Interview - Law Enforcement Officials

School Associated Violent Deaths Surveillance System

Attachment 10 - Law Enforcement Interview

Interview - Law Enforcement Officials

OMB: 0920-0604

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Attachment 10

Law Enforcement Interview

Form Approved

OMB NO: 0920-0604

Exp. Date: 1/31/2013

Public reporting burden of this collection of information is estimated at 1 hour 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. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/Information Collection Review Office, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-0604).

National Center for Injury Prevention and Control

Division of Violence Prevention

National Institute of Justice

National School Safety Center

U.S. Department of Education

School Associated Violent Deaths in the United States

Data Collection Instrument

LAW ENFORCEMENT INTERVIEW

INSTRUCTIONS:

Investigators should record their investigator number in space provided.
Before beginning the interview, be certain to read the telephone script that explains the study and contains the statement of informed consent. DO NOT RECORD ANY IDENTIFYING INFORMATION.
Record the preassigned Event Number in the space provided.
Instructions for the investigator are written in italics, this information should not be read to the respondents.
Information written in bold face is to be read to the respondent, unless specifically stated otherwise.

Date of data collection (code four-digit years) _ _/_ _/_ _ _ _

Investigator Identifier Code _ _

Case ID Number _ _ _ _ _

General Questions

G01. Did you participate in the original investigation of this event? Up to five respondents can be captured using the items below. Coding should reflect actual participant number up to five.

G01a. Respondent 1

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

G01b. Respondent 2

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

G01c. Respondent 3

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

G01d. Respondent 4

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

G01e. Respondent 5

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

*If respondent did not participate in the original investigation, skip to Question #G03, page P3 .... otherwise, proceed with Question #G02

G02. What role(s) did you play in the investigation?

G02a. Respondent 1Code later

G02b. Respondent 2

Code later

G02c. Respondent 3

Code later

G02d. Respondent 4

Code later

G02e. Respondent 5

Code later

G03. Where did the injury event occur?

Read options

1= on school property

2= on the way to or from the campus*

3= at an off-campus school-sponsored event*

4= on the way to or from a school sponsored event*

6= other* (specify..............................................................................................)

8= unknown*

9= refused to answer

*If option 1 is selected, proceed to Question #S01

*If option 3 is selected, skip to Question # SOC01, page 6

*If option 2, 4, or 6 are selected, skip to Question #E03, page P10

QUESTIONS about the school (for events occurring on school property)

S01. Our study defines a school associated violent death as a suicide, homicide or legal intervention related death that occurred on school property, on the way to or from school, or at or on the way to or from a school sponsored event. Has this school ever experienced another violent death that meets this definition?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

S02. During the time when the event of interest occurred, did the school regularly use paid law enforcement or security services---

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

	Code
S02.a) At any time during school hours
S02.b) While students were arriving and/or leaving
S02.c) At selected school activities (e.g., athletic and social events, open houses, science fairs)
S02.d) When school/school activities not occurring
S02.e) Other (please specify)

S03. At the time when the event occurred did the school use full-time security personnel?

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

*If school did not use full-time security personnel, skip to Question #S04 otherwise, proceed with Question #S03.a [If no, SKIP TO S04]

S03.a______Number of School Resource Officers/Sworn Law Enforcement Officers __

S03.b______ Number of Private Security Officers __

S04. Were any of the following security measures in use at the time of this event?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Measure		Location or Type of Measure	Code
S04.a) Walk Through Metal Detectors

S04.a1)		If yes, how often?
		1 Daily
		2 2 to 3 times per week
		3 Weekly
		4 Biweekly
		5 As warranted
		6 Never
S04.a2)		Where were the walk through metal detectors used?
		S04a2.a) Main entry
		S04a.2b) Secondary entries
		SS04a2.c) Other
		Specify

S04.b) Hand Held Metal Detectors

S04.b1)		If yes, how often?
		1 Daily
		2 2 to 3 times per week
		3 Weekly
		4 Biweekly
		5 As warranted
		6 Never
S04.b2)		Where were the walk through metal detectors used?
		S04b2.a) Main entry
		S04b2.b) Secondary entries
		S04b2.c) Other
		Specify
S04.c) Surveillance Cameras

S04.c1)		If yes, When were they used? (Check all that apply)
		1 on school days before classes or official school activities began
		2 While classes were being held
		3 During lunch, recess, or other breaks,
		4 During class changes
		5 immediately after school
		6 During after school practice or detention
		5 After official activities
		6 On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)
		7 Cameras only used as visual detterent
S04.c2)		Where were the surveillance cameras used?

