Form CJ-3 Single-Facility Jail Form

Attachment D
Form CJ-3

OMB No. 1121‐XXXX Approval Expires XX/XX/XXXX

2019 CENSUS OF JAILS

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT
RTI INTERNATIONAL

SINGLE-FACILITY JAIL FORM

Data Supplied By 

Name 
Official 
Addres
Phone 

Title 
Street or P. O. Box           

Area Code     

           Number   

   city    

  Extension 

   State        

Fax 

Area Code     

  Zip 

        Number      

E‐mail 




General Information 
IMPORTANT Please use this form as reference and submit your data at http://jailcensus.rti.org.
User name and password are included in the census invitation email.
If you need assistance, contact RTI, International toll-free at 1-800-344-1387 or email
[email protected].

What types of facilities are included in this census?

Reporting instructions:

The census includes all confinement facilities administered
by a local or regional law enforcement agency, which are
intended for adults but sometimes hold juveniles.

 Please complete this CJ-3 form on information pertaining
to your entire jail jurisdiction.

 INCLUDE jails and city/county or regional correctional
centers.
 INCLUDE special jail facilities operated under the
authority of local or regional correctional authorities, such
as medical/treatment/release centers, halfway houses,
work farms, and private facilities operated under contract
to local, regional, or Federal correctional authorities.
 INCLUDE temporary holding or lockup facilities if they are
a part of your combined jail function.

 If the answer to a question is "not available" or
"unknown," write “DK” in the space provided.
 If the answer to a question is "not applicable," write "NA"
in the space provided.
 If the answer to a question is "none" or "zero, "write "0" in
the space provided.
 When exact numeric answers are not available, provide
estimates and mark X in the box beside each number that
is estimated, e.g., 1,234 .

 EXCLUDE temporary holding or lockup facilities that are
not a part of your combined function from which inmates
are usually transferred within 72 hours and not held
beyond arraignment. If your only function is as a
temporary holding or lockup facility, DO NOT complete
this form. Contact us at 1-800-344-1387 or
[email protected].

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 2 hours and 30 minutes per form, including reviewing instructions, searching existing data sources, gathering necessary data, and
completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the
Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

SECTION I. FACILITY CHARACTERISTICS
1. For which of the following purposes do your jail facilities hold offenders?
Yes

No

a. Detention facility with authority to hold persons facing criminal charges beyond 72 hours

Ο

Ο

b. Correctional facility for persons convicted of offenses with sentences usually of a year or
less

Ο

Ο

c.

Ο

Ο

Ο

Ο

Yes

No

a. General adult population confinement

Ο

Ο

b. Persons returned to custody (e.g., probation, parole, and bail bond violators)

Ο

Ο

c.

Ο

Ο

d. Reception/diagnosis/classification

Ο

Ο

e. Confinement of juveniles

Ο

Ο

f.

Ο

Ο

g. Mental health/psychiatric care

Ο

Ο

h. Alcohol treatment confinement

Ο

Ο

i.

Drug treatment confinement

Ο

Ο

j.

Boot camp

Ο

Ο

k.

Protective Custody

Ο

Ο

l.

Other

Ο

Ο

Correctional facility for persons convicted of felonies with sentences of more than year

d. Temporary holding or lockup facility in which arrestees are usually detained up to 72
hours, excluding holidays and weekends, pending arraignment
2. As a matter of practice, what type of inmates do your jail facilities house?
Mark only ONE choice.
Ο Males only
Ο Females only
Ο Both males and females
3. What are the functions of your jail facilities?

Work release/prerelease

Medical treatment/hospitalization confinement

Specify

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4. On June 28, 2019, what was the total capacity of your jail facilities?
a. Rated Capacity
The maximum number of beds or inmates assigned by a rating official to your jail facilities, excluding
separate temporary holding areas.

b. Design capacity
The number of inmates planners or architects intended for your jail facilities.

5. On June 28, 2019, were any of your jail facilities under a federal, state or local court

order or consent decree to limit the number of inmates they can house?
Ο Yes—go on to 6
Ο No—skip to 7
6. If Yes to 5 (under a court order or consent decree to limit the number of inmates)—
a. What was the maximum number of inmates your jail jurisdiction was allowed to
house?

b. In what year did this order or decree take effect?
If more than one, report the year for the longest in effect.

