PRISON RAPE ELIMINATION ACT (PREA) / 12/13
SEXUAL ABUSE RETALIATION MONITORING
INSTRUCTIONS: To be completed upon receipt of a sexual abuse allegation for monitoring of staff and prisoners who report sexual abuse or for monitoring of prisoners who are an alleged victim of sexual abuse. Retaliation monitoring can cease if an investigation determines No Evidence/Unfounded. Transfer of staff or a prisoner does not discontinue retaliation monitoring.
BASIC INFORMATION
Date Allegation Received / FacilityType of Monitoring
New 90-day Monitoring 30-day Continuation / Monitoring Expiration Date
Assigned Monitor / Title / Date Assigned
Staff / Prisoner Being Monitored / Prisoner / Employee No.
Monitoring Reason
Reported Sexual Abuse/Harassment Victim / Alleged Victim
Fear of Retaliation is Expressed for Cooperating with Sexual Abuse / Harassment Investigation
MONITORING – WEEK 1
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 2
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 3
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 4
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 5
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 6
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 7
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 8
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 9
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 10
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 11
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 12
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
MONITORING – WEEK 13
DateAction(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments
CONCLUSION
FindingMonitoring Complete – No Retaliation Found Monitoring Complete – Retaliation Addressed and Resolved
Continue Monitoring for 30 Days
Assigned Monitor Signature / Date