xxx National Inmate Survey

National Inmate Survey....
Conducted by the Bureau of Justice Statistics and RTI International

.

NOTICE: Public reporting for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Director, Bureau of
Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531 . An agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is xxxx-xxxx.

7. Did you receive a high school diploma or GED?

SECTION A.
Please answer the question in the space provided or
mark your answer in the box, like this ⌧. To protect your
privacy, do not put your name on this questionnaire.

1. How old are you?
Age: ______

Yes ................................................................
No..................................................................

8. On what date were you admitted to this facility?
If you cannot remember the exact date, please write down
whatever you can remember, such as the year and the
month.
_________ / __________ / _________
Month
Day
Year

2. Are you of Hispanic, Latino, or Spanish origin?
Yes.................................................................
No ..................................................................

3. Which of these categories describes your race?
Mark all that apply.
White .............................................................
Black or African American............................
American Indian or Alaska Native ................
Asian..............................................................
Native Hawaiian or other Pacific Islander .....

4. Are you currently married widowed, divorced or
separated, or have you never been married?
Married ..........................................................
Widowed........................................................
Divorced ........................................................
Separated (For reasons other than incarceration)
Never been married .......................................

9. Are you currently being held in this facility for
any of the following:
Mark ⌧ “Yes” or “No” for each item.
A violent offense, such as physical or sexual
assault, rape, robbery, manslaughter, attempted
murder, or murder?
A drug offense, such as possessing, selling, or
manufacturing drugs?
A property offense, such as burglary, larceny,
auto theft, bad checks, fraud, forgery, or grand
theft?
Any other offense?

Yes

No

10. How long have you been in this facility?
Less than 1 month .........................................
At least 1 month but less than 6 months........
At least 6 months but less than 1 year ...........
At least 1 year but less than 5 years ..............
At least 5 years but less than 10 years ...........
10 years or more............................................

5. How tall are you?
Feet: ______
Inches: ______

6. How much do you currently weigh?
Pounds: ______

11. This question is about wanted or voluntary sex or
sexual contact you have had with other inmates
in this facility. Since you arrived at this facility,
did you do any of the following:

1

Mark ⌧ “Yes” or “No” for each item:

Yes

No

Touch another inmate’s body in a sexual way or
have your body touched in a sexual way?
Give or receive a handjob from another inmate
at this facility?
Have oral sex (blowjob) with another inmate at
this facility?

15. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did any single
incident ever involve more than one inmate?
Yes ................................................................
No..................................................................

Have anal sex with another inmate at this facility?

These next questions ask about unwanted sex or sexual
contact you have had with other inmates in this facility.
By unwanted, we mean sex or sexual contact that you
did not want to happen.
12. Since you arrived at this facility, did another
inmate use physical force to make you do any of
the following:
Mark ⌧ “Yes” or “No” for each item:

Yes

No

Touch their body in a sexual way or have your
body touched in a sexual way?
Give them a handjob or receive a handjob from
them?

16. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did it ever happen
during any of the following times:
Mark ⌧ “Yes” or “No” for each item:

Yes No

Between 6:00 in the morning and noon?
After noon but before 6:00 in the evening?
After 6:00 in the evening but before midnight?
After midnight but before 6:00 in the morning?

Have oral sex (blowjob) with them?

17. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did it ever
happen:

Have anal sex with them?

13. Since you arrived at this facility, did another
inmate, without using physical force, pressure
you or make you feel that you had to do any of
the following:
Mark ⌧ “Yes” or “No” for each item:

Yes

Mark ⌧ “Yes” or “No” for each item:
No

Yes

No

In your own cell, room, or sleeping area?

Touch their body in a sexual way or have your
body touched in a sexual way?
Give them a handjob or receive a handjob from
them?

In the cell or room of another inmate?

Have oral sex (blowjob) with them?

In a classroom or library?

Have anal sex with them?

In a workshop, kitchen, or other workplace?

In a shower or bathroom?
In the yard or recreation area?

In a closet, office or other locked room?

14. Since you arrived at this facility, how many times
altogether were you physically forced, pressured,
or made to feel like you had to give another
inmate a handjob or have oral sex or anal sex
with them?
0 times ...................
1 -2 times ...............
3 - 5 times ..............
5 - 10 times ............
11 or more times ..

€ Go to SECTION B, page 3

Somewhere else in the facility?
Off facility grounds?

18. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, were you ever:

Continue to item 15

2

Mark ⌧ “Yes” or “No” for each item:

Yes

No

Persuaded or talked into it?
Given a bribe or blackmailed?
Given drugs or alcohol to get you drunk or high?

22. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did you report it
to any of the following people:

Offered protection from other inmates?

