Today's date:                 Time:

Patient's Initials:                    Patient Number:  

Study Number:                       Rater's Initials:

RAGE                                                                    how often  in the past 3 days

                                                                           never      >1/3d         >1/d         >1/d

1. Demanding/argumentive?                                0       1         2         3                    

2. Shouted, yelled, screamed?                            0       1         2          3                      

3. Sworn; used abusive language?                       0       1         2         3                   

4. Disobeyed ward rules                                     0       1        2       3                             

5. Uncooperative or resisted help                        0       1         2        3                     

6. Bad mood; irritable, quick to fly
                        off handle?                                0        1        2      3                     

7. Critical, sarcastic, derogatory?                       0       1        2       3                 

8. Impatient; angry if something
                does not suit?                                    0       1         2       3             

9. Threatened to harm, or made

statements to scare others?                               0        1        2        3               

10. Indulged in antisocial acts?                         0         1        2        3                 

11. Pushed or shoved others?                          0         1         2       3       

12. Destroyed property or thrown
            things around angrily?                          0        1          2       3                      

13. Angry with self?                                        0         1         2       3                     

14. Attempted to kick anyone?                       0         1         2        3              

15. Attempted to hit others?                            0         1         2        3                     

16. Attempted to bite, scratch,
            spit at, or pinch others?                      0         1         2        3                    

17. Used an object to lash out or
>                hurt someone?                                0        1         2         3                      

In the past 3 days, has the pt. inflicted any injury on....

                                                                      No             Mild           Mod.         Severe

18. Himself/herself?                                         0        1         2          3                  

19. Others?                                                    0         1         2          3  

                                                                                    No             Yes                  

20. Sedation; isolation; physical restraints?                     0       1   

                                                                    Not at all    Mildly      Moderately     Severely                                              

21. Has pt.'s behavior been aggressive?            0       1          2           3