My risk - Self Assessment

1. Have I ever received a blood transfusion or blood products?

Yes No

2. Have I ever used intravenous drugs (needles or syringes)?

Yes No

3. Have I ever gotten a tattoo?

Yes No

4. Have I ever gotten a body piercing (ears included)?

Yes No

5. Have I ever had unprotected sex?

Yes No

6. Have I ever been in a correctional facility (prison, jail, detention centre)?

Yes No

7. Do I live in an environment where I could potentially be exposed to the hepatitis C virus?

Yes No

8. Do I work in an environment where I could potentially be exposed to the hepatitis C virus?

Yes No

9. Have I ever experienced periods of homelessness?

Yes No

10. Have I ever received personal services (manicures, pedicures, hair salons and barber shops)?

Yes No

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