2014 Survey of Crime and Victimization - Person Level Ap

Appendix B 

Bureau of Justice Statistics

2014 Survey
of Crime and
Victimization

Start Here

6.

„ Please use a black or blue pen to complete this
survey, if available.

In the past 3 years, do you believe crime in
your community has:

n
n
n
n

„ Answer each question by marking ý your

response or filling in a number when necessary.

Gotten better
Stayed the same
Gotten worse
don’t know

Safety
1.

n
n
2.

5.

Yes
No

n
n
8.

Very often
Somewhat often
Rarely
Never

Very often
Somewhat often
Rarely
Never

Yes
No

Yes
No

How would you rate the job law enforcement
is doing in your community?

n
n
n
n
n

Do you think children are safe in your
community?

n
n

Yes
No → GO TO Question 8

7a. If so, were you satisfied with the service
provided?

When you leave your home, how often do you
think about it being broken into or vandalized
while you’re away?

n
n
n
n

Have you ever contacted the local police
department for assistance?

n
n

How often does fear of crime prevent you from
doing things you would like to do?

n
n
n
n
4.

7.

Yes
No

Is there any area right around your home, that
is, within a mile, where you would be afraid to
walk alone at night?

n
n
3.

The Local Police Department

On the whole, is your community a safe place
to live?

Excellent
Good
Fair
Poor
Don’t Know

Your Household

4d. What, if anything, was stolen?

______________________________________
1. Do you own or rent the place where you’re
living?
Own
Rent
Other

4e. Did anyone in your household actually
see the offender?
Yes
No

n
n
n

n

5. In the last 12 months, was anything else
stolen that belonged to your household?

2. How long have you lived at this address?
1 year or less
Less than 5 years, more than 1 year
5 years or more

n
n
n

3. What is this household’s approximate
combined annual income?
Less than $10,000
$10,000 to $19,000
$20,000 to $39,000
$40,000 to $59,000
$60,000 or more

n

Yes

n

No

5a. Were any items stolen physically
from you/other household members (as
in a mugging, stick-up, purse
snatching, or pick-pocketing)?
Yes
No

n
n
n
n
n

n

5b Besides what you already reported on,
did your household have any other
items stolen in the past 12 months?
Yes
No

n

Property Crime/Theft

5c. When was the most recent theft?

These questions are about any time someone stole
or tried to steal things from your household.

Month

4. In the last 12 months, did anyone break in or
try to break in to your home?

n

Yes

n

No

Year

5d. What was stolen?
______________________________________

→ GO TO Question 5

6. In the last 12 months, did any steal a
household car, truck, or other motor vehicle
or use it without permission?

4a. When was the most recent breakin/attempt?
Month

→ GO TO Question 6

Year

4b. How did they break or try to break in?
(pick the lock; break a window; break
a door; through unlocked door)?

n

Yes

n

No

→ GO TO Question 7

6a. When was the most recent theft?
Month

Year

Describe: ____________________________
4c. Did they actually get inside the home?
Yes
No

6b. Did they return your vehicle?
Yes
No

n

n

7. Were the police told about any of these break

ins or thefts (from questions
from 4 to 6)?

n

Yes

No

Does not apply
(nothing stolen)

Crimes Against Persons
The questions on the following pages
ask about whether you or another adult
in your household has experienced a
violent crime in the past 12 months.

8. Please provide a summary of the most recent
break-in or incident where something was
stolen in the past 12 months (provide as
many details as you can recall, such as,
where it happened, when it happened, what
was stolen, and who from your household
was present, if anyone).

Please complete the questions for
PERSON1 on the following page. When
you are done, please continue to
PERSON2, PERSON3, and PERSON4 (if
applicable). Please talk with these other
household adults if you are not sure how
they would answer the questions.

______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________

When the survey is complete, please place it in
the enclosed, postage-paid envelope and place it
in the mail.

People in this Household

If your household would like additional
envelopes, or if you have any other questions,
please contact the survey research team at xxxxxx-xxxx.

A. How many adults age 18 and older
(including yourself), live at this address?
Number of people 18 and older
B. In the spaces below, list up to four adults 18
or older who live at this address. Provide a
first name (or initials), age and gender for
each person 18 or older.
Please put yourself as Person 1 and then the
other adults starting with the youngest.
First Name/Initials

Age

Gender

1.
2.
3.
4.
If you have 5 or more adults living at this address, please

Survey continued on next page …

complete the questionnaire for yourself and the 3 other adults
listed above.

