PREA Sexual Abuse Incident Review

Report Summary – Section 1
Date of incident review: Select date Report #: Enter number
Facility: Choose Facility.
Resident (victim) & IDOC #: Enter name and IDOC number
Suspected perpetrator name and ID number: Enter name and ID number
Type of incident:
☐ Resident on Resident
☐ Contractor or Volunteer on Resident
☐ Staff on Resident
Submitted to law enforcement: Select date Date investigation closed: Select date
Initial allegation summary: Click here to enter text.
Findings: ☐ Unfounded ☐ Unsubstantiated ☐ Substantiated
If unfounded, documentation ends here.
If unsubstantiated or substantiated, complete Section 2.

Section 2
Incident Review Team (list by name and position): Click here to enter text.
Consider if there is a need to change IDOC standard operating procedure or practice to better prevent, detect, or respond to sexual abuse?
☐ Yes ☐ No (If yes, add recommendations.)
Recommendations (if applicable): Click here to enter text.
Consider if the incident was motivated by race, ethnicity, gang affiliation, or other group dynamics, or gender identity status or perceived status (lesbian, gay, bisexual, transgender,
or intersex)
☐ Yes ☐ No (If yes, add recommendations.)
Recommendations (if applicable): Click here to enter text.
Examine the area where the incident occurred to assess if physical barriers or other physical characteristics enabled the abuse.
☐ Yes ☐ No (If yes, add recommendations.)
Recommendations (if applicable): Click here to enter text.
Assess the adequacy of staffing in that area.
☐ Meets ☐ Does Not Meet (If yes, add recommendations.)
Recommendations (if applicable): Click here to enter text.
Assess if monitoring technology should be used to increase surveillance/supervision of residents.
☐ Yes ☐ No (If yes, add recommendations.)
Recommendations (if applicable): Click here to enter text.
Additional recommendations or summary of review team: Click here to enter text.

Facility Head Date

Distribution:
When completed, attach to the PREA investigation report, scan and create a PDF, and email to the PREA Coordinator.