CHAT Tool - Offender Health Research Network

Tick No or Yes as appropriate for each question and include additional notes
DELIBERATE SELF-HARM
Have you ever hurt yourself
If yes, how have you hurt yourself
No
Yes
How often would you hurt yourself e.g. more than once a day, once a day, once a week
When did you last hurt yourself
When are you likely to hurt yourself e.g. when bored, alone, thinking about a problem
Surname:
DOB:
Forenames:
NHS Number:
CHAT Tool Secure Estate (Version 3 - June 2013)
65 | P age