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pdfAttachment E: PAPI Questionnaires
Four PAPI questionnaires are included in the attachment, as described below:
Form 1: Intended for female inmates who have been in the facility for 12 months or longer.
Form 2: Intended for male inmates who have been in the facility for 12 months or longer.
Form 3: Intended for female inmates who have been in the facility for a period less than 12
months.
Form 4: Intended for male inmates who have been in the facility for a period less than 12
months.
OMB No.:
Exp.:
XXXX-XXXX
XX/XX/XXXX
NATIONAL INMATE
SURVEY - JAILS
Conducted by the Bureau of Justice Statistics
and
Westat
NOTICE: Public reporting for this collection of information is estimated to average 15 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. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810
Seventh Street, NW, Washington, DC 20531. 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. The OMB control number for this
project is XXXX-XXXX.
6. Are you currently being held in this facility for any
of the following:
SECTION A
Mark
Please answer the question in the space provided or
mark your answer in the box, like this . To protect
your privacy, do not put your name on this survey.
1. On what date were you admitted to this facility?
If you cannot remember the exact date, please write
down whatever you can remember, such as the year
and the month.
________ / ________ / ________
Month
Day
Year
“Yes” or “No” for each item.
Yes
No
A violent offense, such as physical or
sexual assault, rape, robbery,
manslaughter, attempted murder, or
murder?
1
2
A drug offense, such as possessing,
selling, or manufacturing drugs?
1
2
A property offense, such as burglary,
larceny, auto theft, bad checks, fraud,
forgery or grand theft?
1
2
Any other offense?
1
2
2. How old are you?
7. How long have you been in this facility?
Age: _______
Less than 1 week....................................................
At least 1 week but less than 1 month ...................
At least 1 month but less than 2 months ................
At least 2 months but less than 6 months...............
At least 6 months but less than 1 year ...................
At least 1 year but less than 5 years .......................
At least 5 years but less than 10 years ...................
10 years or more ....................................................
3. Are you of Hispanic, Latino, or Spanish origin?
Yes .........................................................................
No ..........................................................................
1
2
4. Which of these categories describes your race:
Mark
“Yes” or “No” for each item.
Yes
No
White
1
2
Black or African American
1
2
American Indian or Alaska Native
1
2
Asian
1
2
Native Hawaiian or other Pacific Islander
1
2
2
3
4
5
6
7
8
8. Before you were admitted to this facility, had you
ever spent time as an adult or juvenile in a prison,
jail, or other correctional facility?
Yes .........................................................................
No ..........................................................................
1
2
9. Which of the following best represents how you
think about yourself?
5. What is the highest level of school you have
completed?
Less than a high school graduate ...........................
High school graduate or GED ...............................
Some college .........................................................
College degree or more .........................................
1
Lesbian or gay........................................................
Straight; that is, not lesbian or gay ........................
Bisexual; that is, you are sexually attracted
to both men and women .........................................
Something else .......................................................
1
2
3
4
1
1
2
3
4
10. What sex were you assigned at birth on your
original birth certificate?
Male ........................................................................
Female ....................................................................
15. This question is about wanted or voluntary sex or
sexual contact you have had with other inmates in
this facility. In the past 12 months, did you do any
of the following:
1
2
“Yes” or “No” for each item.
Yes
No
Touch another inmate's body in a sexual
way or have your body touched in a
sexual way?
1
2
Have oral sex with another inmate at
this facility?
1
2
Have vaginal sex with another inmate
at this facility?
1
2
Have anal sex with another inmate at
this facility?
1
2
Have any type of sex or sexual contact
with another inmate at this facility other
than sexual touching, oral sex, vaginal
sex, or anal sex?
1
2
Mark
11. Do you currently think of yourself as…?
Male .......................................................................
Female ...................................................................
Transgender ...........................................................
None of these .........................................................
1
2
3
4
12. Before you entered this facility, had anyone ever
physically forced, pressured, or made you feel you
had to have sex or sexual contact—that is
unwanted touching of the breasts, genitals or butt,
or vaginal, oral, or anal sex?
Yes ..................................
No ...................................
1
2
Continue to item 13
Go to item 14
These next questions ask about unwanted sex or
sexual contact you have had with other inmates in
this facility. By unwanted, we mean sex or sexual
contact that you did not want to happen.
13. Were you physically forced, pressured, or made to
feel you had to have sex or sexual contact before
you were 18 years old, after you turned 18, or
both?
Before you were 18 ...............................................
After you turned 18 ...............................................
