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Have I injured myself or my children, for instance by intemperance? | 
How often?
 
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Have I endangered or injured the life of my child before its birth by immoderate anxiety, worry, over-exertion, consumption of drugs and alcohol, or utilizing medical treatment that could cause a miscarriage? | 
How often?
 
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Have I hated any of my children; cursed them; given them scandal by cursing, drinking, drug abuse, living openly in fornication, adultery or bigamy etc.? | 
How often?
 
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Have I allowed them to grow up in ignorance, idleness, or sin? | 
For how long?
 
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Have I showed habitual partiality, without cause? | 
How often?
 
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Have I been negligent to procure that my children should be speedily baptized or that they should be timely instructed in their prayers and the Catholic Doctrine? | 
How often?
 
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Have I failed in giving them early instruction in the fear and love of God? | 
How often?
 
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Have I neglected to watch over their bodily health or provide for their necessities? | 
How often?
 
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Though separated from my spouse, have I failed to provide child support? | 
For how long a time?
 
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Have I refused or failed to remove from them bad companions, books, movies, music and other occasions of sin or allowed them to develop any habits dangerous to chastity, faith or morals? | 
How often?
 
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Have I flattered them in their passions, or indulged them in their evil inclinations? | 
How often?
 
  | 
Have I taught them sinful vices or concealed and shielded their wrong doings? | 
How often?
 
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Have I failed to prudently correct or charitably punish them when needful for their own good? | 
How often?
 
  | 
Have I been harsh or cruel in correction? | 
How often?
 
  | 
Have hit or physically abused my children? | 
How often?
 
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Have I verbally abused my chilren? | 
How often?
 
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Have I neglected other people's children that were entrusted to my care? | 
How often?
 
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Have I let boys and girls sleep together or in the same room as me and my spouse? | 
How often?
 
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Have I sent any of my children to Protestant or other dangerous schools to their faith? | 
For how long and how many of my children?
 
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Have I forced my children into marriage or religious life against their will, or opposed their choice obstinately and without good reason? | 
Circumstances?
 
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For Husbands and Wives:
 
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| 
Have I treated my spouse poorly or put obstacles to the fulfillment of their religious duties? | 
How often?
 
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Have I struck or beaten my spouse? | 
How often?
 
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Have I lacked gentleness and consideration in regard to each other's faults? | 
How often?
 
  | 
Have I been guilty of unreasonable jealousy? | 
How often?
 
  | 
Have I neglected my household duties? | 
How often?
 
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Have I been guilty of sulkiness or said injurious words? | 
How often?
 
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For Employers:
 
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| 
Have I not allowed domestics/ employees reasonable time for religious duties and instruction? | 
How often?
 
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Have I given bad example to them, or allowing others to do so? | 
How often?
 
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Have I withholding their lawful wages? | 
Amount and how often?
 
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Have I failed to care for them in sickness? | 
How often?
 
  | 
Have I dismissed them arbitrarily and without cause? | 
How many and how often?
 
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For the Employed:
 
  | 
| 
Have I been disrespectful to my employer? | 
How often?
 
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Have I been disobedient in matters wherein one has bound one's self to obey? | 
How often?
 
  | 
Have I wasted time and neglected my work? | 
How often?
 
  | 
Have I been an unjust steward of my employer's property, by dishonesty, carelessness, or neglect? | 
Amount of damages monetarily?
 
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For Professional Men and Public Officials:
 
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| 
Have I been culpably lacking in the knowledge related to the duties of my office or profession? | 
How long has this been?
 
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Have I been negligent in the discharge of my duties, unjust or showed partiality? | 
How often?
 
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Have I charged exorbitant fees (undue amount)? | 
Amount and how often?
 
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For Teachers:
 
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| 
Have I neglected the progress of those confided to my care? | 
How often?
 
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Have I been unjust, indiscreet, or excessively punished? | 
How often?
 
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Have I been guilty of partiality, bad example, loose and false maxims? | 
How often?
 
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For Pupils:
 
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| 
Have I been disrespectful, disobedient, stubborn, idle, or wasted time? | 
How often?
 
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