		S04c2.a) Entry/exit areas – exterior
		S04c2.b) Athletic areas
		S04c2.c) Entry/exit areas – interior
		S04c2.d) Corridors
		S04c2.e) Other
		Specify
S04.d) Communication Devices
		S04d.1) 2-way radios
		S04d.2) 2-way intercom in most classrooms
		S04d.3) Other
		Specify
S04.e) Access Restrictions

	S04e.1) Proximity or card swipe access for staff
	S04e.2) Intrusion Alarm Systems
S04.e3)		If yes, where?
		S04e3.a) Main building(s) / areas
		S04e3.b) Parking lot(s)
		S04e3.c) Other
		Specify

S04.e4)		If yes, When were they used? (Check all that apply)
		1 on school days before classes or official school activities began
		2 While classes were being held
		3 During lunch, recess, or other breaks,
		4 During class changes
		5 immediately after school
		6 During after school practice or detention
		5 After official activities
		6 On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)

skip to Question #E01, page P9 .

QUESTIONS about the off-campus school sponsored event

SOC01. Our study defines a school associated violent death as a suicide, homicide or legal intervention related death that occurred on school property, on the way to or from school, or at or on the way to or from a school sponsored event. Has this school ever experienced another violent death that meets this definition?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

SOC02. During the time when the event of interest occurred, did the school regularly use paid law enforcement or security services at selected school activities (e.g., athletic and social events, open houses, science fairs)?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

*If school did not use paid law enforcement or security services, skip to Question # SOC04 otherwise, proceed with Question # SOC03 [If no, SKIP TO S18]

SOC03a. Please indicate the number of Sworn Law Enforcement Officers used.

Do NOT read options, code leading zero

00-∞=actual number

777=not applicable

888=unknown

999=refused to answer

_ _

SOC03b. Please indicate the Number of Private Security Officers used __Do NOT read options, code leading zero

00-∞=actual number

777=not applicable

888=unknown

999=refused to answer

SOC04. Were any of the following security measures in use at the time of this event?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Measure		Location or Type of Measure	Code
SOC04.a) Walk Through Metal Detectors

SOC04.a1)		If yes, how often?
		1 Daily
		2 2 to 3 times per week
		3 Weekly
		4 Biweekly
		5 As warranted
		6 Never
SOC04.a2)		Where were the walk through metal detectors used?
		SOC04a2.a) Main entry
		SOC04a2.b) Secondary entries
		SOC04a2.c) Other
		Specify

SOC04.b) Hand Held Metal Detectors

SOC04.b1)		If yes, how often?
		1 Daily
		2 2 to 3 times per week
		3 Weekly
		4 Biweekly
		5 As warranted
		6 Never
SOC04.b2)		Where were the walk through metal detectors used?
		SOC04b2.a) Main entry
		SOC04b2.b) Secondary entries
		SOC04b2.c) Other
		Specify
SOC04.c) Surveillance Cameras

SOC04.c1)		If yes, When were they used? (Check all that apply)
		1 on school days before classes or official school activities began
		2 While classes were being held
		3 During lunch, recess, or other breaks,
		4 During class changes
		5 immediately after school
		6 During after school practice or detention
		5 After official activities
		6 On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)
		7Cameras only used as visual detterent
SOC04.c2)		Where were the surveillance cameras used?

		SOC04c2.a) Entry/exit areas – exterior
		SOC04c2.b) Athletic areas
		SOC04c2.c) Entry/exit areas – interior
		SOC04c2.d) Corridors
		SOC04c2.e) Other
		Specify
SOC04.d) Communication Devices
		SOC04d.1) 2-way radios
		SOC04d.2) 2-way intercom in most classrooms
		SOC04d.3) Other
		Specify
SOC04e) Access Restrictions

	SOC04e.1) Proximity or card swipe access for staff
	SOC04e.2) Intrusion Alarm Systems
SOC04.e3)		If yes, where?
		SOC04e3.a) Main building(s) / areas
		SOC04e3.b Parking lot(s)
		SOC04e3.c) Other
		Specify

SOC04.e4)		If yes, When were they used? (Check all that apply)
		1 on school days before classes or official school activities began
		2 While classes were being held
		3 During lunch, recess, or other breaks,
		4 During class changes
		5 immediately after school
		6 During after school practice or detention
		5 After official activities
		6 On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)

Skip to Question #E02, page P10

QUESTIONS about the event

E01. Where on the campus did the injury event occur?

Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown; code all applicable locations

Location	Code
01= in a classroom
02= in a hallway
03= in a cafeteria
04= in a gymnasium
05= in a locker room
06= in an office
07= in a stairwell
08= in a restroom
09= in a break room or lounge
10= in an auditorium
11= on campus lawn or gardens
12= on sporting fields or playground
13= in a parking lot
14= in a driveway
15= at a bus pickup or drop off point
66= other indoor location
Specify.
67= other outdoor location
Specify
77= not applicable
88= unknown
99= refused to answer

After completing E01, skip to Question #E03.

