Att D_ Law Enforcement Officials (Interview)

School Associated Violent Deaths Surveillance System

Att D_Law Enforcement Interview Instrument

Att D_ Law Enforcement Officials (Interview)

OMB: 0920-0604

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0604 can be found here:

2019-05-02 - Revision of a currently approved collection

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Attachment D

Law Enforcement Interview Instrument

Form Approved

OMB NO: 0920-0604

Exp. Date: 4/30/2016

Public reporting burden of this collection of information is estimated at 1 hour and 5 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. 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 yes, proceed to G02.

*If answer is 2 -9, skip to Question #G03.

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

G02a. Respondent 1

Code 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* (G03a- If Other selected, please specify...................................................................)

8= unknown*

9= refused to answer

*If option 1 is selected, proceed to Question #S01, page 5.

*If option 3 is selected, skip to Question # SOC01, page 8.

*If option 2, 4, or 6 are selected, skip to Question #E02, page 11.

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. At the time when the event occurred did the school use security personnel? _

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to S02a & S02b.

*If answer is 2 -9, skip to Question #S03.

S02a. Number of School Resource Officers/Sworn Law Enforcement Officers __

S02b. Number of Private Security Officers __

S03. 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
S03a) Were they full time? (e.g., 8 hours/day)
S03b) At any time during school hours
S03c) While students were arriving and/or leaving
S03d) At selected school activities (e.g., athletic and social events, open houses, science fairs)
S03e) When school/school activities not occurring
S03f) Other
S03f.1) If Other selected, please specify:

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
S04a) Walk Through Metal Detectors
If yes, proceed to S04a1 & S04a2; if no, proceed to S04b.
S04a1)		If yes, how often?
		1 - Daily 2 - 2 to 3 times per week 3 - Weekly 4 - Biweekly 5 - As warranted 6 - Randomly 7 - Never
S04a2)		Where were the walk through metal detectors used? (Answer each option)
		S04a2.a) Main entry
		S04a2.b) Secondary entries
		S04a2.c) Other
		S04a2.c1) If Other selected, please specify:
S04b) Hand Held Metal Detectors
If yes, proceed to S04b1 & S04b2; if no, proceed to S04c.
S04b1)		If yes, how often?
		1 - Daily 2 - 2 to 3 times per week 3 - Weekly 4 - Biweekly 5 - As warranted 6 - Randomly 7 - Never
S04b2)		Where were the walk through metal detectors used? (Answer each option)
		S04b2.a) Main entry
		S04b2.b) Secondary entries
		S04b2.c) Other
		S04b2.c1) If Other selected, please specify:
S04c) Surveillance Cameras
If yes, proceed to S04c1 – S064e3; if no, proceed to S04d.
S04c1)		If yes, When were they used? (Answer each option)
		S04c1.a) On school days before classes or official school activities began
		S04c1.b) While classes were being held
		S04c1.c) During lunch, recess, or other breaks,
		S04c1.d) During class changes
		S04c1.e) Immediately after school
		S04c1.f) During after school practice or detention
		S04c1.g) After official activities
		S04c1.h) On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)
		S04c1.i) Cameras only used as visual detterent
S04c2)		If yes, where were the surveillance cameras used? (Answer each option)
		S04c2.a) Entry/exit areas – exterior
		S04c2.b) Athletic areas
		S04c2.c) Entry/exit areas – interior
		S04c2.d) Corridors
		S04c2.e) Other
		S04c2.e1) If Other selected, please specify:
S04c3)		If yes, when were the surveillance cameras monitored? (Answer each option)
		S04c3.a) Always
		S04c3.b) Occasionally
		S04c3.c) After an incident
		S04c3.d) Rarely
S04d) Communication Devices
If yes, proceed to S04d1; if no, proceed to S04e.
S04d1)		If yes, what types of devices were used? (Answer each option)
		S04d1.a) 2-way radios
		S04d1.b) 2-way intercom in most classrooms
		S04d1.c) Mass text messages
		S04d1.d) Mass emails
		S04d1.e) Other
		S04d1.e.1) If Other selected, please specify:
S04e) Access Restrictions
If yes, proceed to S04e1; if no, proceed to SOC01.
S04e1)	Proximity or card swipe access for staff
If yes, proceed to S04e1a; if no, proceed to S04e2.
S04e1.a)	If yes, where? (Answer each option)
	S04e1.a1) Main building(s) / areas
	S04e1.a2) Parking lot(s)
	S04e1.a3) Other
	S04e1.a3.1) If Other selected, please specify:
S04e2)	Intrusion Alarm Systems
If yes, proceed to S04e2a & S04e2b; if no, proceed to SOC01.
S04e2.a)	If yes, where? (Answer each option)
		S04e2.a1) Main building(s) / areas
		S04e2.a2) Parking lot(s)
		S04e2.a3) Other
		S04e2.a1.1) If Other selected, please specify:
S04e2.b)		If yes, When were they used? (Answer each option)
		S04e2.b1) on school days before classes or official school activities began
		S04e2.b2) While classes were being held
		S04e2.b3) During lunch, recess, or other breaks,
		S04e2.b4) During class changes
		S04e2.b5) immediately after school
		S04e2.b6) During after school practice or detention
		S04e2.b7) After official activities
		S04e2.b8) On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)