Both .......................................................................
1
16. In the past 12 months, did another inmate use
physical force to make you do any of the following:
2
3
Mark
14. Before you entered this facility, were you
physically forced, pressured, or made to feel that
you had to have sex or sexual contact while you
were an adult or juvenile in a jail, prison, or other
correctional facility?
Yes .........................................................................
No ..........................................................................
1
2
2
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Have oral sex with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
oral sex, vaginal sex, or anal sex?
1
2
17. In the past 12 months, did another inmate, without
using physical force, pressure you or make you feel
that you had to do any of the following:
Mark
“Yes” or “No” for each item.
Yes
20. In the past 12 months, when you were physically
forced, pressured, or made to feel that you had to
have sex or sexual contact with another inmate, did
you ever:
No
Mark
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Have oral sex with them?
1
Have vaginal sex with them?
“Yes” or “No” for each item.
Yes
No
Receive knife or stab wounds?
1
2
2
Receive broken bones?
1
2
1
2
Receive anal or vaginal tearing?
1
2
Have anal sex with them?
1
2
Have your teeth chipped or knocked out?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
oral sex, vaginal sex, or anal sex?
Receive internal injuries?
1
2
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
18. In the past 12 months, how many times altogether
were you physically forced, pressured, or made to
feel like you had to have sex or sexual contact with
another inmate?
0 times ..................
1 time ....................
2 times ..................
3–10 times ............
11 times or more ...
1
2
3
SECTION B
Go to SECTION B
on page 3
These next questions ask about sex or sexual contact
you have had with staff at this facility. By staff, we
mean the employees of this facility and anybody who
works as a volunteer in this facility.
Continue to item 19
4
5
21. This question is about willing sex or sexual contact
you have had with any staff at this facility. In the
past 12 months, did you do any of the following:
19. In the past 12 months, when you were physically
forced, pressured, or made to feel that you had to
have sex or sexual contact with another inmate,
were you ever:
Mark
“Yes” or “No” for each item.
Yes
Mark
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
Offered protection from other inmates?
1
2
Trying to pay off or settle a debt that you
owed?
1
2
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
“Yes” or “No” for each item.
Yes
No
Touch a facility staff person's body in a
sexual way or have your body touched in
a sexual way?
1
2
Give or receive a handjob from a facility
staff person?
1
2
Have oral sex (blowjob) with a facility
staff person?
1
2
Have vaginal sex with a facility staff
person?
1
2
Have anal sex with a facility staff person?
1
2
2
3
22. In the past 12 months, did a facility staff person
use physical force to make you do any of the
following:
Mark
“Yes” or “No” for each item.
Yes
25. In the past 12 months, when you had sex or sexual
contact with facility staff, did any single incident
ever involve more than one facility staff person?
Yes .........................................................................
No ..........................................................................
No
1
2
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have vaginal sex with them?
1
2
Mark
Have anal sex with them?
1
2
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Offered protection from other inmates?
1
2
Offered protection from another
correctional officer?
1
2
Trying to pay off or settle a debt that
you owed?
1
2
Threatened with harm or a weapon?
1
2
26. In the past 12 months, when you had sex or sexual
contact with facility staff, were you ever:
23. In the past 12 months, did a facility staff person
without using physical force, pressure you or make
you feel that you had to do any of the following:
Mark
“Yes” or “No” for each item.
Yes
No
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Physically held down or restrained?
1
2
Have vaginal sex with them?
1
2
Physically harmed or injured?
1
2
Have anal sex with them?
1
2
2
27. In the past 12 months, when you had sex or sexual
contact with facility staff, was it ever with:
24. This question is about both wanted and unwanted
sex with staff at this facility. In the past 12 months,
how many times altogether have you had any type
of wanted or unwanted sex or sexual contact with
staff at this facility?
0 times ..................
1 time ....................
2 times ..................
3–10 times ............
11 times or more ...
1
Go to SECTION C
on page 5
Continue to item 25
2
3
Mark
4
5
4
“Yes” or “No” for each item.
Yes
No
Male facility staff?
1
2
Female facility staff?
1
2
28. In the past 12 months, when you had sex or sexual
contact with facility staff, did you ever:
Mark
“Yes” or “No” for each item.
Yes
No
Receive knife or stab wounds?
1
2
Receive broken bones?
1
2
Receive anal or vaginal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
SECTION C
These last two questions are about your experience
with this survey.
29. How upsetting did you find it to answer questions
about your own experiences with sex and sexual
assault in this facility?
Not upsetting at all.................................................