7. On June 28, 2019, were any of your jail facilities under a federal, state or local court

order or consent decree for specific conditions of confinement?
Ο Yes—go on to 8
Ο No—skip to 9
8. If Yes to 7 (under a court order or consent decree for specific conditions of

confinement), what were those specific conditions?
Yes

No

a. Crowding

Ο

Ο

b. Recreation/exercise

Ο

Ο

c.

Ο

Ο

Staffing
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d. Medical facilities or services

Ο

Ο

e. Visiting/mail/telephone policy

Ο

Ο

f.

Ο

Ο

g. Library services

Ο

Ο

h. Grievance procedures or policies

Ο

Ο

i.

Fire hazards

Ο

Ο

j.

Disciplinary procedures or policies

Ο

Ο

k.

Administrative segregation procedures or policies

Ο

Ο

l.

Religious practices

Ο

Ο

m. Search policies or practices

Ο

Ο

n. Education or training programs

Ο

Ο

o. Counseling programs

Ο

Ο

p. Inmate classification

Ο

Ο

q. Other

Ο

Ο

Food services/nutrition/cleanliness

Specify

SECTION II. SUPERVISED POPULATION AND INMATE COUNTS
9. On June 28, 2019, how many persons under the supervision of your jail jurisdiction

were—
a. CONFINED in your jail facilities?
INCLUDE—
 Inmates held for other jurisdictions
 Persons in community-based programs who RETURN to your jail facilities at night
Community-based programs include electronic monitoring, home detention, community service,
day reporting, other pretrial supervision, other alternative work programs, alcohol/drug treatment
programs, and other programs where offenders are supervised outside of jail.
 Persons on transfer to treatment facilities but who remain under the jurisdiction of your jail facilities
 Persons out to court while under the jurisdiction of your jail facilities.
EXCLUDE—
Χ Persons under the jurisdiction of your jail facilities who are boarded elsewhere
Χ Inmates who are AWOL, escaped, or on long-term transfer to other jurisdictions
Χ Persons in community-based programs run by your jail who do NOT return to your jail facilities at
night.

b. Under jail supervision, but NOT CONFINED?
INCLUDE—
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

Persons in community-based programs run by your jail facilities who do NOT return to your jail
facilities at night.

EXCLUDE—
Χ Persons on pretrial release who are not in a community-based program run by your jail facilities
Χ Persons under the supervision of probation, parole, or other agencies
Χ Inmates on weekend programs that allow offenders to serve their sentences of confinement only on
weekends (e.g., Friday–Sunday)
Χ Inmates participating in community-based programs who RETURN to your jail facilities at night.

c. TOTAL (Sum of items 9a and 9b)
10. On the weekend prior to June 28, 2019, did your jail facilities have a weekend

program?
Weekend programs allow offenders to serve their sentences of confinement only on weekends (e.g.,
Friday–Sunday).
Ο Yes—How many inmates participated?
Ο No
11. On June 28, 2019, how many persons CONFINED in your jail facilities were—
a. Adult males (age 18 or older)
b. Adult females (age 18 or older)
c. Males age 17 or younger
d. Females age 17 or younger
e. TOTAL (Sum of items 11a through 11d should equal item 9a)
12. Of all the persons age 17 or younger CONFINED in your jail facilities on June 28,

2019 (sum of 11c and 11d), how many were tried or awaiting trial in adult court?

13. On June 28, 2019, how many persons CONFINED in your jail facilities were—
a. White (not of Hispanic origin)
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a. Black or African American (not of Hispanic origin)
b. Hispanic or Latino
c. American Indian or Alaska Native (not of Hispanic origin)
d. Asian (not of Hispanic origin)
e. Native Hawaiian or other Pacific Islander (not of Hispanic
origin)
f.

Two or more races (not of Hispanic origin)

g. Additional categories in your jail information system
Specify

h. Not known
i.

TOTAL (Sum of items 13a to 13i should equal item 9a)

14. On June 28, 2019, how many persons CONFINED in your jail facilities were—


INCLUDE persons adjudicated or awaiting revocation hearing.

j.

Probation violators

k. Parole violators
l.

TOTAL (Sum of 14a and 14b)

Questions 15, 16 and 18 ask about the offense seriousness and conviction status of inmates. For
inmates with more than one charge/offense, report the most serious charge/offense and the associated
conviction status. For probation and parole violators, report the most serious original or new
charge/offense. The most serious charge/offense is the one crime for which the person could receive
the longest jail/prison sentence. Alternatively, it can be determined by your jail system’s offense
severity code.