Mark ⌧ “Yes” or “No” for each item:

Threatened with harm or a weapon?

A correctional officer?

Physically held down or restrained?

An administrative staff person?

Physically harmed or injured?

A medical or healthcare staff person?

Yes

No

An instructor, teacher, or counselor?

19. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did it ever involve
an inmate of a different race than yours?

20. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, was it ever
initiated by a gang?

21. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to give another inmate a handjob or have
oral sex or anal sex with them, did you ever:

Receive knife or stab wounds?
Receive broken bones?
Receive anal tearing?
Have your teeth clipped or knocked out?

SECTION B.

23. Since you arrived at this facility, have you
willingly had sex or sexual contact with any staff
at this facility?
Yes ................................................................
No..................................................................

Yes.................................................................
No ..................................................................

Yes

Some other facility staff person?

These next questions are about wanted or unwanted sex or
sexual contact you have had with staff at this facility. By
staff, we mean the employees of this facility and anybody
who works as a volunteer in this facility.

Yes.................................................................
No ..................................................................

Mark ⌧ “Yes” or “No” for each item:

A volunteer?

No

24. Since you arrived at this facility, did a facility
staff person use physical force to make you have
sex or sexual contact with them?
Yes ................................................................
No..................................................................

25. Since you arrived at this facility, did a facility
staff person, without using physical force,
pressure you or make you feel that you had to
have sex or sexual contact with them?
Yes ...............................................................
No..................................................................

Receive internal injuries?
Get knocked unconscious?
Receive bruises, a black eye, sprains, cuts,
scratches, swelling, or welts?
Receive some other injury?

3

26. Since you arrived at this facility, how many times
altogether have you had any type of wanted or
unwanted sex or sexual contact with staff at this
facility?
0 times ...................
1 -2 times ...............
3 - 5 times ..............
5 - 10 times ............
11 or more times ..

€ Go to END, page 4

In the yard or recreation area?
In a classroom or library?
In a workshop, kitchen, or other workplace?
In a closet, office or other locked room?
Somewhere else in the facility?

Continue to item 27

27. Which of the following types of sex or sexual
contact did you have with a facility staff person?
Mark ⌧ “Yes” or “No” for each item:

Yes

No

Off facility grounds?

31. Since you arrived at this facility, when you had
sex or sexual contact with facility staff were you
ever:
Mark ⌧ “Yes” or “No” for each item:

No

Persuaded or talked into it?

You touched a facility staff person’s body in a
sexual way or had your body touched in a sexual
way?
You gave or received a handjob?

Given a bribe or blackmailed?

You gave or received oral sex?

Threatened with harm or a weapon?

Given drugs or alcohol to get you drunk or high?
Offered protection from other inmates?

You had vaginal sex?

Physically held down or restrained?

You had anal sex?

Physically harmed or injured?

28. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did any
single incident ever involve more than one facility
staff person?
Yes ................................................................
No ..................................................................

Yes

32. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, was it
ever with the following:
Mark ⌧ “Yes” or “No” for each item:

Yes

No

Male facility staff?
Female facility staff?

29. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did it
ever happen during any of the following times:
Mark ⌧ “Yes” or “No” for each item:

Yes

No

Between 6:00 in the morning and noon?
After noon but before 6:00 in the evening?

33. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did you
ever:

After 6:00 in the evening but before midnight?

Mark ⌧ “Yes” or “No” for each item:

After midnight but before 6:00 in the morning?

Receive knife or stab wounds?

Yes

No

Receive broken bones?

30. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did it ever
happen:
Mark ⌧ “Yes” or “No” for each item:
In your own cell, room, or sleeping area?
In the cell or room of another inmate?
In a shower or bathroom?

Yes

No

Receive anal or vaginal tearing?
Have your teeth clipped or knocked out?
Receive internal injuries?
Get knocked unconscious?
Receive bruises, a black eye, sprains, cuts,
scratches, swelling, or welts?
Some other injury?

4

34. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did you
ever report it to any of the following people:
Mark ⌧ “Yes” or “No” for each item:

Yes

No

A correctional officer?
An administrative staff person?
A medical or healthcare staff person?
An instructor, teacher, or counselor?
A volunteer?
Some other facility staff person?

END QUESTIONNAIRE
These last two questions are about your
experience with this questionnaire.
35. How upsetting did you find it to answer

questions about your own experiences with
sex and sexual assault in this facility?
Not upsetting at all.........................................
Somewhat upsetting.......................................
Very upsetting ...............................................

36. How accurate and complete are the answers you
gave in this questionnaire?
Not very accurate and complete ....................
Fairly accurate and complete .........................
Very accurate and complete...........................

After you have completed the survey, please put
it in the envelope and seal it before you turn it in.
Thank you!

5