Somewhat upsetting...............................................
Very upsetting .......................................................
1
2
3
30. How accurate are the answers you gave in this
survey?
Not very accurate...................................................
Fairly accurate .......................................................
Very accurate .........................................................
1
2
3
After you have completed the survey, please put it
in the envelope and seal it before you turn it in.
5
Thank You!
2
OMB No.:
Exp.:
XXXX-XXXX
XX/XX/XXXX
NATIONAL INMATE
SURVEY - JAILS
Conducted by the Bureau of Justice Statistics
and
Westat
NOTICE: Public reporting for this collection of information is estimated to average 15 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. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810
Seventh Street, NW, Washington, DC 20531. 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. The OMB control number for this
project is XXXX-XXXX.
6. Are you currently being held in this facility for any
of the following:
SECTION A
Mark
Please answer the question in the space provided or
mark your answer in the box, like this . To protect
your privacy, do not put your name on this survey.
1. On what date were you admitted to this facility?
If you cannot remember the exact date, please write
down whatever you can remember, such as the year
and the month.
________ / ________ / ________
Month
Day
Year
“Yes” or “No” for each item.
Yes
No
A violent offense, such as physical or
sexual assault, rape, robbery,
manslaughter, attempted murder, or
murder?
1
2
A drug offense, such as possessing,
selling, or manufacturing drugs?
1
2
A property offense, such as burglary,
larceny, auto theft, bad checks, fraud,
forgery or grand theft?
1
2
Any other offense?
1
2
2. How old are you?
7. How long have you been in this facility?
Age: _______
Less than 1 week....................................................
At least 1 week but less than 1 month ...................
At least 1 month but less than 2 months ................
At least 2 months but less than 6 months...............
At least 6 months but less than 1 year ...................
At least 1 year but less than 5 years .......................
At least 5 years but less than 10 years ...................
10 years or more ....................................................
3. Are you of Hispanic, Latino, or Spanish origin?
Yes .........................................................................
No ..........................................................................
1
2
4. Which of these categories describes your race:
Mark
“Yes” or “No” for each item.
Yes
No
White
1
2
Black or African American
1
2
American Indian or Alaska Native
1
2
Asian
1
2
Native Hawaiian or other Pacific Islander
1
2
2
3
4
5
6
7
8
8. Before you were admitted to this facility, had you
ever spent time as an adult or juvenile in a prison,
jail, or other correctional facility?
Yes .........................................................................
No ..........................................................................
1
2
9. Which of the following best represents how you
think of yourself?
5. What is the highest level of school you have
completed?
Less than a high school graduate ...........................
High school graduate or GED ...............................
Some college .........................................................
College degree or more .........................................
1
Lesbian or gay........................................................
Straight; that is, not lesbian or gay ........................
Bisexual; that is, you are sexually attracted
to both men and women .........................................
Something else .......................................................
1
2
3
4
1
1
2
3
4
10. What sex were you assigned at birth on your
original birth certificate?
Male ........................................................................
Female ....................................................................
15. This question is about wanted or voluntary sex or
sexual contact you have had with other inmates in
this facility. In the past 12 months, did you do any
of the following:
1
2
“Yes” or “No” for each item.
Yes
No
Touch another inmate's body in a sexual
way or have your body touched in a
sexual way?
1
2
Give or receive a handjob from another
inmate at this facility?
1
2
Have oral sex (blowjob) with another
inmate at this facility?
1
2
Have anal sex with another inmate at
this facility?
1
2
Have any type of sex or sexual contact
with another inmate at this facility other
than sexual touching, handjobs, oral sex
or blowjobs, or anal sex?
1
2
Mark
11. Do you currently think of yourself as…?
Male .......................................................................
Female ...................................................................
Transgender ...........................................................
None of these .........................................................
1
2
3
4
12. Before you entered this facility, had anyone ever
physically forced, pressured, or made you feel you
had to have sex or sexual contact—that is
unwanted touching of the genitals or butt, or
vaginal, oral, or anal sex?
Yes ..................................
No ...................................
1
2
Continue to item 13
Go to item 14
These next questions ask about unwanted sex or
sexual contact you have had with other inmates in
this facility. By unwanted, we mean sex or sexual
contact that you did not want to happen.
13. Were you physically forced, pressured, or made to
feel you had to have sex or sexual contact before
you were 18 years old, after you turned 18, or
both?
Before you were 18 ...............................................
After you turned 18 ...............................................
Both .......................................................................