Page 5

15. On June 28, 2019 how many persons CONFINED in your jail facilities, regardless of

conviction status, had a charge/offense type of—
a. Felony
b. Misdemeanor
c. Other
Specify

d. TOTAL (Sum of items 15a to 15c should equal item 9a)
16. Of all persons CONFINED in your jail facilities on June 28, 2019, how many were—


For persons with more than one charge/offense, report the status associated with the most serious
charge/offense.



For convicted inmates, include probation and parole violators with no new sentence.

a. Convicted
b. Unconvicted
c. TOTAL (Sum of items 16a and 16b should equal item 9a)
17. On June 28, 2019, how many persons CONFINED in your jail facilities were—
a. U.S. citizens
b. Not U.S. citizens
c. Of unknown citizenship status
d. TOTAL (Sum of items 17a to 17c should equal item 9a)
18. On June 28, 2019, how many non-U.S. citizens in item 17b were—
a. Convicted
b. Unconvicted
c. Of unknown conviction status
Page 6

d. TOTAL (Sum of items 18a to 18c should equal item 17b)
19. On June 28, 2019, how many persons CONFINED in your jail facilities were held for—


Count persons with multiple holds only once with priority being federal, state, tribal, and local.



INCLUDE contractual, temporary, courtesy, or ad hoc holds for other agencies.

a. Federal authorities
(1) U.S. Marshals Service
(2) Federal Bureau of Prisons
(3) U.S. Immigration and Customs Enforcement (ICE)
(4) Bureau of Indian Affairs (BIA)
X

EXCLUDE inmates being housed for tribal governments in item 19c below.

(5) Other FEDERAL authorities
Specify

b. State prison authorities
(1) For your state
(2) For other states
c. American Indian or Alaska Native tribal governments
Χ

EXCLUDE inmates being housed for the BIA in item 19a4.

d. Other local jails
EXCLUDE—
Χ Inmates being housed for your own jail jurisdiction (i.e., your own county/city inmates).
Χ Inmates being housed for tribal governments in item 19c.
(1) Within your state
(2) Outside your state
e. TOTAL (Sum of items 19a to 19d)

Page 7

20. a. During the 30-day period from June 1 to June 30, 2019, on what day your jail

facilities hold the greatest number of inmates?
Peak population should be equal to or greater than the confined inmate population reported in item 9a.

June

, 2019

b. How many persons were CONFINED on that day?
21. Between July 1, 2018, and June 30, 2019, what was the average daily population of

all jail confinement facilities operated by your jail jurisdiction?


INCLUDE inmates who participated in weekend programs that allow offenders to serve their sentences of
confinement only on weekends (e.g., Friday–Sunday).



To calculate the average daily population, add the number of persons for each day during the period July
1, 2018, through June 30, 2019, and divide the result by 365.



If daily counts are not available, estimate the average daily population by adding the number of persons
held on the same day of each month and divide the result by 12.



If average daily population cannot be calculated as directed above, then estimate the typical number of
persons held in your jail facilities each day.

a. Males
b. Females
c. TOTAL (Sum of items 21a and 21b)
22. How many persons under the supervision of your jail facilities were—
a. ADMITTED to your jail facilities between July 1, 2018, and June 30, 2019?
INCLUDE—
 Persons officially booked into and housed in your jail by formal legal document and by the authority of
the courts or some other official agency
 Repeat offenders booked on new charges
 Persons serving a weekend sentence coming into jail for the FIRST time only (Do not count
subsequent admissions for the same weekend sentences).
EXCLUDE—
Χ Returns from escape, work release, medical appointments/treatment facilities, furloughs, bail/bond
releases, and court appearances.
(1) Males
(2) Females
(3) TOTAL (Sum of items 22a1 and 22a2)
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b. DISCHARGED from your jail facilities between July 1, 2018, and June 30, 2019?
INCLUDE—
 Persons released after a period of confinement (e.g., sentence completion, bail/bond releases, other
pretrial releases, transfers to other jurisdictions, or deaths)
 Persons completing their weekend sentence leaving jail for the LAST time.
EXCLUDE—
Χ Temporary discharges (e.g., work releases, medical appointments/treatment, out to courts, furloughs,
day reporters, or transfers to other facilities within your jail jurisdiction).
(1) Males
(2) Females
(3) TOTAL (Sum of items 22b1 and 22b2)

SECTION III.

FACILITY STAFFING

23. On June 28, 2019, how many staff employed in your jail facilities were—


Count each employee only once. Classify employees with multiple functions by the function performed
most frequently.



