Symptom and Safety Behavior Checklist
This is the section on safety behaviors only from the above document which can be given to patients to fill out.
Checklists for Minors
The following are safety behavior checklists for minors. One version is for parents or can be used by teachers. The second is a self-report form for minors.
Parent Form
Child/Teen Self-Report Form
EmetQ-13
The EmetQ-13 is designed to measure the severity of symptoms. Further info can be found here. The range of scores is 13-65. Scores above 22 are normally considered as diagnostic of emetophobia.
The assessment has three subscales.
Items 1-6 indicate avoidance of travel and places where help isn’t readily available.
Items 7-9 indicate how dangerous exposure to vomit feels to the patient
Items 10-13 indicate avoiding others
SPOVI
Below is the Specific Phobia of Vomiting Inventory (SPOVI). A score above 10 is considered a likely diagnosis of emetophobia. Information on the development of the scale can be found here.
Y-BOCS
You can find a good page with the Y-BOCS (OCD) assessment here. The webpage will calculate the assessment scores and give a severity rating. There is good explanation for it as well.