16. In the past 12 months, did another inmate use
physical force to make you do any of the following:
1
2
Mark
3
14. Before you entered this facility, were you
physically forced, pressured, or made to feel that
you had to have sex or sexual contact while you
were an adult or juvenile in a jail, prison, or other
correctional facility?
Yes .........................................................................
No ..........................................................................
1
2
2
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a handjob
from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have anal sex with them?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
handjobs, oral sex or blowjobs, or anal
sex?
1
2
17. In the past 12 months, did another inmate, without
using physical force, pressure you or make you feel
that you had to do any of the following:
Mark
“Yes” or “No” for each item.
Yes
No
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Mark
Have anal sex with them?
1
2
Receive knife or stab wounds?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
handjobs, oral sex or blowjobs, or anal
sex?
Receive broken bones?
1
2
1
2
Receive anal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
20. In the past 12 months, when you were physically
forced, pressured, or made to feel that you had to
have sex or sexual contact with another inmate, did
you ever:
18. In the past 12 months, how many times altogether
were you physically forced, pressured, or made to
feel like you had to have sex or sexual contact with
another inmate?
0 times ..................
1 time ....................
2 times ..................
3–10 times ............
11 times or more ...
1
Go to SECTION B
on page 3
Continue to item 19
2
3
Yes
No
SECTION B
4
These next questions ask about sex or sexual contact
you have had with staff at this facility. By staff, we
mean the employees of this facility and anybody who
works as a volunteer in this facility.
5
19. In the past 12 months, when you were physically
forced, pressured, or made to feel that you had to
have sex or sexual contact with another inmate,
were you ever:
Mark
“Yes” or “No” for each item.
“Yes” or “No” for each item.
Yes
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Offered protection from other inmates?
1
2
Trying to pay off or settle a debt that
you owed?
1
2
3
21. This question is about willing sex or sexual contact
you have had with any staff at this facility. In the
past 12 months, did you do any of the following:
Mark
“Yes” or “No” for each item.
Touch a facility staff person's body in a
sexual way or have your body touched in
a sexual way?
Give or receive a handjob from a facility
staff person?
Yes
1
1
24. This question is about both wanted and unwanted
sex with staff at this facility. In the past 12 months,
how many times altogether have you had any type
of wanted or unwanted sex or sexual contact with
staff at this facility?
No
0 times...................
1 time ....................
2 times...................
3–10 times.............
11 times or more ...
2
2
Have oral sex (blowjob) with a facility
staff person?
1
2
Have vaginal sex with a facility staff
person?
1
2
Have anal sex with a facility staff person?
1
2
“Yes” or “No” for each item.
Touch their body in a sexual way or have
your body touched in a sexual way?
Yes
1
Go to SECTION C
on page 5
Continue to item 25
2
3
4
5
25. In the past 12 months, when you had sex or sexual
contact with facility staff, did any single incident
ever involve more than one facility staff person?
Yes .........................................................................
No ..........................................................................
22. In the past 12 months, did a facility staff person
use physical force to make you do any of the
following:
Mark
1
1
2
26. In the past 12 months, when you had sex or sexual
contact with facility staff, were you ever:
No
Mark
2
“Yes” or “No” for each item.
Yes
No
Persuaded or talked into it?
1
2
2
Given a bribe or blackmailed?
1
2
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Have vaginal sex with them?
1
2
Offered protection from other inmates?
1
2
Have anal sex with them?
1
2
Offered protection from another
correctional officer?
1
2
Trying to pay off or settle a debt that
you owed?
1
2
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
Give them a handjob or receive a handjob
from them?
1
Have oral sex (blowjob) with them?
23. In the past 12 months, did a facility staff person
without using physical force, pressure you or make
you feel that you had to do any of the following:
Mark
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
4
27. In the past 12 months, when you had sex or sexual
contact with facility staff, was it ever with:
Mark
“Yes” or “No” for each item.
Yes
No
Male facility staff?
1
2
Female facility staff?
1
2
28. In the past 12 months, when you had sex or sexual
contact with facility staff, did you ever:
Mark
“Yes” or “No” for each item.
Yes
No
Receive knife or stab wounds?
1
2
Receive broken bones?
1
2
Receive anal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
SECTION C
These last two questions are about your experience
with this survey.
29. How upsetting did you find it to answer questions
about your own experiences with sex and sexual
assault in this facility?
Not upsetting at all.................................................
Somewhat upsetting...............................................
Very upsetting .......................................................
1
2
3
30. How accurate are the answers you gave in this
survey?
Not very accurate...................................................