E02. Where did the off-campus injury event occur?

Read options; code written responses later; code leading zeros

01= on the street, sidewalk, footpath

02= on a bus or public transport vehicle

03= waiting for or getting on or off a bus or public transport vehicle

04= in a privately-owned vehicle / car

05= on private property (specify________________________)

06= at a sporting complex (pool, stadium, off campus gym, rec center etc…)

66= other (specify..............................................................................................)

77= not applicable

88= unknown

99= refused to answer

_ _

E03. Which of the following best describes the context in which the injury event occurred?

Read options; code written responses later; code leading zeros

01= on a day when no classes or school events were held (e.g., a weekend, holiday, or an
official school break)

02= on a school day before classes began

03= while classes were being held

04= during a school assembly

04= on a school day during lunch, recess or other break, including class changes

05= immediately after school

06= on a school day during after-school practice or detention

07= on a school day after official activities

08= at a school sporting activity

09= at another official school-sponsored activity

10= on the way to or from a school-sponsored activity

66= other (specify..............................................................................................)

77= not applicable

88= unknown

99= refused to answer

_ _

E04. What were the motives for the fatal injury?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown; code all applicable motives.

Motive	Code
a) single suicide
b) suicide pact
c) drug related
d) gang related
e) robbery, attempted robbery
f) rape, attempted sex crime
g) dispute over money or property
h) dispute over romantic relationship
i) dispute related to sporting event
j) dispute, other or unspecified
k) racially or hate crime motivated
l) victim killed by law enforcement or security personnel
m) victim killed by civilian during commission of a crime
n) expressed act of terrorism
o) random victim
p) victim was a bystander
q) victim was intervener assisting a crime victim
r) other
specif y

E05. Briefly describe the circumstances of the fatal injury and events leading up to it, including history of prior conflicts between the principles, etc.

Code later

E06. What was the method of fatal injury?

Read options;

Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown; code all applicable methods used

Method	Code
01= firearm
Specify
02= knife, razor, box cutter or other blade
03= beaten with club, bat, pipe, chain, or other object
04= beaten, no weapon used
05= motor vehicle
06= hanging/strangulation/asphyxiation by hanging
07= poisoning, solid or liquid
08= asphyxiation by gas
09= other asphyxiation
66= other
Specify
77= not applicable
88= unknown
99= refused to answer

E07. After a tragedy such as this people look for things, such as comments, notes, threats, or actions that took place prior to the incident that could have signaled a potential risk for this type of behavior. Which of the following did any of the offenders, or victims in the case of suicide, leave as signs that they were considering this action? Please include as many signs as you can think of even if they were things that no one could have recognized as a sign at the time they happened.

Read options, Coding instructions: 1=yes, 2=no, 8=unknown. Code all applicable signs.

Sign	Code
{E07a} notes
{E07b} journal entry
{E07c} social media (e.g. blogs, Twitter, wall postings on social networking sites)
{E07d} verbal threats___
{E07e} electronic media (e.g., email messages, IM, or texts via cellphone, voice mail, video, ect.)
{E07f} other actions (e.g., playful suggestion that person might commit act, voiced suicidal thoughts)
Specify

E08. Did anyone know about the possibility of this event before it happened?

Do NOT read options

1=yes (specify........................................................................................................... )

2=no*

7=not applicable

9=unknown/refused to answer

*If option 2 is selected, skip to Question #V01, page P15

_ _

E09. What information was known by the bystander(s) in advance of the attack?

Instructions: Capture information for up to five bystanders.

E09a.

Code later

E10. What relationship did the bystander have to the perpetrator(s)?

Read options; code written responses later

E10a. Bystander #1

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

E10b. Bystander #2

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

E10c. Bystander #3

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

E10d. Bystander #4

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

E10e. Bystander #5

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

_ _

E11. Did the bystander share the information he or she learned of the planned violence with

others?

Do NOT read options

1=yes (specify........................................................................................................... )

2=no

7=not applicable

9=unknown/refused to answer

E12. With whom was this information shared?

Do not read options; Coding instructions: 1=yes, 2=no, 8=unknown. Select all applicable options.

E12a.

	Code
01=no one
02=parents
03=other family
04=peers
05=school staff
06=other medical/mental health professional
66=other
Specify
77=not applicable
88=unknown
99=refused to answer

QUESTIONS about the Victim

CaseID. Case ID Number

To be assigned by study coordinator, record 5-digit number

_ _ _ _ _

V01. How many victims were fatally injured in this event?

