National Inmate Survey.... Conducted by the Bureau of Justice Statistics and RTI International . 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. 7. Did you receive a high school diploma or GED? SECTION A. Yes ................................................................ No.................................................................. Please answer the question in the space provided or 8. On what date were you admitted to this facility? mark your answer in the box, like this ⌧. To protect your If you cannot remember the exact date, please write down privacy, do not put your name on this questionnaire. whatever you can remember, such as the year and the month. 1. How old are you? _________ / __________ / _________ Age: ______ Month Day Year 2. Are you of Hispanic, Latino, or Spanish origin? 9. Are you currently being held in this facility for Yes................................................................. any of the following: No .................................................................. Mark ⌧ “Yes” or “No” for each item. Yes No 3. Which of these categories describes your race? A violent offense, such as physical or sexual Mark all that apply. assault, rape, robbery, manslaughter, attempted murder, or murder? White ............................................................. A drug offense, such as possessing, selling, or Black or African American............................ manufacturing drugs? American Indian or Alaska Native ................ A property offense, such as burglary, larceny, Asian.............................................................. auto theft, bad checks, fraud, forgery, or grand Native Hawaiian or other Pacific Islander..... theft? Any other offense? 4. Are you currently married widowed, divorced or separated, or have you never been married? 10. How long have you been in this facility? Married .......................................................... Less than 1 month ......................................... Widowed........................................................ At least 1 month but less than 6 months........ Divorced ........................................................ At least 6 months but less than 1 year ........... Separated (For reasons other than incarceration) At least 1 year but less than 5 years .............. Never been married ....................................... At least 5 years but less than 10 years........... 10 years or more............................................ 5. How tall are you? Feet: ______ Inches: ______ 11. This question is about wanted or voluntary sex or sexual contact you have had with other inmates 6. How much do you currently weigh? in this facility. Since you arrived at this facility, Pounds: ______ did you do any of the following: 1 Mark ⌧ “Yes” or “No” for each item: Yes No 15. Since you arrived at this facility, when you were physically forced, pressured, or made to feel that Touch another inmate’s body in a sexual way or have your body touched in a sexual way? you had to give another inmate a handjob or have Give or receive a handjob from another inmate oral sex or anal sex with them, did any single at this facility? incident ever involve more than one inmate? Have oral sex (blowjob) with another inmate at Yes ................................................................ this facility? No.................................................................. Have anal sex with another inmate at this facility? These next questions ask about unwanted sex or sexual 16. Since you arrived at this facility, when you were contact you have had with other inmates in this facility. physically forced, pressured, or made to feel that By unwanted, we mean sex or sexual contact that you you had to give another inmate a handjob or have did not want to happen. oral sex or anal sex with them, did it ever happen during any of the following times: 12. Since you arrived at this facility, did another inmate use physical force to make you do any of Mark ⌧ “Yes” or “No” for each item: Yes No the following: Between 6:00 in the morning and noon? Mark ⌧ “Yes” or “No” for each item: Yes No After noon but before 6:00 in the evening? Touch their body in a sexual way or have your body touched in a sexual way? After 6:00 in the evening but before midnight? Give them a handjob or receive a handjob from After midnight but before 6:00 in the morning? them? Have oral sex (blowjob) with them? 17. Since you arrived at this facility, when you were Have anal sex with them? physically forced, pressured, or made to feel that you had to give another inmate a handjob or have 13. Since you arrived at this facility, did another oral sex or anal sex with them, did it ever inmate, without using physical force, pressure happen: you or make you feel that you had to do any of the following: Mark ⌧ “Yes” or “No” for each item: Yes No Mark ⌧ “Yes” or “No” for each item: Yes No In your own cell, room, or sleeping area? Touch their body in a sexual way or have your In the cell or room of another inmate? body touched in a sexual way? In a shower or bathroom? Give them a handjob or receive a handjob from them? In the yard or recreation area? Have oral sex (blowjob) with them? In a classroom or library? Have anal sex with them? In a workshop, kitchen, or other workplace? In a closet, office or other locked room? 14. Since you arrived at this facility, how many times Somewhere else in the facility? altogether were you physically forced, pressured, Off facility grounds? or made to feel like you had to give another inmate a handjob or have oral sex or anal sex with them? 18. Since you arrived at this facility, when you were 0 times ................... Go to SECTION B, page 3 physically forced, pressured, or made to feel that 1 -2 times ............... you had to give another inmate a handjob or have 3 - 5 times .............. oral sex or anal sex with them, were you ever: Continue to item 15 5 - 10 times ............ 11 or more times .. 2 Mark ⌧ “Yes” or “No” for each item: Yes No 22. Since you arrived at this facility, when you were physically forced, pressured, or made to feel that Persuaded or talked into it? you had to give another inmate a handjob or have Given a bribe or blackmailed? oral sex or anal sex with them, did you report it Given drugs or alcohol to get you drunk or high? to any of the following people: Offered protection from other inmates? Mark ⌧ “Yes” or “No” for each item: Yes No Threatened with harm or a weapon? A correctional officer? Physically held down or restrained? An administrative staff person? Physically harmed or injured? A medical or healthcare staff person? An instructor, teacher, or counselor? 19. Since you arrived at this facility, when you were A volunteer? physically forced, pressured, or made to feel that Some other facility staff person? you had to give another inmate a handjob or have oral sex or anal sex with them, did it ever involve SECTION B. an inmate of a different race than yours? Yes................................................................. These next questions are about wanted or unwanted sex or No .................................................................. 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. 20. Since you arrived at this facility, when you were physically forced, pressured, or made to feel that 23. Since you arrived at this facility, have you you had to give another inmate a handjob or have willingly had sex or sexual contact with any staff oral sex or anal sex with them, was it ever at this facility? initiated by a gang? Yes ................................................................ Yes................................................................. No.................................................................. No .................................................................. 24. Since you arrived at this facility, did a facility staff person use physical force to make you have 21. Since you arrived at this facility, when you were sex or sexual contact with them? physically forced, pressured, or made to feel that you had to give another inmate a handjob or have Yes ................................................................ oral sex or anal sex with them, did you ever: No.................................................................. Mark ⌧ “Yes” or “No” for each item: Yes No 25. Since you arrived at this facility, did a facility Receive knife or stab wounds? staff person, without using physical force, pressure you or make you feel that you had to Receive broken bones? have sex or sexual contact with them? Receive anal tearing? Yes ..............................................................