Fairly accurate .......................................................
Very accurate .........................................................
1
2
3
5
After you have completed the survey, please put it
in the envelope and seal it before you turn it in.
Thank You!
1
OMB No.:
Exp.:
XXXX-XXXX
XX/XX/XXXX
NATIONAL INMATE
SURVEY - JAILS
Conducted by the Bureau of Justice Statistics
and
Westat
NOTICE: Public reporting for this collection of information is estimated to average 15 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. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810
Seventh Street, NW, Washington, DC 20531. 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. The OMB control number for this
project is XXXX-XXXX.
6. Are you currently being held in this facility for any
of the following:
SECTION A
Mark
Please answer the question in the space provided or
mark your answer in the box, like this . To protect
your privacy, do not put your name on this survey.
1. On what date were you admitted to this facility?
If you cannot remember the exact date, please write
down whatever you can remember, such as the year
and the month.
________ / ________ / ________
Month
Day
Year
“Yes” or “No” for each item.
Yes
No
A violent offense, such as physical or
sexual assault, rape, robbery,
manslaughter, attempted murder, or
murder?
1
2
A drug offense, such as possessing,
selling, or manufacturing drugs?
1
2
A property offense, such as burglary,
larceny, auto theft, bad checks, fraud,
forgery or grand theft?
1
2
Any other offense?
1
2
2. How old are you?
7. How long have you been in this facility?
Age: _______
Less than 1 week ..................................................
At least 1 week but less than 1 month ...................
At least 1 month but less than 2 months ................
At least 2 months but less than 6 months ..............
At least 6 months but less than 1 year ...................
At least 1 year but less than 5 years ......................
At least 5 years but less than 10 years ...................
10 years or more...................................................
3. Are you of Hispanic, Latino, or Spanish origin?
Yes ......................................................................
No .......................................................................
1
2
4. Which of these categories describes your race:
Mark
“Yes” or “No” for each item.
Yes
No
White
1
2
Black or African American
1
2
American Indian or Alaska Native
1
2
Asian
1
2
Native Hawaiian or other Pacific Islander
1
2
2
3
4
5
6
7
8
8. Before you were admitted to this facility, had you
ever spent time as an adult or juvenile in a prison,
jail, or other correctional facility?
Yes ......................................................................
No........................................................................
1
2
9. Which of the following best represents how you
think about yourself?
5. What is the highest level of school you have
completed?
Less than a high school graduate ..........................
High school graduate or GED ..............................
Some college .......................................................
College degree or more ........................................
1
Lesbian or gay ......................................................
Straight; that is, not lesbian or gay .......................
Bisexual; that is, you are sexually attracted
to both men and women .......................................
Something else .....................................................
1
2
3
4
1
1
2
3
4
10. What sex were you assigned at birth on your
original birth certificate?
Male ....................................................................
Female.................................................................
15. This question is about wanted or voluntary sex or
sexual contact you have had with other inmates in
this facility. Since you arrived at this facility, did
you do any of the following:
1
2
Mark
11. Do you currently think of yourself as…?
Male ....................................................................
Female.................................................................
Transgender .........................................................
None of these.......................................................
1
2
3
4
12. Before you entered this facility, had anyone ever
physically forced, pressured, or made you feel you
had to have sex or sexual contact—that is
unwanted touching of the breasts, genitals or butt,
or vaginal, oral, or anal sex?
Yes .................................
No ..................................
1
2
Continue to item 13
Go to item 14
No
Touch another inmate's body in a sexual
way or have your body touched in a
sexual way?
1
2
Have oral sex with another inmate at
this facility?
1
2
Have vaginal sex with another inmate
at this facility?
1
2
Have anal sex with another inmate at
this facility?
1
2
Have any type of sex or sexual contact
with another inmate at this facility other
than sexual touching, oral sex, vaginal
sex, or anal sex?
1
2
16. Since you arrived at this facility, did another
inmate use physical force to make you do any of
the following:
1
2
3
Mark
14. Before you entered this facility, were you
physically forced, pressured, or made to feel that
you had to have sex or sexual contact while you
were an adult or juvenile in a jail, prison, or other
correctional facility?
Yes ......................................................................
No .......................................................................
Yes
These next questions ask about unwanted sex or
sexual contact you have had with other inmates in
this facility. By unwanted, we mean sex or sexual
contact that you did not want to happen.
13. Were you physically forced, pressured, or made to
feel you had to have sex or sexual contact before
you were 18 years old, after you turned 18, or
both?
