Appendix D Noninterview Worksheet

Appendix D: SILJ Non-Interview Worksheet

1. Respondent ID# _______________

2. Facility ID# _______________

3. Data Collection Date _______________

4. Interviewer ID# _______________

5. Inmate sex 1=Male and 2=Female] _______________

6. Race/Ethnicity (Mark all that apply)

1=White

2=Black or African American

3=Hispanic or Latino(a)

4=American Indian or Alaskan Native

5=Asian

6= Native Hawaiian or other Pacific Islander

7=Other [specify] ____________

7. Is this inmate convicted of any offense? Yes/No

If no, no further information required.

8. If yes, is this inmate sentenced for any offense? Yes/No

If yes, enter most serious offense for which sentenced _______________

If no, enter most serious offense for which convicted _______________

Interview Status

9. Reason for Non-Interview

a. Declined to be Interviewed 1=yes 2=no _____

b. Not Available 1=yes 2=no _____

[Must have 1 in 9a OR 9b]

c. Reason

1=Did not want to be interviewed

2=Out to court

3=Temporarily absent (e.g., furlough, work release)

4=Released

5=Transferred to another facility

6= Mentally incapable

7=Physically unable

8=Medical Unit, out to hospital

9=Violent or uncontrolled behavior

10=Physically ill

11=Language barrier [specify] ____________

12=Other reason[Specify] ____________