LSI-R Risk Assessment Questionnaire Form
Please complete the LSI-R Risk Assessment Questionnaire Form to help evaluate key risk factors. Select the option that best describes each area. Your responses will remain confidential and are used solely for assessment purposes.
Criminal History
*
No prior offenses
One or two prior offenses
Three or more prior offenses
Education/Employment Status
*
Rows
Stable
Occasional
Unstable
Education
1
2
3
Employment
4
5
6
Family/Marital Relationships
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Leisure/Recreation Involvement
*
None
1
2
3
4
Active
5
1 is None, 5 is Active
Companions/Peer Associations
*
Mostly prosocial peers
Mixed peers
Mostly antisocial peers
Alcohol/Drug Use Problems
*
No problems
Occasional problems
Frequent or severe problems
Emotional/Personal Issues
*
None
1
2
3
4
Severe
5
1 is None, 5 is Severe
Attitudes/Orientation
*
Pro-social
Neutral
Anti-social
Problem-Solving/Decision-Making Skills
*
1
2
3
4
5
Motivation to Change
*
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
Submit Assessment
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