INCLUDE payroll staff, nonpayroll staff on the payroll of other government agencies (e.g., health
department, school district, or court), and unpaid interns.

Χ

EXCLUDE staff paid through contractual agreements and community volunteers.

a. Correctional officers


INCLUDE deputies, monitors, and other custody staff who spend more than 50% of their time with the
incarcerated population.

(1) Males
(2) Females
(3) TOTAL (Sum of items 23a1 and 23a2)
b. All other staff


INCLUDE administrators, clerical and maintenance staff, educational staff, professional and technical
staff, and other staff who spend more than 50% of their time in your jail.

(1) Males
(2) Females
(3) TOTAL (Sum of items 23b1 and 23b2)
Page 9

SECTION IV.

PROGRAMS ON OPIOID TESTING, SCREENING AND TREATMENT

The following questions are about opioids. Opioids are a class of drug that include heroin, synthetic
opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone
(OxyContin), hydrocodone (Vicodin), codeine, and morphine.
24. As a matter of practice, do any jail confinement facilities operated by your jail

jurisdiction—


INCLUDE testing, screening, and treatment that are conducted either on or off facility grounds.
Yes

No

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

Ο

g. Continue providing prescription opioids to inmates with acute or chronic pain
admitted to your jail facilities with a current prescription from a health care
professional prior to admission

Ο

Ο

h. Initiate providing opioids to inmates to relieve acute or chronic pain

Ο

Ο

a. Conduct routine urinalysis tests on inmates during intake for the detection of
opioids
b. Screen inmates during intake for opioid use disorder with a questionnaire or
interview
c. Provide overdose education to inmates identified as having opioid use disorders
d. Initiate behavioral or psychological treatment for inmates identified as having
opioid use disorders
e. Provide medications to inmates for the treatment of opioid withdrawal symptoms,
such as clonidine, lofexidine, methadone, or buprenorphine (e.g., Suboxone).
Χ EXCLUDE non-prescription or over the counter medication.
f.

Provide medication-assisted treatment (MAT) to inmates for treatment of opioid use
disorder.
Medication-assisted treatment (MAT) refers to the use of FDA-approved
medications, such as methadone, buprenorphine (e.g., Suboxone), and
naltrexone (e.g., Vivitrol), in the treatment of substance use disorders.
If NO to 24f, SKIP to 24g.
1) Continue MAT for inmates who are admitted with a current prescription for
buprenorphine (e.g., Suboxone) or naltrexone (e.g., Vivitrol) or were getting
services from a methadone clinic prior to admission
2) Initiate MAT for those identified as having opioid use disorders

i.

Provide overdose reversal medications such as naloxone (Narcan) to inmates with
opioid use disorders to take with them at the time of release from jail

Ο

Ο

j.

Link inmates with opioid use disorder to MAT in community care upon release

Ο

Ο

Page 10

If YES to 24b or 24e, go on to 25.
If NO to 24b and 24e, SKIP to 26.
25. During the 30-day period from June 1 to June 30, 2019—
a. How many persons were admitted to your jail facilities?
INCLUDE—
 Persons officially booked into and housed in your jail by formal legal document and by the authority of
the courts or some other official agency
 Repeat offenders booked on new charges
 Persons serving a weekend sentence coming into jail for the FIRST time only (Do not count
subsequent admissions for the same weekend sentences).
EXCLUDE—
Χ Returns from escape, work release, medical appointments/treatment facilities, furloughs, bail/bond
releases, and court appearances.

If NO to 24b, SKIP to 25c.
b. Of the admissions reported in item 25a, how many were screened with a
questionnaire or interview (24b) for opioid use disorder?

(1) How many screened positive for opioid use disorders?

(2) How many of those screened positive (25b1) were unique individuals (i.e., count
multiple positive results for the same individual only once)?

If NO to 24e, SKIP to 26.
c. Of the admissions reported in item 25a, how many did your jail facilities treat for
opioid withdrawal with medications (24e)?

(1) How many treated for opioid withdrawal were unique individuals (i.e., count
multiple treatments for the same individual only once)?

Page 11

If NO to 24f, END SURVEY.
26. On June 28, 2019, how many persons CONFINED in your jail facilities were receiving

medication-assisted treatment for opioid use disorders?


INCLUDE persons on transfer to treatment facilities but who remain under the jurisdiction of your jail
facilities.

END OF SURVEY

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