Write in actual number

_ _

V01a. Victim Number

Number for this victim, is assigned by the primary data collector.

V02. What was the date of the injury event?

Record month/date/year, code leading zeros (code four-digit years)

_ _/_ _/_ _ _ _

V03. What was the time of the injury event?

Record in military time

_ _ _ _

V04. What was the date of death?

Record month/date/year, code leading zeros (code four-digit years)

_ _/_ _/_ _ _ _

V05. What was this victim's date of birth?

Record month/date/year, code leading zeros (code four-digit years)

_ _/_ _/_ _ _ _

V06. What was this victim's age in years at the time of death?
Do NOT read options, code leading zero

01-∞=actual age in years

77=not applicable

88=unknown

99=refused to answer

_ _

V07. What was this victim's gender?

Do NOT read options

1=male

2=female

3=transgender

7=not applicable

8=unknown

9=refused to answer

_ _

V08. What was the victim's race?

Do NOT read Options

1 White

2 Black or African American

3 American Indian or Alaska Native

4 Asian Indian

5 Chinese

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13 Samoan

14 Other Pacific Islander

15 Other (Specify) ______________

88 Unknown—a person’s race is unknown

99 Refused to Answer

V09. Was this victim of Hispanic, Latino/a ,or Spanish Origin?

(One or more categories may be selected)

Do NOT read options

1 Not Hispanic or Latino/a or Spanish origin

2 Yes, Mexican, Mexican American, Chicano/a

3 Yes, Puerto Rican

4 Yes, Cuban

5 Yes, another Hispanic, Latino, or Spanish origin

8 Unknown if victim is of Hispanic or Latino origin

9 Refused to Answer

V10. Which of the following best describes the victim's family structure/living arrangements at the time of death?

Read options

01= two-parent nuclear family

02= single parent household

03= lives with adult relative other than parent

04= lives with legal guardian

05= lives independently

06= foster care

07= residential institution

66= other (specify:...................)

77=not applicable

88=unknown

99=refused to answer

_ _

V11. Individuals often affiliate with distinct peer groups. To your knowledge, was the victim associated with any distinct peer group?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused

*If answer is no, skip to Question # V14… otherwise, proceed with Question # V11a.

V11a. What group(s) were they affiliated with?

Code later

_ _

V12. In the year prior to this event, did the victim leave an existing peer group?

Do not read options

1=yes Specify____________

2=no

7=not applicable

8=unknown

9=refused to answer

V13. In the year prior to this event, did the victim join a new peer group?

Do not read options

1=yes Specify____________

2=no

7=not applicable

8=unknown

9=refused to answer

V14. Did the victim use alcohol or drugs?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

*If answer is not yes, skip to Question # V15 … otherwise, proceed with Question # V14a.

V14a. What types of substances did the victim use?

Code later

V15. Was there evidence that the victim was intoxicated with alcohol or drugs at the time of death?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V16. At the time of death, was the victim perceived by self or others to have a problem with, or to be addicted to, alcohol or other drugs?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V17. Was the victim carrying a weapon at the time of the fatal injury?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

*If no, Go to Question #V20.

V18. At the time of the fatal injury, which of the following types of weapon was this victim carrying?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Weapon	Code
a) firearm
Specify
b) knife, razor, box cutter or other blade
c) bat, pipe, chain, or other object
d) rope or wire
e) other
Specify

V19. Where did this victim obtain these weapons?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Weapons source	Code
a) from home
specify weapon
b) from friend or relative outside household
specify weapon
c) purchased for himself/herself
specify weapon
d) stolen
specify weapon
e) home-made weapon
f) weapon of opportunity (used weapon already present in environment / used object in environment as weapon)
g) from the victim
specify weapon
h) other _
specify weapon

V20. What was the highest grade or year of school this victim completed?

Do NOT read options, code leading zero

00-12=last completed grades K-12

13=high school equivalency (GED)

14=some college or trade school

15=college graduate or more

16=never attended

66=other (specify........................................................................................................)

77=not applicable

88=unknown

99=refused to answer

_ _

V21. What was the victim's affiliation with the school associated with this death?

Do NOT read options, code leading zero

01=a student at this school

02=former student at this school

03=a student at another school

04=a teacher at this school*

05=administrator at this school*

06=other staff at this school*

07=security guard or law enforcement officer (SRO)*

08=family member of a student*

09=family member of staff member

10=resident of surrounding community*

11=not associated with the school or community*

12=unidentified victim*

66=other* (specify.............................................................................................................)

77=not applicable*

88=unknown*

99=refused to answer*

_ _

*If the victim is NOT a student, go to Question #V26, P22.