Before you were 18..............................................
After you turned 18..............................................
Both ....................................................................
“Yes” or “No” for each item.
1
2
2
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Have oral sex with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
oral sex, vaginal sex, or anal sex?
1
2
17. Since you arrived at this facility, did another
inmate, without using physical force, pressure you
or make you feel that you had to do any of the
following:
Mark
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Have oral sex with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
Have any type of sex or sexual contact
with them other than sexual touching,
oral sex, vaginal sex, or anal sex?
20. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, did you ever:
Mark
2
1
2
1
Go to SECTION B
on page 3
Continue to item 19
2
3
No
1
2
Receive broken bones?
1
2
Receive anal or vaginal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
SECTION B
These next questions ask about sex or sexual contact
you have had with staff at this facility. By staff, we
mean the employees of this facility and anybody who
works as a volunteer in this facility.
4
5
21. This question is about willing sex or sexual contact
you have had with any staff at this facility. Since
you arrived at this facility, did you do any of the
following:
19. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, were you ever:
Mark
Yes
Receive knife or stab wounds?
18. Since you arrived at this facility, how many times
altogether were you physically forced, pressured,
or made to feel like you had to have sex or sexual
contact with another inmate?
0 times ..................
1 time ...................
2 times ..................
3–10 times ............
11 times or more ...
“Yes” or “No” for each item.
“Yes” or “No” for each item.
Yes
Mark
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
Offered protection from other inmates?
1
2
Trying to pay off or settle a debt that you
owed?
1
2
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
“Yes” or “No” for each item.
Yes
No
Touch a facility staff person's body in a
sexual way or have your body touched in
a sexual way?
1
2
Give or receive a handjob from a facility
staff person?
1
2
Have oral sex (blowjob) with a facility
staff person?
1
2
Have vaginal sex with a facility staff
person?
1
2
Have anal sex with a facility staff person?
1
2
2
3
22. Since you arrived at this facility, did a facility staff
person use physical force to make you do any of
the following:
Mark
“Yes” or “No” for each item.
Yes
25. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, did any single
incident ever involve more than one facility staff
person?
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a handjob
from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
Yes ......................................................................
No........................................................................
Mark
“Yes” or “No” for each item.
Yes
2
26. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, were you ever:
23. Since you arrived at this facility, did a facility staff
person without using physical force, pressure you
or make you feel that you had to do any of the
following:
Mark
1
No
“Yes” or “No” for each item.
Yes
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Offered protection from other inmates?
1
2
Offered protection from another
correctional officer?
1
2
Trying to pay off or settle a debt that you
owed?
1
2
Touch their body in a sexual way or have
your body touched in a sexual way?
1
Give them a handjob or receive a handjob
from them?
1
2
Threatened with harm or a weapon?
1
2
Have oral sex (blowjob) with them?
1
2
Physically held down or restrained?
1
2
Have vaginal sex with them?
1
2
Physically harmed or injured?
1
2
Have anal sex with them?
1
2
2
27. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, was it ever
with:
24. This question is about both wanted and unwanted
sex with staff at this facility. Since you arrived at
this facility, how many times altogether have you
had any type of wanted or unwanted sex or sexual
contact with staff at this facility?
0 times ..................
1 time ...................
2 times ..................
3–10 times ............
11 times or more ...
1
Go to SECTION C
on page 5
Continue to item 25
2
3
Mark
4
5
4
“Yes” or “No” for each item.
Yes
No
Male facility staff?
1
2
Female facility staff?
1
2
28. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, did you ever:
Mark
“Yes” or “No” for each item.
Yes
No
Receive knife or stab wounds?
1
2
Receive broken bones?
1
2
Receive anal or vaginal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
SECTION C
These last two questions are about your experience
with this survey.
29. How upsetting did you find it to answer questions
about your own experiences with sex and sexual
assault in this facility?
Not upsetting at all...............................................
Somewhat upsetting .............................................
Very upsetting .....................................................
1
2
3
30. How accurate are the answers you gave in this
survey?
Not very accurate.................................................
Fairly accurate .....................................................
Very accurate ......................................................
1
2
3
After you have completed the survey, please put it
in the envelope and seal it before you turn it in.
5
Thank You!
2
OMB No.:
Exp.:
XXXX-XXXX
XX/XX/XXXX
NATIONAL INMATE
SURVEY - JAILS
Conducted by the Bureau of Justice Statistics
and
Westat
NOTICE: Public reporting for this collection of information is estimated to average 15 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. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810
Seventh Street, NW, Washington, DC 20531. 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. The OMB control number for this
project is XXXX-XXXX.
