27799668__HEADSSS_Questions__Long_Form___Short_Form
[Subject] Safety [Long Form] Are you afraid of violence in your school? In your neighborhood? At home? Do you carry a weapon to school? What kind and how often? Do your friends carry weapons? What kind? Do you have a personal history of fighting? Have you used weapons? Are there guns in your home? Do you have access to them? Have you been a victim of a violent crime? When? Where? Who was involved? What happened? Do you have a history of physical abuse? Have you been the victim of date rape or rape? Have you been arrested? Have you run away from home? Been homeless? Been involved with cults? Are you a member of a gang? [Short Form] 
Do you ever feel unsafe? When? At school? At home? In your neighborhood? Have you ever been hurt by someone?
Adolescent Health Care - Sample HEADSSS Questions (Long Form)
Short Form