V22. How many years had the victim attended his or her school?

Do NOT read options; code leading zeros

00=less than one school year

01-12=number of years

13=more than 12 years

77=not applicable

88=unknown

99=refused to answer

_ _

V23. What extracurricular activities was the victim involved in?

To be coded later

........................................................................................................................................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

V24. Did the victim experience any school-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

*If no, not applicable, unknown, or refuse, go to Question #V25.

V24a. Please briefly describe the specific school-related crises or traumatic events experienced.

Code later

V25. Was a school-related crisis or traumatic event imminent within two weeks of this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

V25a. Please briefly describe the specific school-related crises or traumatic events that may have been imminent.

Code later

V26. Did any the victim experience any community-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

V26a. Please briefly describe the specific community-related crises or traumatic events experienced.

Code later

V27. Was a community-related crisis or traumatic event imminent within two weeks of the this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

V27a. Please briefly describe the specific community-related crises or traumatic events that may have been imminent.

Code later

V28. Did any the victim experience any family-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

V28a. Please briefly describe the specific family-related crises or traumatic events experienced.

Code later

V29. Was a family-related crisis or traumatic event imminent within two weeks of the this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

V29a. Please briefly describe the specific family-related crises or traumatic events that may have been imminent.

Code later

V30. To the best of your knowledge, in the 12 months prior to this event did the victim engage in any of the following behaviors?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Behavior	Code
{V30a} disobeying authority figure
{V30b} namecalling, taunting, or teasing peers
V30b.1 Face to face?
V30b.2 Using Electronic means?
{V30c} Verbal threats
{V30d} sent written threats
{V30e} sent electronic threats
{V30f} Bullied peers
{V30f} physically threatened peers
{V30g} physically fought with peers
{V30h} damaged another's personal property
{V30i} damaged school property (tagging, vandalism etc…)
{V30j}stole another's personal property
{V30k} truancy (skipped school)
{V30l} possessed / used illegal substances
{V30m}possessed a weapon

V31. To the best of your knowledge, in the 12 months prior to this event was this individual victimized in any of the following ways?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Type	Code
{V31.a} called names by peers
{V31.b} bullied by peers
{V31.c} had personal property damaged or stolen
{V31.d}verbally threatened by peers
{V31.e}received written threats
{V31.f} electronic threats
{V31.g}physically threatened by peers
{V31.h}physically assaulted by peers

V32. At the time of the event, did this victim have a diagnosed Learning Disability?

Do not read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V33. In the year prior to this event, did this victim receive any of the following services?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Services	Code
{ V33a} guidance counseling / advising
{ V33b} psychological counseling
{V33c} Psychiatric or mental health services
{V33d} social services
{V33e} supplemental educational services (including efforts to address learning disabilities)
{V33f} other services
Specify

V34. In the year prior to this event, was this victim ever treated for depression?

Do not read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V35. Had the victim ever received professional treatment for any other emotional or mental health problem?

Do not read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V36. If yes, What specific kinds of emotional or mental health problems were treated?

To be coded later

V37. Did this victim have a documented family history of .....

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

	Code
{V37.a} alcoholism
{V37.b} drug abuse
{V37.c} intimate partner violence
{V37.d} sexual violence
{V37.e}attempted / completed suicide
{V37.f} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

V38. Did this victim suffer

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

	Code
{V38.a} physical child abuse
{V38.b} sexual child abuse
{V38.c} emotional / psychological abuse as a child
{V38.d} neglect
{V38.e} victimization in intimate partner violence_/ teen dating violence
{V38.f} victimization in sexual violence

V39. To the best of your knowledge, did this victim have a suspected family history of .....

Read only those options not confirmed above, Coding instructions: 1=yes, 2=no, 8=unknown.

	Code
{V39.1} alcoholism
{V39.2} drug abuse
{V39.3} intimate partner violence
{V39.4} sexual violence
{V39.5}attempted / completed suicide
{V39.6} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

V40. Which of the following situations best describes this victim's death?

Read options; code leading zero

01= single victim suicide*

02= multiple victim suicide*

03= single victim homicide; unknown number of offenders

04= single victim homicide; single offender

05= single victim homicide; multiple offenders

06= multiple victim homicide; unknown number of offenders

07= multiple victim homicide; single offender

08= multiple victim homicide; multiple offenders

09= combination murder/suicide

10= intention undetermined

66= other (specify........................................................................................................)

77=not applicable

88=unknown

99=refused to answer

_ _

V41. Do you have any knowledge that this victim had, in the year prior to this event exhibited any of the following signs and symptoms of suicide?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Signs	Code
{V41.a} Thoughts/threats of suicide
{V41.b} Plans of suicide
{V41.c} Previous suicide attempts

*If no to all, skip to V44, page P27.