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 yes, proceed to SOC02a – SOC02b;

*If answer is 2 -9, skip to Question #SOC03.

SOC02a. 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

SOC02b. 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

SOC03. 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
SOC03a) Walk Through Metal Detectors
If yes, proceed to SOC03a1 & SOC03a2; if no, proceed to SOC03b.
SOC03a1)		If yes, how often?
		1 - Daily 2 - 2 to 3 times per week 3 - Weekly 4 - Biweekly 5 - As warranted 6 - Randomly 7 - Never
SOC03a2)		Where were the walk through metal detectors used? (Answer each option)
		SOC03a2.a) Main entry
		SOC03a2.b) Secondary entries
		SOC03a2.c) Other
		SOC03a2.c1) If Other selected, please specify:
SOC03b) Hand Held Metal Detectors
If yes, proceed to SOC03b1 & SOC03b2; if no, proceed to SOC03c.
SOC03b1)		If yes, how often?
		1 - Daily 2 - 2 to 3 times per week 3 - Weekly 4 - Biweekly 5 - As warranted 6 - Randomly 7 - Never
SOC03b2)		If yes, where were the walk through metal detectors used? (Answer each option)
		SOC03b2.a) Main entry
		SOC03b2.b) Secondary entries
		SOC03b2.c) Other
		SOC03b2.c1) If Other selected, please specify:
SOC03c) Surveillance Cameras
If yes, proceed to SOC03c1 - SOC03c3; if no, proceed to SOC03d.
SOC03c1)		If yes, When were they used? (Answer each option)
		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
		7 - After official activities
		8 - On days when no classes or school events were held (e.g., weekends, holidays, or official school breaks)
		9 - Cameras only used as visual detterent
SOC03c2)		If yes, where were the surveillance cameras used? (Answer each option)
		SOC03c2.a) Entry/exit areas – exterior
		SOC03c2.b) Athletic areas
		SOC03c2.c) Entry/exit areas – interior
		SOC03c2.d) Corridors
		SOC03c2.e) Other
		SOC03c2.e1) If Other selected, please specify:
SOC03d) Communication Devices
If yes, proceed to SOC03.d1; if no, proceed to SOC03e.
SOC03d1		If yes, what types of devices were used? (Answer each option)
		SOC03d1.a) 2-way radios
		SOC03d1.b) 2-way intercom in most classrooms
		SOC03d1.c) Mass text messages
		SOC03d1.d) Mass emails
		SOC03d1.e) Other
		SOC03d1.e1) If Other selected, please specify:
SOC03e) Access Restrictions
If yes, proceed to SOC03e1; if no, proceed to SOC03f.
SOC03e1)	Proximity or card swipe access for staff
SOC03e2)	If yes, where? (Answer each option)
	SOC03e2.a) Main building(s) / areas
	SOC03e2.b) Parking lot(s)
	SOC03e2.c) Other
	SOC03e2.c1) If Other selected, please specify:
SOC03f) Intrusion Alarm Systems
If yes, proceed to SOC03f1 & SOC03f2; if no, proceed to E01.
SOC03f1)		If yes, where? (Answer each option)
		SOC03e4.a) Main building(s) / areas
		SOC03e4.b) Parking lot(s)
		SOC03e4.c) Other
		SOC03e4.c1) If Other selected, please specify:
SOC03f2)		If yes, when were they used? (Answer each option)
		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)

