Form D NIS PAPI

OMB No.: 1121-0311
Exp.: 01/31/2010

N ATIONAL I NMATE
S URVEY
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 1121-0311.

 6. Are you currently being held in this facility for
any of the following:

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

Mark x “ Yes” or “No” for each item.

1. 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.

A drug offense, such as possessing, selling, c c
1
2
or manufacturing drugs?

No

A violent offense, such as physical or
sexual assault, rape, robbery, manslaughter, c 1 c 2
attempted murder, or murder?

_________ / __________ / _________
Month
Day
Year

2. How old are you?

A property offense, such as burglary,
­larceny, auto theft, bad checks, fraud,
­forgery, or grand theft?

c 1 c 2

Any other offense?

c 1 c 2

7. How long have you been in this facility?

Age: ______

3. Are you of Hispanic, Latino, or Spanish origin?

Yes.............................................................. c 1

No.............................................................. c 2

4. Which of these categories describes your race:
Mark x “ Yes” or “No” for each item.

Yes

Yes

No

White

c 1 c 2

Black or African American

c 1 c 2

American Indian or Alaska Native

c 1 c 2

Asian

c 1 c 2

High school graduate or GED................... c 2

Some college.............................................. c 3

College degree or more.............................. c 4

At least 1 week but less than 1 month....... c 2

At least 1 month but less than 2 months... c 3

At least 2 months but less than 6 months... c 4

At least 6 months but less than 1 year........ c 5

At least 1 year but less than 5 years............ c 6

At least 5 years but less than 10 years........ c 7

10 years or more......................................... c 8

Yes.............................................................. c 1

No.............................................................. c 2

9. Do you consider yourself to be:

5. What is the highest level of school you have
­completed?
Less than a high school graduate............... c 1

Less than 1 week........................................ c 1

8. Before you were admitted to this facility, had you
ever spent time as an adult or juvenile in a prison,
jail, or other correctional facility?

Native Hawaiian or other Pacific Islander c 1 c 2

1

Heterosexual or ‘Straight’........................... c 1

Bi-sexual.................................................... c 2

Homosexual or Gay................................... c 3

Other......................................................... c 4

 10. Before you entered this facility, had anyone ever
physically forced, pressured, or made you feel
you had to have sex or sexual contact – that is
unwanted touching of the genitals or butt, or
vaginal, oral, or anal sex?

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.

14. Since you arrived at this facility, did another
­inmate use physical force to make you do any of
the following:

Yes........................... c 1 → Continue to item 11
No........................... c 2 → Go to item 12

11. Were you physically forced, pressured, or made to
feel you had to have sex or sexual contact before
you were 18 years old, after you turned 18, or both?

Mark x “ Yes” or “No” for each item.

Before you were 18..................................... c 1

After you turned 18.................................... c 2

Give them a handjob or receive a handjob c c
1
2
from them?

Both........................................................... c 3

Touch their body in a sexual way or have
your body touched in a sexual way?

12. Before you entered this facility, were you
physically forced, pressured, or made to feel that
you had to have sex or sexual contact while you
were an adult or juvenile in a jail, prison, or other
correctional facility?

Yes.............................................................. c 1

No.............................................................. c 2

Yes

c 1 c 2

Have anal sex with them?

c 1 c 2

Touch their body in a sexual way or have
your body touched in a sexual way?

Touch another inmate’s body in a sexual
way or have your body touched in a sexual c 1 c 2
way?

Have oral sex (blowjob) with another
inmate at this facility?

c 1 c 2

Yes

No

c 1 c 2

Give them a handjob or receive a handjob c c
1
2
from them?

No

c 1 c 2

c 1 c 2

Have oral sex (blowjob) with them?

Mark x “ Yes” or “No” for each item.

Give or receive a handjob from another
inmate at this facility?

No

15. 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:

13. 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:
Mark x “ Yes” or “No” for each item.

Yes

Have oral sex (blowjob) with them?

c 1 c 2

Have anal sex with them?

c 1 c 2

16. Since you arrived at this facility, how many times
altogether were you physically forced, pressured,
or made to feel like you had to have sex or sexual
contact with another inmate?