V42. To whom was this suicidal behavior reported?

Do not read options; Coding instructions: 1=yes, 2=no, 8=unknown. Select all applicable options.

	Code
01=no one
02=parents
03=other family
04=peers
05=school staff
06=other medical/mental health professional
66=other
Specify
77=not applicable
88=unknown
99=refused to answer

V43. What, if any, actions were taken in response to this suicidal behavior?

………………………………………………………………………………………………………………………….

V44. Did perceptions about the victim being gay, bisexual, or transgendered contribute to their victimization?

Do not read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

*If there is more than one victim, complete a "Victim" section for each victim, starting with Question V01...Otherwise go to Question V45.

V45. Were there any victims that suffered nonfatal injuries at the time of this event?

Do not read options

1=yes

2=no* (insert prompt to skip the next set of questions)

7=not applicable*

8=unknown*

9=refused to answer*

*If no to all, skip to Questions on Alleged Offender #O01 Page P29

V46. How many persons suffered non-fatal injuries at the time of this event?

01-##=actual number of nonfatal injuries

77=not applicable

88=unknown

99=refused to answer

_ _

V47. How many victims that suffered nonfatal injuries required hospital admission?

00-##=actual number of nonfatal injuries that required hospital admission

77=not applicable

88=unknown

99=refused to answer

_ _

V48. How many alleged offenders were responsible for the victim's death?

Do NOT read options (PROBE: alleged offender = legally charged as offender)

0=none, death was self-inflicted

1-5=actual number of offenders*

6=more than 5*

7=not applicable

8=unknown

9=refused to answer

*If there are no data available on any alleged offender, conclude the interview...Otherwise, complete "Offender" section, starting with question #O01 Page P29

QUESTIONS about Alleged Offender

CaseID. Case ID Number

Case number is assigned by study coordinator.

_ _ _ _ _

O01. How many alleged offenders were officially charged for this incident?

Write in actual number.

_ _

O01a. Offender Number

Number for this alleged offender is assigned by the primary data collector.

O02. What was this alleged offender's date of birth?

Record month/date/year, code leading zeros, code four-digit years

_ _/_ _/_ _ _ _

O03. What was this alleged offender's age in years at time of victim's death?

Do NOT read options, code leading zero

01-∞=actual age in years

77=not applicable

88=unknown

99=refused to answer

_ _

O04. What was this alleged offender's gender?

Do NOT read options

1=male

2=female

3=transgender

7=not applicable

8=unknown

9=refused to answer

_ _

O05. What was this alleged offender's race?

Do NOT read options

1 White

2 Black or African American

3 American Indian or Alaska Native

4 Asian Indian

5 Chinese

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13 Samoan

14 Other Pacific Islander

15 Other (Specify) ______________

88 Unknown—a person’s race is unknown

99 Refused to Answer _

O06. Was this alleged offender of Hispanic, Latino/a ,or Spanish Origin?

(One or more categories may be selected) origin?

Do NOT read options

1 Not Hispanic or Latino/a or Spanish origin

2 Yes, Mexican, Mexican American, Chicano/a

3 Yes, Puerto Rican

4 Yes, Cuban

5 Yes, another Hispanic, Latino, or Spanish origin

9 Unknown if elder is of Hispanic or Latino origin

O07. Which of the following best describes this alleged offender's family structure or living arrangements at the time of the victim's death?

Read options

01= two-parent nuclear family

02= single parent household

03= lives with adult relative other than parent

04= lives with legal guardian

05= lives independently

06= foster care

07= residential institution

66= other (specify:...................)

77=not applicable

88=unknown

99=refused to answer

_ _

O08. Had this alleged offender ever been arrested before the victim's death?

Do NOT read options

1=yes

2=no*

7=not applicable

8=unknown

9=refused to answer

O09. Had this alleged offender ever been charged with a crime before the victim's death?

Do NOT read options

1=yes

2=no*

7=not applicable

8=unknown

9=refused to answer

*If answer is no, skip to Question # O10 page P31.... otherwise, proceed with Question # O09a

O09a. What types of charges did the alleged offender face?

Code later

O09b. Which charges resulted in convictions?

Code later

O10. Youth often affiliate with distinct peer groups. To your knowledge, was the alleged offender associated with any distinct peer group?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused

*If answer is not yes, skip to Question # O13.page P32.... otherwise, proceed with Question # O10a

O10a. What group(s) were they affiliated with?

Code later

O11. In the year prior to this event, did the offender leave an existing peer group?

Do NOT read options

1=yes Specify _________________________

2=no

7=not applicable

8=unknown

9=refused to answer

O12. In the year prior to this event, did the offender or join a new peer group?

Do NOT read options

1=yes Specify_____________

2=no

7=not applicable

8=unknown

9=refused to answer

O13. Did this alleged offender use alcohol or drugs at the time of the victim's death?

Do NOT read options

1=yes Specify ___________________________

2=no

7=not applicable

8=unknown

9=refused to answer

*If answer is no skip to Question # O14.. . otherwise, proceed with Question # O13a.

O13a. What types of substances did the alleged offender use?

Code later

O14. Was there evidence that this alleged offender was intoxicated with alcohol or drugs at the time of the victim's death?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O15. At the time of death, was the alleged offender perceived by self or others to have a problem with, or to be addicted to, alcohol or other drugs?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O16. What was the relationship of this alleged offender to the victim?

Read options; code written responses later

01= relatives (specify..................)

02= romantic partner

03= close friend

04= classmate

05= faculty/staff

06= fellow student at school, but not classmate

07= community / neighborhood acquaintance

08= strangers

66= other (specify......................)

77=not applicable

88=unknown

99=refused to answer

_ _

O17. Was this alleged offender carrying a weapon at the time of the fatal injury?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

*If no, Skip to Question #O20, page P34_.

O18. At the time of the fatal injury, which of the following types of weapon was this alleged offender carrying?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Weapon	Code
a) firearm
Specify
b) knife, razor, box cutter or other blade
c) bat, pipe, chain, or other object
d) rope or wire
e) other
Specify

O19. Where did this alleged offender obtain these weapons?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown

Weapons source	Code
a) from home
specify weapon
b) from friend or relative outside household
specify weapon
c) purchased for himself/herself
specify weapon
d) stolen
specify weapon
e) home-made weapon
f) weapon of opportunity (used weapon already present in environment / used object in environment as weapon)
g) from the victim
specify weapon
h) other _
specify weapon

O20. What was the highest grade or year of school this alleged offender completed?

Do NOT read options, code leading zero

00-12=last completed grades K-12

13=high school equivalency (GED)

14=some college or trade school

15=college graduate or more

16=never attended

66=other (specify..................)

77=not applicable

88=unknown

99=refused to answer

_ _

O21. What was this alleged offender's affiliation with the school associated with the victim's death?

Do NOT read options, code leading zero

02=former student at this school

03=a student at another school

04=a teacher at this school*

05=administrator at this school*

06=other staff at this school*

07=security guard or law enforcement officer (SRO)*

08=family member of a student*

09family member of staff member

10=resident of surrounding community*

11=not associated with the school or community*

12=unidentified victim*

66=other* (specify.............................................................................................................)

77=not applicable*

88=unknown*

99=refused to answer*

_ _

*If this alleged offender is NOT a student, Go to Question O26, page P36 .

O22. For how many years has this alleged offender attended his or her school?

Do NOT read options; code leading zeros

00=less than one school year

01-12=number of years

13=more than 12 years

77=not applicable

88=unknown

99=refused to answer

_ _

O23. What extracurricular activities was this alleged offender involved in at the time of the victim's death?

to be coded later; please note the sources.

O24. Did any the offender experience any school-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

*If no, not applicable, unknown, or refuse Go to Question #O25.Otherwise, proceed to question O24a

O24a. Please briefly describe the specific school-related crises or traumatic events experienced.

Code later

O25. Was a school-related crisis or traumatic event imminent within two weeks of the this incident?

If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

O25a. Please briefly describe the specific school-related crises or traumatic events that may have been imminent.

Code later

O26. Did any the offender experience any community-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

O26a. Please briefly describe the specific community-related crises or traumatic events experienced.

Code later

O27. Was a community-related crisis or traumatic event imminent within two weeks of the this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

O27a. Please briefly describe the specific community-related crises or traumatic events that may have been imminent.

Code later

O28. Did the alleged offender experience any family-related crises or traumatic events during the 2 weeks before or after this incident? If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

O28a. Please briefly describe the specific family-related crises or traumatic events experienced.

Code later

O29. Was a family-related crisis or traumatic event imminent within two weeks of the this incident?

If yes, please specify :

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

O29a. Please briefly describe the specific family-related crises or traumatic events that may have been imminent.

Code later

O30. To the best of your knowledge, in the 12 months prior to this event did the alleged offender engage in any of the following behaviors?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Behavior	Code
{O30.a} disobeying authority figure
{O30.b} namecalling, taunting, or teasing peers
O30b.1 Face to face?
O30b.2 Using Electronic means?
{O30.c} Verbal threats
{O30.d} sent written threats
{O30.e} sent electronic threats
{O30.f} Bullied peers
{O30.f} physically threatened peers
{O30.g} physical fought with peers
{O30.h} damaged another's personal property
{O30.i} damaged school property (tagging, vandalism etc…)
{O30.j}stole another's personal property
{O30.k} truancy (skipped school)
{O30.l} possessed / used illegal substances
{O30.m}possessed a weapon

O31. To the best of your knowledge, in the 12 months prior to this event was this alleged offender victimized in any of the following ways?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Type	Code
{O31.a} called names by peers
{O31.b} bullied by peers
{O31.c} had personal property damaged or stolen
{O31.d}verbally threatened by peers
{O31.e}received written threats
{O31.f} electronic threats
{O31.g}physically threatened by peers
{O31.h}physically assaulted by peers

O32. At the time of the event, did this alleged offender have a diagnosed Learning Disability?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O33. In the year prior to this event, did this alleged offender receive any of the following services?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Services	Code
{O33.a} guidance counseling / advising
{O33.b} psychological counseling
{O33.c} Psychiatric or mental health services
{O33.d} social services
{O33.e} supplemental educational services (including efforts to address learning disabilities)
{O33.f} other services
Specify

O34. In the year prior to this event, was this alleged offender ever treated for depression?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O35. Had the alleged offender ever received professional treatment for any other emotional or mental health problem?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O35a. If yes, what specific kinds of emotional or mental health problems were treated?

To be coded later

O36. Did this alleged offender have a documented family history of .....

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

	Code
{O36.a} alcoholism
{O36.b} drug abuse
{O36.c} intimate partner violence
{O36.d} sexual violence
{O36.e}attempted / completed suicide
{O36.f} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

O37. Did this alleged offender suffer

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

	Code
{O37.a} physical child abuse
{O37.b} sexual child abuse
{O37.c} emotional / psychological abuse as a child
{O37.d} neglect
{O37.e} victimization in intimate partner violence_/ teen dating violence
{O37.f} victimization in sexual violence

*If yes to all of the above, then skip to O39 below.

O38. Do you have any knowledge that this alleged offender had, in the year prior to this event exhibited any of the following signs and symptoms of suicide?

Read options, Coding instructions: 1=yes, 2=no, 8=unknown.

Signs	Code
{O38.a} Thoughts/threats of suicide
{O38.b} Plans of suicide
{O38.c} Previous suicide attempts

*If no to all, skip to O41 below.

O39. To whom was this suicidal behavior reported?

Do not read options; Coding instructions: 1=yes, 2=no, 8=unknown. Select all applicable options.

	Code
01=no one
02=parents
03=other family
04=peers
05=school staff
06=other medical/mental health professional
66=other
Specify
77=not applicable
88=unknown
99=refused to answer

O40. What, if any, actions were taken in response to this suicidal behavior?

To be coded later

O41. Was this alleged offender fatally injured during the event?

Do NOT read options

1=yes

2=no*

7=not applicable

8=unknown

9=refused to answer

*If no then skip to O48 page P43. Otherwise proceed to question O43.

O42. What was the date of the injury event?

Record month/date/year, code leading zeros (code four-digit years)

_ _/_ _/_ _ _ _

O43. What was the time of the injury event?

Record in military time

_ _ _ _

O44 What was the date of death?

Record month/date/year, code leading zeros (code four-digit years)

_ _/_ _/_ _ _ _

O45. What were the motives for the fatal injury?

Read options, Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown; code all applicable motives.

Motive	Code
a) single suicide
b) suicide pact
c) alleged offender killed by law enforcement or security personnel
d) alleged offender killed by civilian during commission of a crime
e) other
specif y

O46. Briefly describe the circumstances of the fatal injury and events leading up to it, including history of prior conflicts between the principles, etc.

Code later

O47. What was the method of fatal injury?

Weapon	Code
a) firearm
Specify
b) knife, razor, box cutter or other blade
c) bat, pipe, chain, or other object
d) rope or wire
e) other
Specify

O48. Did perceptions about the offender being gay, bisexual, or transgendered contribute to their perpetration?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O49. Was there evidence that this alleged offender was targeting a specific person or group?

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

O50. Was there another alleged offender, in addition to the one we just discussed, involved in this event?

Do NOT read options

1=yes*

2=no

7=not applicable

8=unknown

9=refused to answer

*If there is a second alleged offender identified as Offender Y, complete a second "Offender" section, starting with Question O01.......otherwise, conclude the interview.

File Type	application/msword
File Title	Attachment 5
Author	ESB1
Last Modified By	CDC User
File Modified	2013-01-09
File Created	2012-12-06