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; (answer each option)

Location	Code
E01a) in a classroom
E01b) in a hallway
E01c) in a cafeteria
E01d) in a gymnasium
E01e) in a locker room
E01f) in an office
E01g) in a stairwell
E01h) in a restroom
E01i) in a break room or lounge
E01j) in an auditorium
E01k) on campus lawn or gardens
E01l) on sporting fields or playground
E01m) in a parking lot
E01n) in a driveway
E01o) at a bus pickup or drop off point
E01p) other indoor location
E01p1) If Other selected, please specify:
E01q) other outdoor location
E01q1) If Other selected, please specify:
E01r) not applicable
E01s) unknown
E01t) refused to answer

If yes to any of 01 - 67 above, Skip to Question #E03, otherwise proceed to question E02.

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 (E02a: If Private property selected, specify ...................................)

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

66= other (E02b: If Other selected, please 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

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

06= immediately after school

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

08= on a school day after official activities

09= at a school sporting activity

10= at another official school-sponsored activity

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

66= other (E03a: If Other selected, please 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; (answer each option)

Motive	Code
E04a) single suicide
E04b) suicide pact
E04c) drug related
E04d) gang related
E04e) robbery, attempted robbery
E04f) rape, attempted sex crime
E04g) dispute over money or property
E04h) dispute over romantic relationship
E04i) dispute related to sporting event
E04j) dispute, other or unspecified
E04k) racially or hate crime motivated
E04l) victim killed by law enforcement or security personnel
E04m) victim killed by civilian during commission of a crime
E04n) act of terrorism
E04o) random victim
E04p) victim was a bystander
E04q) victim was intervener assisting a crime victim
E04r) mimicking a video game, tv, movie, or other violent media
E04s) media-related coverage of a similar event (e.g., violence contagion)
E04t) other
E04t1) If Other selected, please specify

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

Code later

E06. What was the method of fatal injury?

Read options;

Coding instructions: 1=yes, 2=no, 7=not applicable, 8=unknown; (answer each option)

Method	Code
E06a) firearm
E06a1) If Other selected, please specify
E06b) knife, razor, box cutter or other blade
E06c) beaten with club, bat, pipe, chain, or other object
E06d) beaten, no weapon used
E06e) motor vehicle
E06f) hanging/strangulation/asphyxiation by hanging
E06g) poisoning, solid or liquid
E06h) asphyxiation by gas
E06i) other asphyxiation
E06j) other
E06j1) If Other selected, please specify
E06k) not applicable
E06l) unknown
E06m) 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. (answer each option)

Sign	Code
{E07a} notes
{E07a1} If yes, specify:
{E07b} journal entry
{E07b1} If yes, specify:
{E07c} social media (e.g. blogs, Twitter, wall postings on social networking sites)
{E07c1} If yes, specify
{E07d} verbal threats
{E07d1} If yes, specify
{E07e} electronic media (e.g., email messages, IM, or texts via cellphone, voice mail, video etc..)
{E07e1} If yes, specify
{E07f} other actions (e.g., playful suggestion that person might commit act, voiced suicidal thoughts)
{E07f1} If yes, specify

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

Do NOT read options

1=yes (E08a. If yes, please specify _________________________________)

2=no*

7=not applicable*

9=unknown/refused to answer*

If yes, proceed to E08a;

*If answer 2 - 9, skip to Question #V01.

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
________________________________________________________________________________________________________________________________________________________________________________

E09b. Code later
_____________________________________________________________________________________________________________________________________________________________________

E09c. Code later
________________________________________________________________________________________________________________________________________________________________________________

E09d. Code later
_____________________________________________________________________________________________________________________________________________________________________

E09e. Code later
_________________________________________________________________________________________________________________________________________________________________________________________________________________

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

Read options; code written responses later

E10a. Bystander #1

01= relatives (E10a1) 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 (E10a2)specify.............)