Person 1

Violent Crimes

These questions ask about things that happened to you
personally.

3. In the last 12 months, did anyone hit or
attack you without a weapon?

n

Yes

n

No

→ GO TO Question 4

3a. When was the most recent attack?

1. In the last 12 months, were you knifed, shot
at or attacked with some other weapon by
anyone at all?
Yes

Month

Year

n
n

No

3b. Did they take/steal anything during
any of the attacks?
Yes
No

→ GO TO Question 2

n

1a. When was the most recent attack?
Month

Year

3c. Were you injured during any of these
attacks?
Yes
No

n

1b. Did they take/steal anything during
any of the attacks?
Yes
No

4. In the last 12 months, did anyone take
something directly from you by using force,
such as by a stick-up, mugging or threat?

n

1c. Were you injured during any of these
attacks?
Yes
No

n

Yes

n

No

Yes

n

No

→ GO TO Question 5

4a. When was the most recent attack?

2. In the last 12 months, did anyone threaten
you with a knife, gun or some other weapon?
Please do not include telephone threats.

n

n

Month

Year

4b. Did they take/steal anything during
any of the attacks?
Yes
No

→ GO TO Question 3

n

2a. When was the most recent attack?
Month

Year

4c. Were you injured during any of these
attacks?
Yes
No

n

2b. Did they take/steal anything during
any of the attacks?
Yes
No

n

Person 1 (continued)

8. Were any of these attacks (questions 1 to 6)
committed by a family member,
spouse/partner, boyfriend/girlfriend, or
someone you live with?

the last 12 months, did anyone TRY to

  5. In
attack you (but did not succeed)?

n

Yes

n

No

n

No

Does not apply
(not attacked)

9. Please provide a summary of the most recent
incident where you were attacked/threatened
in the past 12 months (provide as many
details as you can recall, such as, where it
happened, what your injuries were, what was
stolen, who attacked/threatened you, and
who else from your household was present,
if anyone).

→ GO TO Question 6

5a. When was the most recent attack?
Month

Yes

Year

______________________________________
______________________________________

Incidents involving forced or unwanted sexual acts can
occur between strangers, as well as people that know
each other.

______________________________________
______________________________________

6. In the last 12 months, did anyone force you
or threaten you to have sexual intercourse,
oral or anal sex, or any other type of
unwanted sexual activity? Include times
when someone threatened or tried to force
you but did not succeed.

n

Yes

n

No

______________________________________

Person 1 Background
10. What is your age?
11. What is your gender?
Male
Female

n

→ GO TO Question 7

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

n
n

6a. When was the most recent attack?
Month

Year

Yes
No

13. What is your race? Mark one or more
boxes.

n
n
n
n
n
n

6b. Were you injured during any of these
attacks?
Yes
No

n

7. Were any of these attacks (where you said Yes
to any question from 1 to 6) reported to the
police?

n

Yes

No

White
Black, African American
American Indian or Alaska Native
Asian
Native Hawaiian / Pacific Islander
Some other race (specify below)
____________________________

Does not apply
(not attacked)

If there is another adult in the household, proceed to the
next page and answer questions about “Person 2.”
Otherwise please return the questionnaire in the
envelope provided.

Person 2

  Violent Crimes

16. In the last 12 months, did anyone hit or
attack Person2 without a weapon?

n

Yes

These questions ask about things that happened to
Person2 personally.

n

No

14. In the last 12 months, was Person2 knifed,
shot at or attacked with some other weapon
by anyone at all?

16a. When was the most recent attack?

n

Yes

n

No

Month

n

14a. When was the most recent attack?
Year

n

n

No

15. In the last 12 months, did anyone threaten
Person2 with a knife, gun or some other
weapon? Please do not include telephone
threats.

n

Yes

n

No

Yes

No

n

Yes

n

No

→ GO TO Question 18

17a. When was the most recent attack?
Month

Year

17b. Did they take/steal anything during
any of the attacks?

→ GO TO Question 16

n

15a. When was the most recent attack?
Month

No

17. In the last 12 months, did anyone take
something directly from Person2 by using
force, such as by a stick-up, mugging or
threat?

14c. Was Person2 injured during any of
these attacks?
Yes

Yes

16c. Was Person2 injured during any of
these attacks?

14b. Did they take/steal anything during
any of the attacks?
Yes
No

n

Year

16b. Did they take/steal anything during
any of the attacks?