Have anal sex with another inmate at this c c
1
2
facility?

2

0 times..................... c 1 → Go to SECTION B on page 4
1 time...................... c 2

2 times..................... c 3

3 – 10 times............. c 4

11 times or more..... c 5

}

→ Continue to item 17 on page 3

 17. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel
that you had to have sex or sexual contact with
another inmate, did it ever happen during any of
the ­following times:
Mark x “ Yes” or “No” for each item.
Between 6:00 in the morning and noon?

Yes

19. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, were you ever:
Mark x “ Yes” or “No” for each item.

No

c 1 c 2

After noon but before 6:00 in the evening? c 1 c 2
After 6:00 in the evening but before
midnight?

c 1 c 2

After midnight but before 6:00 in the
morning?

c 1 c 2

18. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, did it ever happen:
Mark x “ Yes” or “No” for each item.

Yes

Yes

No

Persuaded or talked into it?

c 1 c 2

Given a bribe or blackmailed?

c 1 c 2

Given drugs or alcohol to get you drunk
or high?

c 1 c 2

Offered protection from other inmates?

c 1 c 2

Trying to pay off or settle a debt that you
owed?

c 1 c 2

Threatened with harm or a weapon?

c 1 c 2

Physically held down or restrained?

c 1 c 2

Physically harmed or injured?

c 1 c 2

20. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, did you ever:

No

In your own cell, room, or sleeping area?

c 1 c 2

In the cell, room, or housing unit of
another inmate?

c 1 c 2

In a shower or bathroom?

c 1 c 2

In the yard or recreation area?

c 1 c 2

In a classroom or library?

c 1 c 2

In a workshop, kitchen, or other
workplace?

c 1 c 2

In a closet, office, or other locked room?

c 1 c 2

c 1 c 2

On the stairs?

Receive internal injuries?

c 1 c 2

c 1 c 2

Somewhere else in the facility?

Get knocked unconscious?

c 1 c 2

Off facility grounds?

c 1 c 2

Receive bruises, a black eye, sprains, cuts,
scratches, swelling, or welts?

c 1 c 2

Mark x “ Yes” or “No” for each item.

Yes

No

Receive knife or stab wounds?

c 1 c 2

Receive broken bones?

c 1 c 2

Receive anal tearing?

c 1 c 2

Have your teeth chipped or knocked out? c 1 c 2

3

 21. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, did you report it to any of the following
people:
Mark x “ Yes” or “No” for each item.

Yes

23. Since you arrived at this facility, did a facility staff
person use physical force to make you do any of
the following:
Mark x “ Yes” or “No” for each item.

No

A correctional officer?

c 1 c 2

An administrative staff person?

c 1 c 2

A medical or healthcare staff person?

c 1 c 2

An instructor or teacher?

c 1 c 2

A counselor or other mental health care
provider?

c 1 c 2

A chaplain or other religious official?

c 1 c 2

A volunteer?

c 1 c 2

Some other type of facility staff person?

c 1 c 2

A telephone hotline?

c 1 c 2

Another inmate?

c 1 c 2

A family member or friend?

c 1 c 2

c 1 c 2

Have oral sex (blowjob) with them?

c 1 c 2

Have vaginal sex with them?

c 1 c 2

Have anal sex with them?

c 1 c 2

Mark x “ Yes” or “No” for each item.

Yes

No

Touch their body in a sexual way or have
your body touched in a sexual way?

c 1 c 2

Have oral sex (blowjob) with them?

c 1 c 2

Have vaginal sex with them?

c 1 c 2

Have anal sex with them?

c 1 c 2

Give them a handjob or receive a handjob c c
1
2
from them?

25. This question is about both wanted and unwanted
sex with staff at this facility. 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?

22. This question is about willing sex or sexual contact
you have had with any staff at this facility. Since
you arrived at this facility, did you do any of the
following:
Yes

No

Touch a facility staff person’s body in a
sexual way or have your body touched in a c 1 c 2
sexual way?