77=not applicable

88=unknown

99=refused to answer

E10b. Bystander #2

01= relatives (E10b1) 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 (E10b2)specify.............)

77=not applicable

88=unknown

99=refused to answer

E10c. Bystander #3

01= relatives

(E10c1) 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

(E10c2) specify.........)

77=not applicable

88=unknown

99=refused to answer

E10d. Bystander #4

01= relatives

(E10d1) 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

(E10d2) specify.........)

77=not applicable

88=unknown

99=refused to answer

E10e. Bystander #5

01= relatives

(E10e1) 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

(E10e2) 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= (E11a. If yes, please specify ________________________________________)

2=no*

7=not applicable*

9=unknown/refused to answer*

If yes, proceed to E11a & E11b;

*If answer is 2 -9, skip to Question #V01.

E11b. With whom was this information shared?

Do not read options; Coding instructions: 1=yes, 2=no, 8=unknown. (answer each option)

	Code
{E11b1} no one
{E11b2} parents
{E11b3} other family
{E11b4} peers
{E11b5} school staff
{E11b6} other medical/mental health professional
{E11b7} other
{E11b7a} If Other selected, please specify
{E11b8} not applicable
{E11b9} unknown
{E11b10} refused to answer

QUESTIONS about the Victim

V01. How many victims were fatally injured in this event? _ _ Write in actual number

V01a. Victim Identification 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 (V08a. If Other selected, please 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)

Coding instructions: 1=yes, 2=no

	Code
{V09a} Hispanic or Latino/a or Spanish origin
{V09b} Mexican, Mexican American, Chicano/a
{V09c} Puerto Rican
{V09d} Cuban
{V09e} Another Hispanic, Latino, or Spanish origin
{V09f} Unknown
{V09g} 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 (V10a: If Other selected, please 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 yes, proceed to V11a;

*If answer is 2 -9, skip to Question # V12.

V11a. If yes, 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 (V12a. If yes, please specify _______________________________________)

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V12a;

*If answer is 2 -9, skip to Question # V13.

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

Do not read options

1=yes (V13a. If yes, please specify _______________________________________)

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V13a;

*If answer is 2 -9, skip to Question # V14.

V14. Did the victim use alcohol or other drugs? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V15a;

*If answer is 2 -9, skip to Question # V16.

V14a. If yes, 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 the fatal incident? _

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

V16. At the time of the fatal incident, 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 yes, proceed to V17a & V17b;

*If answer is 2 -9, skip to Question # V18.

V17a. 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
{O17a1} firearm
{O17a1.1} If firearm selected, please specify
{O17a2} knife, razor, box cutter or other blade
{O17a3} bat, pipe, chain, or other object
{O17a4} rope or wire
{O17a5} other
{O17a5.1} If other selected, please specify

V17b. Where did this victim obtain these weapons?

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

Weapons source	Code
{O17b1} from home
{O17b1.1} specify weapon
{O17b2} from friend or relative outside household
{O17b2.1} specify weapon
{O17b3} purchased for himself/herself
{O17b3.1} specify weapon
{O17b4} stolen
{O17b4.1} specify weapon
{O17b5} home-made weapon
{O17b6} weapon of opportunity (used weapon already present in environment / used object in environment as weapon}
{O17b7} from the victim
{O17b7.1} specify weapon

V18. 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 (V18a: If Other selected, please specify: _________________ )

77=not applicable

88=unknown

99=refused to answer

V19. 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* (V19a: If Other selected, please specify: .................................................)

77=not applicable*

88=unknown*

99=refused to answer*

*If the victim is NOT a student, go to Question #V39.

V20. 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

V21. What extracurricular activities was the victim involved in?

To be coded later

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

V22. Did the victim experience any school-related crises or traumatic events during the 2 weeks before this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V22a;

*If answer is 2 -9, skip to Question V23.

