Child Abuse Questionnaire

Place a checkmark in the space (___) next to the item if you have completed that item. Check only those items you have completed in full. For an item not started or unfinished, put a firm date as to when you will have it finished. This tool is only as good as your level of honesty. Let’s work together at keeping our kids safe.

Section One: Bonding and Relationships

(___) I have established a “bond” with my child since birth.

(___) I talk to my child daily.

(___) I spend at least 20 minutes of undistracted time with my child (talking, walking, playing, and listening).

Section Two: Your Child’s Life

(___) I have knowledge of most of my child’s daily activities.

(___) I have knowledge of all my child’s companions and friends.

(___) I know what my child thinks about life.

(___) I know the family of my child’s friends.

Section Three: Sexual Education

(___) I have taught my child about sexual matters in a slow and gentle manner.

(___) I have taught my child to be open, curious, and not embarrassed about sexual matters.

(___) I have taught my child that his/her body is his/her own.

(___) My child knows I will listen if something or someone has made him or her physically or sexually uncomfortable.

Section Four: Environment Education

(___) I have taught my child that there are predators in his or her world.

(___) I have taught my child that all persons, including relatives, are capable of child abuse.

(___) I have provided my child with a Kid-Code (a sign or signal from my child that he or she needs help) so that strangers cannot interfere.

Section Five: Positive Discipline

(___) I provide positive, nonphysical discipline as the main disciplinary tool and have utilized physical discipline only in a calm, rational, and very selective manner.

(___) I attempt to communicate with my child before and after each and every disciplinary action.

(___) I do not stand by and watch others excessively discipline their child without doing something about it.

Section Six: Child Care

(___) I have thoroughly examined the caregiver’s environment, and it appears to be safe.

(___) I have thoroughly checked the background of my child’s daycare person and provider.

Section Seven: Health and Medical

(___) I pay regular attention to my child’s attitude/behavior, sleeping/eating habits, and personal care habits, in order to note any significant behavioral changes.

(___) I pay regular attention to my child’s physical person and overall medical conditions, in order to note any unusual symptoms or concerns (headaches or stomachaches, abrasions, blisters, swelling, listlessness, depression, hyperactivity, hand-and-eye engagement).

(___) I have seen to it that my child has regular medical checkups and examinations and/or any needed consultations with a professional counselor.

(___) I do not ignore early warning medical or psychological signs.


Parenting/Caregiver Score

Total Items Checked
18–23 A
16–18 B
14–16 C
12–14 D
Below 12 NI (noninvolved)


A: You’re likely doing a great job; keep up the good work!

B: You’re likely doing better than average. Set a date for what has not been done and incorporate these into your daily activities.

C: You’re likely doing an average job. Review the items ignored or incomplete. Set a date for getting them done and make a purposed effort to incorporate these in your daily activities.

D: You’re likely doing a below average job. Consider asking others for help, including professional consultation, immediately.

NI: You’re likely doing well below average and are not involved. Much improvement is needed; consider pursuing professional consultation and accountability immediately.




Protect Your Kids Right: Keep Your Children Safe From Sexual and Physical Assaults, Violence, Injury, Harm, and Murder by Lawrence W. Daly, 2014.

Available at and in eBook format

Help and Hotlines

Real World Ministries:

Coalition for Children:

Child Help National Hotline: 1-800-422-4453

The hotline offers crisis intervention, information, literature, and referrals to thousands of emergency, social service, and support resources. All calls are confidential. For more information, see:

National Children’s Advocacy Center:

Copyright © 2014 by Lawrence W. Daly. All rights are reserved. Used by permission.

About the author

Larry Daly

Lawrence Daly

Lawrence Daly is an international leader, speaker, and skilled professional striving to make this world a safer place for our kids. We must know our rights and responsibilities as adults in our churches and communities today.

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