→ GO TO Question 15

Month

→ GO TO Question 17

Year

Yes

No

17c. Was Person2 injured during any of
these attacks?
15b. Did they take/steal anything during
any of the attacks?

n

Yes

n

No

Yes

No

Person 2 (continued)

21. Were any of these attacks (questions 1
to 6) committed by a family member,
spouse/partner, boyfriend/girlfriend, or
someone Person2 lives with?

the last 12 months, did anyone TRY to

  18. In
attack Person2 (but did not succeed)?

n

Yes

n

No

n

No

Does not apply
(not attacked)

22. Please provide a summary of the most recent
incident where Person2 was attacked/
threatened in the past 12 months (provide as
many details as you can recall, such as,
where it happened, what your injuries were,
what was stolen, who attacked/threatened
you, and who else from your household was
present, if anyone).

→ GO TO Question 19

18a. When was the most recent attack?
Month

Yes

Year

______________________________________
Incidents involving forced or unwanted sexual acts can
occur between strangers, as well as people that know
each other.

______________________________________

19. In the last 12 months, did anyone force or
threaten Person2 to have sexual intercourse,
oral or anal sex, or any other type of
unwanted sexual activity? Include times
when someone threatened or tried to force
Person2 but did not succeed.

______________________________________

n

Yes

n

No

______________________________________

______________________________________

Person 2 Background
23. What is Person2’s age?
24. What is Person2’s gender?
Male
Female

n

→ GO TO Question 20

25. Is Person2 of Hispanic, Latino, or Spanish
origin?

19a. When was the most recent attack?
Month

n
n

Year

Yes

n
n
n
n
n
n

No

20. Were any of these attacks (where you said
Yes to any question from 1 to 6) reported to
the police?

n

Yes

No

No

26. What is Person2’s race? Mark one or
more boxes.

19b. Was Person2 injured during any of
these attacks?

n

Yes

Does not apply
(not attacked)

White
Black, African American
American Indian or Alaska Native
Asian
Native Hawaiian / Pacific Islander
Some other race (specify below)
____________________________

If there is another adult in the household, proceed to the
next page and answer questions about “Person 3.”
Otherwise please return the questionnaire in the
envelope provided.

Person 3

  Violent Crimes

29. In the last 12 months, did anyone hit or
attack Person3 without a weapon?

n

Yes

These questions ask about things that happened to
Person3 personally.

n

No

27. In the last 12 months, was Person3 knifed,
shot at or attacked with some other weapon
by anyone at all?
Yes

29a. When was the most recent attack?

→ GO TO Question 30

Month

Year

n
n

→ GO TO Question 28

No

29b. Did they take/steal anything during
any of the attacks?

n

27a. When was the most recent attack?
Month

Year

Yes

No

29c. Was Person3 injured during any of
these attacks?
27b. Did they take/steal anything during
any of the attacks?

n

Yes

n

No

Yes

No

28. In the last 12 months, did anyone threaten
Person3 with a knife, gun or some other
weapon? Please do not include telephone
threats.

n

Yes

n

No

n

Yes

n

No

→ GO TO Question 31

30a. When was the most recent attack?
Month

Year

30b. Did they take/steal anything during
any of the attacks?

→ GO TO Question 29

n

28a. When was the most recent attack?
Month

No

30. In the last 12 months, did anyone take
something directly from Person3 by using
force, such as by a stick-up, mugging or
threat?

27c. Was Person3 injured during any of
these attacks?

n

Yes

Year

Yes

No

30c. Was Person3 injured during any of
these attacks?
28b. Did they take/steal anything during
any of the attacks?

n

Yes

n

No

Yes

No

  34. Were any of these attacks (questions 1 to

Person 3 (continued)

6) committed by a family member,
spouse/partner, boyfriend/girlfriend, or
someone Person3 lives with?

the last 12 months, did anyone TRY to

  31. In
attack Person3 (but did not succeed)?

n

Yes

n

No

n

No

Does not apply
(not attacked)

35. Please provide a summary of the most recent
incident where Person3 was attacked/
threatened in the past 12 months (provide as
many details as you can recall, such as,
where it happened, what your injuries were,
what was stolen, who attacked/threatened
you, and who else from your household was
present, if anyone).

→ GO TO Question 32

31a. When was the most recent attack?
Month

Yes

Year

______________________________________
______________________________________

Incidents involving forced or unwanted sexual acts can
occur between strangers, as well as people that know
each other.