V22a. Please briefly describe the specific school-related crises or traumatic events experienced.

Code later

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

V23. Was a school-related crisis or traumatic event imminent within two weeks of this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V23a;

*If answer is 2 -9, skip to Question V24.

V23a. Please briefly describe the specific school-related crises or traumatic events that may have

been imminent. Code later

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

V24. Did the victim experience any community-related crises or traumatic events during the 2 weeks before this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V24a;

*If answer is 2 -9, skip to Question V26.

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

experienced. Code later

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

V25. Was a community-related crisis or traumatic event imminent within two weeks of this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V25a;

*If answer is 2 -9, skip to Question V26.

V25a. Please briefly describe the specific community-related crises or traumatic events that may

have been imminent. Code later

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

V26. Did the victim experience any family-related crises or traumatic events during the 2 weeks before this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V26a;

*If answer is 2 -9, skip to Question V27.

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

Code later

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

V27. Was a family-related crisis or traumatic event imminent within two weeks of this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V27a;

*If answer is 2 -9, skip to Question V28.

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

been imminent. Code later

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

V28. Did the victim experience any relationship-related crises or traumatic events during the 2 weeks before the incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V28a;

*If answer is 2 -9, skip to Question V.

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

experienced. Code later

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

V29. Was a relationship-related crisis or traumatic event imminent within two weeks of this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V29a;

*If answer is 2 -9, skip to Question V30.

V29a. Please briefly describe the specific relationship-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} name-calling, taunting, or teasing peers
If yes, please complete V30b.1 & V30b.2:
V30b.1 Face to face?
V30b.2 Using Electronic means? (e.g., phone, computer)
{V30c} Verbal threats
{V30d} sent written threats
{V30e} sent electronic threats
{V30f} Bullied peers
{V30g} physically threatened peers
{V30h} physically fought with peers
{V30i} damaged another's personal property
{V30j} damaged school property (tagging, vandalism etc…)
{V30k} stole another's personal property
{V30l} truancy (skipped school)
{V30m} possessed / used illegal substances
{V30n} possessed a weapon
{V30o} physically threatened an authority figure

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
{V31a} called names by peers
{V31b} bullied by peers
{V31c} had personal property damaged or stolen
{V31d} verbally threatened by peers
{V31e} received written threats
{V31f} electronic threats
{V31g} physically threatened by peers
{V31h} physically assaulted by peers

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

physical health problem? _

Do not read options

1=yes (V32a. If yes, please specify. ____________________________)

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} social services
{V33c} supplemental educational services (including efforts to address learning disabilities, such as a formal school psychoeducational evaluation)
{V33d} other services
{V33d.1} If Other selected, please 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, such as by a psychiatrist/psychologist? _

Do not read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V35a & V35b.

*If answer 2 - 9, skip to Question #V36.

V35a. If yes, what specific kinds of emotional or mental health problems were treated?

To be coded later

V35b. In what type of setting were they treated?

To be coded later

V36. Did this victim have a documented family history of ....

Read options, Coding instructions: 1=yes, 2=no, 8=unknown. (Answer all options)

	Code
{V36a} alcoholism
{V36b} drug abuse
{V36c} intimate partner violence
{V36d} sexual violence
{V36e} attempted / completed suicide
{V36f} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

V37. Did this victim suffer

Read options, Coding instructions: 1=yes, 2=no, 8=unknown. (Answer all options)

	Code
{V37a} physical child abuse
{V37b} sexual child abuse
{V37c} emotional / psychological abuse as a child
{V37d} neglect
{V37e} victimization in intimate partner violence_/ teen dating violence
{V37f} victimization in sexual violence

V38. 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
{V38a} alcoholism
{V38b} drug abuse
{V38c} intimate partner violence
{V38d} sexual violence
{V38e} attempted / completed suicide
{V38f} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

V39. Which of the following situations best describes this victim's death? _ _

Read options; code leading zero

01= single victim suicide*

02= multiple victim suicide* (i.e., suicide pact)

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 (V39a: If Other selected, please specify..........................................................)

