Appendix 8: Sample sexual abuse incident review forms

Quarterly/biannual sexual abuse incident review checklist

Quarterly/biannual sexual abuse incident review checklist

Sexual abuse incident reviews conclude with recommendations for changes. Depending on the frequency of incidents reviewed, the Sexual Abuse Incident Review Checklists could be reviewed twice or four times a year, but they must be conducted at least annually, to determine whether any problems were rectified and recommendations adopted, and, if not, to address any identified issues. This questionnaire can help staff complete the annual report on incidents and corrective actions required under PREA Standard 115.288/388: Data Review for Corrective Action.

Quarterly/Biannual Sexual Abuse Incident Review Checklist

Date of review: ­­­­­­­­­­­­­­­­­­­­­­­­______________________________________________

Review period: Beginning date _______________ End date: __________________________

How many incidents or reports were reviewed? _______________

How many were deemed founded/substantiated? _________________________

How many will be reported to the U.S. Department of Justice as “PREA incidents”? ____

How many were reported to law enforcement? __________________

How many have been referred for prosecution or investigated for prosecution? ________

How many were prosecuted? ________________

Were any founded incidents motivated by the actual or perceived gender identity or sexual orientation of the victim?

No ___

Yes ___  How many? ____   

Describe: ________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Were the recommendations implemented?

List all problems identified and all recommendations.

Consider the following possible categories:

  • Timeliness of review and participation of all responders, including the SART
  • Policies
  • Staff training
  • Resident education
  • Notification of emergency contacts
  • Notification of law enforcement/Involvement of SART in response
  • Timeliness of response
  • Treatment of victim
  • Treatment of alleged perpetrator
  • Facility safety
  1. 1. PROBLEM:
  2. RECOMMENDATION(S):
  3. RECOMMENDATION IMPLEMENTED?
    1. Yes ___ Date of implementation
    2. No ___
      1. What obstacles are interfering with the needed improvements?
      2. How will the problem be addressed?
      3. When will the problem be addressed?
  4. 2. PROBLEM:
  5. RECOMMENDATION(S):
  6. RECOMMENDATION IMPLEMENTED?
    1. Yes ___ Date of implementation
    2. No ___
      1. What obstacles are interfering with the needed improvements?
      2. How will the problem be addressed?
      3. When will the problem be addressed?
  7. 3. PROBLEM:
  8. RECOMMENDATION(S):
  9. RECOMMENDATION IMPLEMENTED?
    1. Yes ___ Date of implementation
    2. No ___
      1. What obstacles are interfering with the needed improvements?
      2. How will the problem be addressed?
      3. When will the problem be addressed?
  10. Overall appraisal:
    1. Are recommendations usually implemented in a timely fashion? If so, please describe the process. If not, are recommendations unrealistic given financial, logistical, staffing, or population issues? Are there systemic issues that need to be addressed, such as communication, leadership, or time?

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