______________________________________
______________________________________

32. In the last 12 months, did anyone force or
threaten Person3 to have sexual intercourse,
oral or anal sex, or any other type of
unwanted sexual activity? Include times
when someone threatened or tried to force
Person3 but did not succeed.

n

Yes

n

No

______________________________________

Person 3 Background
36. What is Person3’s age?
37. What is Person3’s gender?
Male
Female

n

→ GO TO Question 33

38. Is Person3 of Hispanic, Latino, or Spanish
origin?

n
n

32a. When was the most recent attack?
Month

Year

Yes

n
n
n
n
n
n

No

33. Were any of these attacks (where you said
Yes to any question from 1 to 6) reported to
the police?

n

Yes

No

No

39. What is Person3’s race? Mark one or
more boxes.

32b. Was Person3 injured during any of
these attacks?

n

Yes

White
Black, African American
American Indian or Alaska Native
Asian
Native Hawaiian / Pacific Islander
Some other race (specify below)
____________________________

Does not apply
(not attacked)

If there is another adult in the household, proceed to the
next page and answer questions about “Person 4.”
Otherwise If there is another adult in the household,
proceed to the next page and answer questions about
“Person 2.” Otherwise please return the questionnaire in
the envelope provided.

Person 4

  Violent Crimes

42. In the last 12 months, did anyone hit or
attack Person4 without a weapon?

n

Yes

These questions ask about things that happened to
Person4 personally.

n

No

40. In the last 12 months, was Person4 knifed,
shot at or attacked with some other weapon
by anyone at all?
Yes

42a. When was the most recent attack?

→ GO TO Question 43

Month

Year

n
n

→ GO TO Question 41

No

42b. Did they take/steal anything during
any of the attacks?

n

40a. When was the most recent attack?
Month

Year

Yes

No

42c. Was Person4 injured during any of
these attacks?
40b. Did they take/steal anything during
any of the attacks?

n

Yes

n

No

Yes

No

41. In the last 12 months, did anyone threaten
Person4 with a knife, gun or some other
weapon? Please do not include telephone
threats.

n

Yes

n

No

n

Yes

n

No

→ GO TO Question 44

43a. When was the most recent attack?
Month

Year

43b. Did they take/steal anything during
any of the attacks?

→ GO TO Question 42

n

41a. When was the most recent attack?
Month

No

43. In the last 12 months, did anyone take
something directly from Person4 by using
force, such as by a stick-up, mugging or
threat?

40c. Was Person4 injured during any of
these attacks?

n

Yes

Year

Yes

No

43c. Was Person4 injured during any of
these attacks?
41b. Did they take/steal anything during
any of the attacks?

n

Yes

n

No

Yes

No

Person 4 (continued)

47. Were any of these attacks (questions 1 to 6)
committed by a family member,
spouse/partner, boyfriend/girlfriend, or
someone Person4 lives with?

the last 12 months, did anyone TRY to

  44. In
attack Person4 (but did not succeed)?

n

Yes

n

No

n

No

Does not apply
(not attacked)

48. Please provide a summary of the most recent
incident where Person4 was
attacked/threatened in the past 12 months
(provide as many details as you can recall,
such as, where it happened, what your
injuries were, what was stolen, who
attacked/threatened you, and who else from
your household was present, if anyone).

→ GO TO Question 45

44a. When was the most recent attack?
Month

Yes

Year

______________________________________
Incidents involving forced or unwanted sexual acts can
occur between strangers, as well as people that know
each other.

______________________________________

45. In the last 12 months, did anyone force or
threaten Person4 to have sexual intercourse,
oral or anal sex, or any other type of
unwanted sexual activity? Include times
when someone threatened or tried to force
Person4 but did not succeed.

______________________________________

n

Yes

n

No

______________________________________

______________________________________

Person 4 Background
49. What is Person4’s age?
50. What is Person4’s gender?
Male
Female

n

→ GO TO Question 46

51. Is Person4 of Hispanic, Latino, or Spanish
origin?

45a. When was the most recent attack?
Month

n
n

Year

Yes

n
n
n
n
n
n

No

46. Were any of these attacks (where you said
Yes to any question from 1 to 6) reported to
the police?

n

Yes

No

No

52. What is Person4’s race? Mark one or
more boxes.

45b. Was Person4 injured during any of
these attacks?

n

Yes

Does not apply
(not attacked)

White
Black, African American
American Indian or Alaska Native
Asian
Native Hawaiian / Pacific Islander
Some other race (specify below)
____________________________

Thank you. Please return survey in
the envelope provided.