SECTION: Health Care Coverage and Utilization Survey Entry ...

Survey Entry - 2011 College Student Health Surveyhttp://internetstudy.cbsol.com/Survey/BSurvey.aspSECTION: Personal Safety6 SURVEY PAGE: 6 of 26 pages You have completed 0 of 17 Items on this pageThe following questions pertain to issues related to personal safety. When answering the questionsplease use the following definitions: sexual intercourse - oral, vaginal, or anal penetration; sexualtouching - touching of breasts, buttocks, or genitals.1 1.01 Within your lifetimehave you:1.02 Within the past 12months have you:Yes No Yes NoHad sexual intercourse with someonewithout that person's consent or againsthis/her willTouched someone sexually without thatperson's consent or against his/her willSlapped, kicked, or pushed your significantother or spouse/partnerThreatened or "put-down" your significantother or spouse/partnerExperienced actual or attempted sexualintercourse without your consent or againstyour willExperienced actual or attempted sexualtouching without your consent or againstyour willBeen slapped, kicked, or pushed by yoursignificant other or spouse/partnerBeen hurt by threats, "put-downs", oryelling from your significant other orspouse/partner2 If you experienced sexual intercourse/sexual touching against your will, did you reportthe incident to any of the following?**(Mark all that apply)**Not applicable - I was not involved in any incidentHealth care provider (e.g. Physician, Nurse, or Therapist)Hall director or community advisorCampus sexual violence officePoliceOtherI did not report the incident1 of 2 5/10/11 3:00 PM