77=not applicable

88=unknown

99=refused to answer

V40. Did the victim ever do something to purposely hurt him/herself without wanting to die, such as cutting or burning him/herself on purpose, engaging in the choking game, etc.? _

Do not read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

If yes, proceed to V40a & V40b.

*If answer 2 - 9, skip to Question #V41.

V40a. To whom was this self-harm behavior reported? Do not read options (Answer all options)

	Code
{V40a1} no one
{V40a2} parents
{V40a3} other family
{V40a4} peers
{V40a5} school staff
{V40a6} other medical/mental health professional
{V40a7} other
{V40a7a} If Other selected, please specify:
{V40a8} not applicable
{V40a9} unknown
{V40a10} refused to answer

V40b. What, if any, actions were taken in response to this self-harm behavior?

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. (Answer all options)

Signs	Code
{V41a} Thoughts/threats of suicide
{V41b} Plans of suicide
{V41c} Previous suicide attempts

If yes to any of V41a – V41c, proceed to V41d & V41e.

*If no to all of V41a – V41c, skip to V42.

V41d. To whom was this suicidal behavior reported?

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

	Code
{V41d1} no one
{V41d2} parents
{V41d3} other family
{V41d4} peers
{V41d5} school staff
{V41d6} other medical/mental health professional
{V41d7} other
{V41d7a}: If Other selected, please specify
{V41d8} not applicable
{V41d9} unknown
{V41d10} refused to answer

V41e. What, if any, actions were taken in response to this suicidal behavior?

V42. 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 V43.

V43. Were there any victims that suffered nonfatal injuries at the time of this event? _

Do not read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes, proceed to V43a & V43b.

*If answer 2 - 9, skip to V44.

V43a. 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

V43b. How many victims that suffered non-fatal injuries required hospital admission? _ _

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

77=not applicable

88=unknown

99=refused to answer

V44. 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 30.

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

01-100=actual age in years

777=not applicable

888=unknown

999=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 (O05a: If Other selected, please 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)? Do NOT read options

Coding instructions: 1=yes, 2=no

	Code
{O06a} Hispanic or Latino/a or Spanish origin
{O06b} Mexican, Mexican American, Chicano/a
{O06c} Puerto Rican
{O06d} Cuban
{O06e} Another Hispanic, Latino, or Spanish origin
{O06f} Unknown
{O06g} Refused to answer

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 (O07a: If Other selected, please 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 yes, proceed to O09a –O09b.

*If answer 2 - 9, skip to Question O10.

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 yes, proceed to O10a.

*If answer 2 - 9, skip to Question O11.

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

Code later

O10b. In the year prior to this event, did the alleged offender leave an existing peer group? _

Do NOT read options

1=yes (O10b1. If yes, please specify ____________________)

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O10b, proceed to O10b1.

*If answers 2 – 9, skip to O10c.

O10c. In the year prior to this event, did the alleged offender or join a new peer group? _

Do NOT read options

1=yes (O10c1. If yes, please specify _____________________)

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O10c, proceed to O10c1.

*If answers 2 – 9, skip to O11.

O11. Did this alleged offender use alcohol or drugs at the time of the incident? _

Do NOT read options

1=yes

2=no

7=not applicable

8=unknown

9=refused to answer

If yes to O11, proceed to O11a.

*If answers 2 – 9, skip to O12.

O11a. If yes, what types of substances did the alleged offender use?

Code later

O12. 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

O13. 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

O14. What was the relationship of this alleged offender to the victim? _ _

Read options; code written responses later

01= relatives (O14a: If relatives selected, specify relationship_______________________)

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 (O14b: If Other selected, please specify__________________________________)

77=not applicable

88=unknown

99=refused to answer

O15. 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 yes to O15, proceed to O15a – O15b.

*If answers 2 – 9, skip to O16.

