Maslow's Hierarchy of Needs 2

SAFETY NEEDS

MAZLOW'S HIERARCHY OF NEEDS LEVEL 2
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Welcome to the second of five questionnaires, based on Malow's hierarchy of needs. These are designed to help your counsellor better understand your life position, and assist you in devising tools and processes to benefit you.

Rate each statement from 0 = “not at all true for me” to 10 = “completely true for me.” quickly with your first honest number.

You must provide a number for each statement

Once you have submitted the questionnaire, we will contact you within a week to discuss with you how you would like to progress.

PERSONAL SECURITY
I feel safe walking in my neighbourhood at the hours I keep.*
My home has locks, lighting, and other features that enhance security.*
I seldom worry about becoming a victim of violence or theft.*
Measures are in place that reduce personal risk in daily life.*
Emergency services are reachable and responsive where I live.*
Past experiences don’t dominate my current sense of safety.*

HEALTH & WELLBEING
I attend routine medical and dental check-ups as recommended.*
I can obtain affordable healthcare and medication when needed.*
My lifestyle habits generally support good physical health.*
I know whom to contact quickly for urgent medical advice.*
Mental-health support is available to me if required.*
I feel capable of managing any ongoing health conditions.*

FINANCIAL SECURITY
My income reliably covers essential expenses.*
I maintain savings or resources to handle emergencies.*
Debt, if any, is at a manageable level.*
Unexpected costs can be met without financial crisis.*
I monitor and understand my financial situation regularly.*
Long-term financial goals feel attainable.*

ENVIRONMENTAL SAFETY
My home is free from serious hazards such as mould or exposed wiring.*
Local air, water, and noise levels don’t threaten my health.*
Basic supplies and information are on hand for local natural disasters.*
Community services exist to assist during environmental emergencies.*
I limit my exposure to pollutants when possible.*
Climate-related risks don’t immediately endanger my living situation.*

ROUTINE & PREDICTABILITY
A consistent daily rhythm provides stability in my life.*
Sudden changes rarely push me into crisis.*
Regular sleep, meals, and activity patterns are in place.*
I can adjust plans without excessive stress.*
Clear schedules improve both productivity and relaxation.*
I enjoy a healthy balance between routine and spontaneity.*

LEGAL & JUSTICE PROTECTION
My fundamental rights are respected where I live and work..*
I can access legal advice or representation if necessary.*
I trust local justice systems to act fairly.*
I don’t face discrimination from authorities or institutions.*
Reporting wrongdoing doesn’t expose me to retaliation.*
Community advocacy groups are available if I need support.*
Should be Empty: