already triggered above, as a result of the victim’s response to the below question, or whenever the officer believes the victim is in a potentially lethal situation.
  • Note: The questions above and the criteria for determining the level of risk a person faces is based on the best available research on factors associated with lethal violence by a current or former intimate partner. However, each situation may present unique actors that influence risk for lethal violence that are not captured by this screen. Although most victims who screen “positive” or “high danger” would not be expected to be killed, these victims face a much higher risk than that of other victims of intimate partner violence.
  • Merryman House Domestic Crisis Center

    Phone: 270-443-6001
    Fax: 270-443-9146

    If no answer, call Dr. Mary Foley: 270-210-6223

    For program questions or concerns, call 270-448-8056