O15a. At the time of the fatal injury, which of the following types of weapon was this alleged

offender carrying? (Answer all options)

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

Weapon	Code
{O15a1} firearm
{O15a1.1} If firearm selected, please specify
{O15a2} knife, razor, box cutter or other blade
{O15a3} bat, pipe, chain, or other object
{O15a4} rope or wire
{O15a5} other
{O15a5.1} If other selected, please specify

O15b. Where did this alleged offender obtain these weapons? (Answer all options)

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

Weapons source	Code
{O15b1} from home
{O15b1.1} specify weapon
{O15b2} from friend or relative outside household
{O15b2.1} specify weapon
{O15b3} purchased for himself/herself
{O15b3.1} specify weapon
{O15b4} stolen
{O15b4.1} specify weapon
{O15b5} home-made weapon
{O15b6} weapon of opportunity (used weapon already present in environment / used object in environment as weapon}
{O15b7} from the victim
{O15b7.1} specify weapon
{O15b8} other
{O15b8.1} specify weapon

O16. 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 (O16a: If Other selected, please specify__________________________________)

77=not applicable

88=unknown

99=refused to answer

O17. 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* (O17a: If Other selected, please specify__________________________________)

77=not applicable*

88=unknown*

99=refused to answer*

*If this alleged offender is NOT a student, skip to Question O22.

O18. 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

O19. 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.

O20. Did the alleged offender experience any school-related crises or traumatic events during the 2 weeks before this incident? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O20, proceed to O20a.

*If answers 2 – 9, skip to O21.

O20a. Please briefly describe the specific school-related crises or traumatic events experienced.

Code later

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

O21. Was a school-related crisis or traumatic event imminent within two weeks of this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O21, proceed to O21a.

*If answers 2 – 9, skip to O22.

O21a. Please briefly describe the specific school-related crises or traumatic events that may have

been imminent. Code later

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

O22. Did the alleged offender experience any community-related crises or traumatic events during the 2 weeks before this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O22, proceed to O22a.

*If answers 2 – 9, skip to O23.

O22a. Please briefly describe the specific community-related crises or traumatic events

experienced. Code later

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

O23. Was a community-related crisis or traumatic event imminent within two weeks of this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O23, proceed to O23a.

*If answers 2 – 9, skip to O24.

O23a. Please briefly describe the specific community-related crises or traumatic events that may

have been imminent. Code later

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

O24. Did the alleged offender experience any family-related crises or traumatic events during the 2 weeks before this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O24, proceed to O24a.

*If answers 2 – 9, skip to O25.

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

Code later

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

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

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O25, proceed to O25a.

*If answers 2 – 9, skip to O26.

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

been imminent. Code later

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

O26. Did the alleged offender experience any relationship-related crises or traumatic events during the 2 weeks before this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O26, proceed to O26a.

*If answers 2 – 9, skip to O27.

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

experienced. Code later

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

O27. Was a relationship-related crisis or traumatic event imminent within two weeks of this incident?

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O27, proceed to O27a.

*If answers 2 – 9, skip to O28.

O27a. Please briefly describe the specific relationship-related crises or traumatic events that may

have been imminent. Code later

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

O28. 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
{O28a} disobeying authority figure
{O28b} name-calling, taunting, or teasing peers
If yes to O28b, please complete O28b.1 & O28b.2:
O28b.1 Face to face?
O28b.2 Using Electronic means? (e.g., phone, computer)
{O28c} verbal threats
{O28d} sent written threats
{O28e} sent electronic threats
{O28f} bullied peers
{O28g} physically threatened peers
{O28h} physically fought with peers
{O28i} damaged another's personal property
{O28j} damaged school property (tagging, vandalism etc…)
{O28k} stole another's personal property
{O28l} truancy (skipped school)
{O28m} possessed / used illegal substances
{O28n} possessed a weapon

O29. 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
{O29a} called names by peers
{O29b} bullied by peers
{O29c} had personal property damaged or stolen
{O29d} verbally threatened by peers
{O29e} received written threats
{O29f} electronic threats
{O29g} physically threatened by peers
{O29h} physically assaulted by peers

O30. At the time of the event, did this alleged offender have a diagnosed Learning Disability, physical disability, or physical health problem? _

Do NOT read options

1=yes (O30a: If yes, please specify__________________________________)

2=no

7=not applicable

8=unknown

9=refused to answer

O31. 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
{O31a} guidance counseling / advising
{O31b} social services
{O31c} supplemental educational services (including efforts to address learning disabilities), such as a formal school psychoeducational evaluation
{O31d} other services
{O31d.1} If Other selected, please specify

O32. 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

O33. Had the alleged offender ever received professional treatment for any other emotional or mental

health problem, such as by a psychiatrist/psychologist? _

Do NOT read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to O33, proceed to O33a & O33b.