6. Are you currently being held in this facility for any
of the following:
SECTION A
Mark
Please answer the question in the space provided or
mark your answer in the box, like this . To protect
your privacy, do not put your name on this survey.
1. On what date were you admitted to this facility?
If you cannot remember the exact date, please write
down whatever you can remember, such as the year
and the month.
________ / ________ / ________
Month
Day
Year
“Yes” or “No” for each item.
Yes
No
A violent offense, such as physical or
sexual assault, rape, robbery,
manslaughter, attempted murder, or
murder?
1
2
A drug offense, such as possessing,
selling, or manufacturing drugs?
1
2
A property offense, such as burglary,
larceny, auto theft, bad checks, fraud,
forgery or grand theft?
1
2
Any other offense?
1
2
2. How old are you?
7. How long have you been in this facility?
Age: _______
Less than 1 week ..................................................
At least 1 week but less than 1 month ...................
At least 1 month but less than 2 months ................
At least 2 months but less than 6 months ..............
At least 6 months but less than 1 year ...................
At least 1 year but less than 5 years ......................
At least 5 years but less than 10 years ...................
10 years or more...................................................
3. Are you of Hispanic, Latino, or Spanish origin?
Yes ......................................................................
No .......................................................................
1
2
4. Which of these categories describes your race:
Mark
“Yes” or “No” for each item.
Yes
No
White
1
2
Black or African American
1
2
American Indian or Alaska Native
1
2
Asian
1
2
Native Hawaiian or other Pacific Islander
1
2
2
3
4
5
6
7
8
8. Before you were admitted to this facility, had you
ever spent time as an adult or juvenile in a prison,
jail, or other correctional facility?
Yes ......................................................................
No........................................................................
1
2
9. Which of the following best represents how you
think about yourself?
5. What is the highest level of school you have
completed?
Less than a high school graduate ..........................
High school graduate or GED ..............................
Some college .......................................................
College degree or more ........................................
1
Lesbian or gay......................................................
Straight; that is, not lesbian or gay .......................
Bisexual; that is, you are sexually attracted
to both men and women .......................................
Something else .....................................................
1
2
3
4
1
1
2
3
4
10. What sex were you assigned at birth on your
original birth certificate?
Male ....................................................................
Female.................................................................
15. This question is about wanted or voluntary sex or
sexual contact you have had with other inmates in
this facility. Since you arrived at this facility, did
you do any of the following:
1
2
Mark
11. Do you currently think of yourself as…?
Male ....................................................................
Female.................................................................
Transgender .........................................................
None of these.......................................................
1
2
3
4
12. Before you entered this facility, had anyone ever
physically forced, pressured, or made you feel you
had to have sex or sexual contact—that is
unwanted touching of the genitals or butt, or
vaginal, oral, or anal sex?
Yes .................................
No ..................................
1
2
Continue to item 13
Go to item 14
No
Touch another inmate's body in a sexual
way or have your body touched in a
sexual way?
1
2
Give or receive a handjob from another
inmate at this facility?
1
2
Have oral sex (blowjob) with another
inmate at this facility?
1
2
Have anal sex with another inmate at
this facility?
1
2
Have any type of sex or sexual contact
with another inmate at this facility other
than sexual touching, handjobs, oral sex
or blowjobs, or anal sex?
1
2
16. Since you arrived at this facility, did another inmate
use physical force to make you do any of the following:
1
2
Mark
3
14. Before you entered this facility, were you
physically forced, pressured, or made to feel that
you had to have sex or sexual contact while you
were an adult or juvenile in a jail, prison, or other
correctional facility?
Yes ......................................................................
No .......................................................................
Yes
These next questions ask about unwanted sex or
sexual contact you have had with other inmates in
this facility. By unwanted, we mean sex or sexual
contact that you did not want to happen.
13. Were you physically forced, pressured, or made to
feel you had to have sex or sexual contact before
you were 18 years old, after you turned 18, or
both?
Before you were 18..............................................
After you turned 18..............................................
Both ....................................................................
“Yes” or “No” for each item.
1
2
2
“Yes” or “No” for each item.
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have anal sex with them?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
handjobs, oral sex or blowjobs, or anal
sex?
1
2
17. Since you arrived at this facility, did another inmate,
without using physical force, pressure you or make
you feel that you had to do any of the following:
Mark
“Yes” or “No” for each item.
Yes
No
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Mark
Have anal sex with them?
