AGIM (Aggression Incident Measurement)

  You have been trained and have applied the Aggression Intervention Program AGGRIP® on a specific aggressive resident.
  Now YOU and your experience are IMPORTANT!
  You should fill in the questionnaire after every AGGRIP® implementation cycle; even if the same resident is concerned. This way - as time continues - the questionnaire should be filled in many times by the same or different users in every institution. Note the number of implementation cycles that have been applied on the aggressive resident.
  Thank you very much for taking 5 minutes to fill in the questionnaire.


Information about your institution (all information will be treated confidentially)

Name of your institution    *
What is your occupation  
When were you trained in AGGRIP®    (date)
When did you last implement AGGRIP®      (date)
What is YOUR...   Age:   (years)        Gender:   male  female
How severely challenged was
the aggressive resident 
  Mentally challenged:   *
   severely    midrange    slightly  
    Physically challenged: *
     severely    midrange    slightly    not at all
What is the gender
of the aggressive RESIDENT? 
   male         female  *

How many cycles have you been
implementing AGGRIP® on the
aggressive resident?
    (number of cyles)  *
('*' = input necessary)


Please answer the following questions by clicking ONE answer.

1. How intense was the recent aggressive incident? * (input necessary)
very strong strong fair medium moderate low very low

(attack resulting in injury)

(attack resulting in damage) (attack with no con-sequence) (intended attack) (irritating, threatening) (irritating but harmless) (provo-cations)

2. Did the AGGRIP® training help to prevent severe harm or injury during the recent incident? *
It was not helpful at all It was not helpful It didn't really help me I don't know It was a slight support It was a support It helped to entirely prevent

3. How capable do you feel after using AGGRIP® during the recent incident? *
helpless less competent somewhat less competent as competent as before somewhat more competent more competent very competent

4. Confronted with the recent aggression; how anxious do you feel after using AGGRIP®? *
full of fear more fearful than before somewhat more fearful as fearful as before a little bit less fearful less fearful not fearful at all

5. What was the overall effect on the resident and you after the recent application of AGGRIP®? *

total disaster very negative negative fairly negative none fairly positive positive very positive total improvement

6. How safe do you personally feel after having applied AGGRIP®? *

totally consigned less safe somewhat less safe as safe as before a little bit safer safer very safe

7. How did you feel after training AGGRIP® and BEFORE your first intervention? *
bored about the theme anxious unprotected the same as always safe good interested in learing more

You have been applying AGGRIP® since (date) in your institution:  *

8. After the application of AGGRIP® the intensity of aggressive incidents became... *

much more intensive more intensive fairly more intensive the same as before fairly less intensive less intensive much less intensive

9. Since the first implementation of AGGRIP®, has the number of weekly incidents changed? *
the number is much higher the number is higher the number is somewhat higher no the number is somewhat lower the number is lower the number is much lower

10. Is there any other feedback which you would like to give us? (voluntary)

Your E-mail address:     (voluntary)

Thank you very much for your participation!

Contact:    Robin Mindell, AGGRIP® Project Manager
  Ihre IP-Adresse: