MICHIGAN DEPARTMENT OF CORRECTIONS / CAJ-1022
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 / Facility
Type 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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(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

Date
Action(s) Taken
Reviewed disciplinary reports Reviewed housing changes Face-to-face contact
Reviewed program changes Reviewed performance evaluations Reviewed staff reassignments
Comments

CONCLUSION

Finding
Monitoring Complete – No Retaliation Found Monitoring Complete – Retaliation Addressed and Resolved
Continue Monitoring for 30 Days
Assigned Monitor Signature / Date