*If answer 2 - 9, skip to Question #O34.

O33a. If yes, what specific kinds of emotional or mental health problems were treated?

To be coded later

O33b. In what type of setting were they treated (e.g., inpatient, outpatient)?

To be coded later

O34. Did this alleged offender have a documented family history of ....

Read options, Coding instructions: 1=yes, 2=no, 8=unknown. (Answer all options)

	Code
{O34a} alcoholism
{O34b} drug abuse
{O34c} intimate partner violence
{O34d} sexual violence
{O34e} attempted / completed suicide
{O34f} arrests / convictions for violent offenses (e.g., assault, homicide etc…)

O35. Did this alleged offender suffer

Read options, Coding instructions: 1=yes, 2=no, 8=unknown. (Answer all options)

	Code
{O35a} physical child abuse
{O35b} sexual child abuse
{O35c} emotional / psychological abuse as a child
{O35d} neglect
{O35e} victimization in intimate partner violence_/ teen dating violence
{O35f} victimization in sexual violence

O36. Did the alleged offender ever do something to purposely hurt him/herself without wanting to die, such as cutting or burning him/herself on purpose, engaging in the choking game, etc.?

Do not read options

1=yes

2=no*

7=not applicable*

8=unknown*

9=refused to answer*

If yes to Q36, proceed to V36a & V36b.

*If answer 2 - 9, skip to Question #V37.

O36a. To whom was this self-harm behavior reported? Do not read options (Answer all options)

	Code
{O36a1} no one
{O36a2} parents
{O36a3} other family
{O36a4} peers
{O36a5} school staff
{O36a6} other medical/mental health professional
{O36a7} other
{O36a7a} If Other selected, please specify:
{O36a8} not applicable
{O36a9} unknown
{O36a10} refused to answer

O36b. What, if any, actions were taken in response to this self-harm behavior?

O37. 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
{O37a} Thoughts/threats of suicide
{O37b} Plans of suicide
{O37c} Previous suicide attempts

If yes to any of O37a – O37c, proceed to O37d – O37e.

*If answers 2 – 9, skip to O38.

O37d. To whom was this suicidal behavior reported?

Do not read options; Coding instructions: 1=yes, 2=no, 8=unknown. Select all applicable options.	Code
{O37d1} no one
{O37d2} parents
{O37d3} other family
{O37d4} peers
{O37d5} school staff
{O37d6} other medical/mental health professional
{O37d7} other
{O37d7a}) If Other selected, please specify
{O37d8} not applicable
{O37d9} unknown
{O37d10} refused to answer

O37e. What, if any, actions were taken in response to this suicidal behavior? To be coded later

O38. 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 yes to Q38, proceed to O39.

*If answer 2 - 9, skip to O44.

O39. What was the date of the injury event? _ _/_ _/_ _ _ _

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

O40. What was the time of the injury event? _ _: _ _ Record in military time

O41. What was the date of death? _ _/_ _/_ _ _ _

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

O42. 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
{O42a} single suicide
{O42b} suicide pact
{O42c} victim killed by law enforcement or security personnel
{O42d} victim killed by civilian during commission of a crime
{O42e} other
{O42e1} If Other selected, please specify:

O43. Briefly describe the circumstances of the fatal injury and events leading up to it, including history of prior conflicts between those involved, etc.

Code later

O44. What was the method of fatal injury?

Weapon	Code
{O44a} firearm
{O44a1}) - If firearm selected, please specify
{O44b} knife, razor, box cutter or other blade
{O44c} bat, pipe, chain, or other object
{O44d} rope or wire
{O44e} other
{O44} - If Other selected, please specify

O45. Did perceptions about the alleged 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

O46. 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

O47. 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/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Kristin Marie Holland
File Modified	0000-00-00
File Created	2021-01-24