SOP 208.06-att-10: PREA Initial Notification Form
Summary
Key Topics
- PREA
- sexual abuse
- sexual harassment
- initial notification
- allegation reporting
- victim protection
- administrative segregation
- SANE examination
- SART
- Criminal Investigations
- Internal Affairs
- PREA Coordinator
- incident documentation
- sexual misconduct
- prison safety
Full Text
SOP 208.06
Attachment 10
# PREA Initial Notification Form Revised: 06-23-22
Page 1 of 1
Facility: Date of Incident:
Location: Time of Incident:
Incident Report #:
Type of Allegation (Select one): Alleged Victim(s) Alleged Aggressor(s)
S/I Harassment
I/I Abuse
I/I Harassment
|Summary of Incident:|Col2|
|---|---|
|(This Section should answer the questions: 1. What was the specific allegation (details)? 2. What steps were taken
to protect the victim? 3. Were either the victim or aggressor placed in Administrative segregation/Why? 4. Was
SANE necessary/Was a SANE examination conducted?)|(This Section should answer the questions: 1. What was the specific allegation (details)? 2. What steps were taken
to protect the victim? 3. Were either the victim or aggressor placed in Administrative segregation/Why? 4. Was
SANE necessary/Was a SANE examination conducted?)|
|How were you notified of this incident?(Grievance, Hotline,
Staff, Ombudsman, 3rd party, etc.)||
|Name|ID#|Name|ID#|
|---|---|---|---|
|||||
|||||
|||||
Y/
N
SART notified? If yes, name
By whom
Date/Time
Y/
N
SANE notified? If yes, name
By whom
Date/Time
Y/
N
Criminal Investigations notified? If yes, name
By whom
Date/Time
Y/
N
Internal Affairs notified? If yes, name
By whom
Date/Time
Y/
N
PREA Coordinator notified? If yes, name
By whom
Date/Time
Name/Title (Person Submitting Report) Signature/Title
Retention Schedule: Upon completion this form is to be placed in the PREA case file as well as emailed to the
PREA Unit.