SOP_NUMBER: 208.06-att-10
TITLE: PREA Initial Notification Form
DIVISION: Executive
TOPIC_AREA: 101 & 208 Policy-Compliance Unit
EFFECTIVE_DATE: 0007-11-22
WORD_COUNT: 231
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/223760
URL: https://gps.press/sop-data/208.06-att-10/

SUMMARY:
This form is used to document and report initial notifications of alleged sexual abuse, sexual harassment, and other PREA-related incidents in GDC facilities. Staff must complete the form with incident details, protective measures taken, victim and aggressor information, and notifications made to required agencies including SART, SANE, Criminal Investigations, Internal Affairs, and the PREA Coordinator. The completed form is filed in the PREA case file and submitted to the PREA Unit.

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

ATTACHMENTS:
  1. Sexual Abuse_Sexual Harassment Prison Rape Elimination Act Education Acknowledgement Statement
     URL: https://gps.press/sop-data/208.06-att-1/
  2. PREA Sexual Victim_Sexual Aggressor Classification Screening Instrument
     URL: https://gps.press/sop-data/208.06-att-2/
  3. PREA Disposition Offender Notification Form
     URL: https://gps.press/sop-data/208.06-att-3/
  4. Sexual Allegation Response Checklist
     URL: https://gps.press/sop-data/208.06-att-4/
  5. Procedure for SANE Evaluation/Forensic Collection
     URL: https://gps.press/sop-data/208.06-att-5/
  6. PREA Investigative Summary
     URL: https://gps.press/sop-data/208.06-att-6/
  7. PREA Local Procedure Directive and Coordinated Response Plan
     URL: https://gps.press/sop-data/208.06-att-7/
  8. Retaliation Monitoring Checklist
     URL: https://gps.press/sop-data/208.06-att-8/
  9. Sexual Abuse Incident Review Checklist
     URL: https://gps.press/sop-data/208.06-att-9/
  10. PREA Initial Notification Form
     URL: https://gps.press/sop-data/208.06-att-10/
  11. PREA Staffing Plan Template
     URL: https://gps.press/sop-data/208.06-att-11/
  12. PREA Victim Advocate Request Form
     URL: https://gps.press/sop-data/208.06-att-12/
  13. Contractor/Volunteer Verification Form – Sexual Abuse/Sexual Harassment (PREA)
     URL: https://gps.press/sop-data/208.06-att-13/
  14. PREA Counseling Referral Form
     URL: https://gps.press/sop-data/208.06-att-14/
  15. Investigative File Summary Checklist
     URL: https://gps.press/sop-data/208.06-att-15/
  16. Investigative File Detail Checklist
     URL: https://gps.press/sop-data/208.06-att-16/
  17. Prison Rape Elimination Act (PREA) Offender Brochure (English)
     URL: https://gps.press/sop-data/208.06-att-17/
  18. PREA Offender Brochure (Spanish)
     URL: https://gps.press/sop-data/208.06-att-18/
  19. Staff Guide on the Prevention and Reporting of Sexual Misconduct with Offenders
     URL: https://gps.press/sop-data/208.06-att-19/

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FULL TEXT:
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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<br>to protect the victim? 3. Were either the victim or aggressor placed in Administrative segregation/Why? 4. Was<br>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<br>to protect the victim? 3. Were either the victim or aggressor placed in Administrative segregation/Why? 4. Was<br>SANE necessary/Was a SANE examination conducted?)|
|How were you notified of this incident?(Grievance, Hotline,<br>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.