Have oral sex (blowjob) with a facility
staff person?

Touch their body in a sexual way or have
your body touched in a sexual way?

24. 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 do any of the
following:

These next questions ask about 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.

Give or receive a handjob from a facility
staff person?

No

Give them a handjob or receive a handjob c c
1
2
from them?

SECTION B

Mark x “ Yes” or “No” for each item.

Yes

c 1 c 2
c 1 c 2

Have vaginal sex with a facility staff
person?

c 1 c 2

Have anal sex with a facility staff person?

c 1 c 2

4

0 times..................... c 1 → Go to SECTION C on page 6

1 time...................... c 2

2 times..................... c 3

3 – 10 times............. c 4

11 times or more..... c 5

}

→ Continue to item 26 on page 5

 26. 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?

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

Yes

No

Persuaded or talked into it?

c 1 c 2

Given a bribe or blackmailed?

c 1 c 2

Given drugs or alcohol to get you drunk
or high?

c 1 c 2

Offered protection from other inmates?

c 1 c 2

Offered protection from another
correctional officer?

c 1 c 2

Trying to pay off or settle a debt that you
owed?

c 1 c 2

After noon but before 6:00 in the evening? c 1 c 2

Threatened with harm or a weapon?

c 1 c 2

After 6:00 in the evening but before
midnight?

c 1 c 2

Physically held down or restrained?

c 1 c 2

After midnight but before 6:00 in the
morning?

c 1 c 2

c 1 c 2

Physically harmed or injured?

Yes ............................................................. c 1

No.............................................................. c 2

27. 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 x “ Yes” or “No” for each item.
Between 6:00 in the morning and noon?

Yes

No

c 1 c 2

30. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, was it ever
with:

28. Since you arrived at this facility, when you had
sex or sexual contact with facility staff, did it ever
happen:
Mark x “ Yes” or “No” for each item.

Yes

Mark x “ Yes” or “No” for each item.

No

In your own cell, room, or sleeping area?

c 1 c 2

In the cell, room, or housing unit of
another inmate?

c 1 c 2

In a shower or bathroom?

c 1 c 2

In the yard or recreation area?

c 1 c 2

In a classroom or library?

c 1 c 2

In a workshop, kitchen, or other
workplace?

Yes

No

Male facility staff?

c 1 c 2

Female facility staff?

c 1 c 2

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

Yes

No

Receive knife or stab wounds?

c 1 c 2

c 1 c 2

Receive broken bones?

c 1 c 2

In a closet, office, or other locked room?

c 1 c 2

Receive anal tearing?

c 1 c 2

On the stairs?

c 1 c 2

Somewhere else in the facility?

c 1 c 2

Off facility grounds?

c 1 c 2

Have your teeth chipped or knocked out? c 1 c 2

5

Receive internal injuries?

c 1 c 2

Get knocked unconscious?

c 1 c 2

Receive bruises, a black eye, sprains, cuts,
scratches, swelling, or welts?

c 1 c 2

 32. 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 x “ Yes” or “No” for each item.

Yes

SECTION C
These last two questions are about your experience
with this survey.

No

A correctional officer?

c 1 c 2

An administrative staff person?

c 1 c 2

A medical or healthcare staff person?

c 1 c 2

An instructor or teacher?

c 1 c 2

A counselor or other mental health care
provider?

Not upsetting at all.................................... c 1

c 1 c 2

A chaplain or other religious official?

c 1 c 2

Somewhat upsetting................................... c 2
Very upsetting............................................ c 3

A volunteer?

c 1 c 2

Some other type of facility staff person?

c 1 c 2

34. How accurate are the answers you gave in this
­survey?

A telephone hotline?

c 1 c 2

Not very accurate....................................... c 1

Another inmate?

c 1 c 2

Fairly accurate............................................ c 2

A family member or friend?

c 1 c 2

Very accurate.............................................. c 3

33. How upsetting did you find it to answer questions
about your own experiences with sex and sexual
­assault in this facility?

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

6