1
2
Receive knife or stab wounds?
1
2
Have any type of sex or sexual contact
with them other than sexual touching,
handjobs, oral sex or blowjobs, or anal
sex?
Receive broken bones?
1
2
1
2
Receive anal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
20. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, did you ever:
18. Since you arrived at this facility, how many times
altogether were you physically forced, pressured,
or made to feel like you had to have sex or sexual
contact with another inmate?
0 times ..................
1 time ...................
2 times ..................
3–10 times ............
11 times or more ...
1
Go to SECTION B
on page 3
Continue to item 19
2
3
Yes
No
SECTION B
4
These next questions ask about sex or sexual contact
you have had with staff at this facility. By staff, we
mean the employees of this facility and anybody who
works as a volunteer in this facility.
5
19. Since you arrived at this facility, when you were
physically forced, pressured, or made to feel that
you had to have sex or sexual contact with another
inmate, were you ever:
Mark
“Yes” or “No” for each item.
“Yes” or “No” for each item.
Yes
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Offered protection from other inmates?
1
2
Trying to pay off or settle a debt that
you owed?
1
2
3
21. This question is about willing sex or sexual contact
you have had with any staff at this facility. Since
you arrived at this facility, did you do any of the
following:
Mark
“Yes” or “No” for each item.
Yes
Touch a facility staff person's body in a
sexual way or have your body touched in
a sexual way?
1
Give or receive a handjob from a facility
staff person?
1
Have oral sex (blowjob) with a facility
staff person?
1
23. Since you arrived at this facility, did a facility staff
person without using physical force, pressure you
or make you feel that you had to do any of the
following:
No
Mark
2
2
1
2
Have anal sex with a facility staff person?
1
2
Yes
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
24. This question is about both wanted and unwanted
sex with staff at this facility. Since you arrived at
this facility, how many times altogether have you
had any type of wanted or unwanted sex or sexual
contact with staff at this facility?
22. Since you arrived at this facility, did a facility staff
person use physical force to make you do any of
the following:
“Yes” or “No” for each item.
Yes
2
Have vaginal sex with a facility staff
person?
Mark
“Yes” or “No” for each item.
0 times .................
1 time ...................
2 times .................
3–10 times ...........
11 times or more ..
No
Touch their body in a sexual way or have
your body touched in a sexual way?
1
2
Give them a handjob or receive a
handjob from them?
1
2
Have oral sex (blowjob) with them?
1
2
Have vaginal sex with them?
1
2
Have anal sex with them?
1
2
1
Go to SECTION C
on page 5
Continue to item 25
2
3
4
5
25. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, did any single
incident ever involve more than one facility staff
person?
Yes ......................................................................
No........................................................................
4
1
2
26. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, were you ever:
Mark
“Yes” or “No” for each item.
Yes
No
Persuaded or talked into it?
1
2
Given a bribe or blackmailed?
1
2
Given drugs or alcohol to get you drunk
or high?
1
2
Offered protection from other inmates?
1
2
Offered protection from another
correctional officer?
1
SECTION C
These last two questions are about your experience
with this survey.
29. How upsetting did you find it to answer questions
about your own experiences with sex and sexual
assault in this facility?
Not upsetting at all ...............................................
Somewhat upsetting .............................................
Very upsetting ......................................................
2
Trying to pay off or settle a debt that you
owed?
1
2
Threatened with harm or a weapon?
1
2
Physically held down or restrained?
1
2
Physically harmed or injured?
1
2
“Yes” or “No” for each item.
Yes
Not very accurate .................................................
Fairly accurate .....................................................
Very accurate .......................................................
No
Male facility staff?
1
2
Female facility staff?
1
2
28. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, did you ever:
Mark
“Yes” or “No” for each item.
Yes
No
Receive knife or stab wounds?
1
2
Receive broken bones?
1
2
Receive anal tearing?
1
2
Have your teeth chipped or knocked out?
1
2
Receive internal injuries?
1
2
Get knocked unconscious?
1
2
Receive bruises, a black eye, sprains,
cuts, scratches, swelling, or welts?
1
2
2
3
30. How accurate are the answers you gave in this
survey?
27. Since you arrived at this facility, when you had sex
or sexual contact with facility staff, was it ever
with:
Mark
1
5
1
2
3
After you have completed the survey, please put it
in the envelope and seal it before you turn it in.
Thank You!
6
| File Type | application/pdf |
| Author | Field, Michael (OJP) |
| File Modified | 2022-07-18 |
| File Created | 2022-07-15 |