Physical Address: Mailing Address (if different than above): Telephone Number: The Facility Is: Military Private for Profit Private not for Profit Municipal County Federal Facility Type: Community treatment center Halfway house Restitution center Mental health facility Alcohol or drug rehabilitation center Other community correctional facility Facility Mission: Facility Website with PREA Information: Have there been any internal or external audits of and/or accreditations by any other organization? Yes No Director Name: Telephone: Facility PREA Compliance Manager Name: Title: Email: Telephone: Facility Health Service Administrator Name: Title: Email: Telephone: Facility Characteristics Designated Facility Capacity: Current Population of Facility: Number of residents admitted to facility during the past 12 months Number of residents admitted to facility during the past 12 months who were transferred from a different community confinement facility: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 30 days or more: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 72 hours or more: Number of residents on date of audit who were admitted to facility prior to August 20, 2012: Age Range of Population: Adults Juveniles Youthful residents Average length of stay or time under supervision: Facility Security Level:
Standard 115.221: Evidence protocol and forensic medical examinations All Yes/No Questions Must Be Answered by the Auditor to Complete the Report 115.221 (a) If the agency is responsible for investigating allegations of sexual abuse, does the agency follow a uniform evidence protocol that maximizes the potential for obtaining usable physical evidence for administrative proceedings and criminal prosecutions? (N/A if the agency/facility is not responsible for conducting any form of criminal OR administrative sexual abuse investigations.) Yes No NA 115.221 (b) Is this protocol developmentally appropriate for youth where applicable? (N/A if the agency/facility is not responsible for conducting any form of criminal OR administrative sexual abuse investigations.) Yes No NA Is this protocol, as appropriate, adapted from or otherwise based on the most recent edition of the U.S. Department of Justice’s Office on Violence Against Women publication, “A National Protocol for Sexual Assault Medical Forensic Examinations, Adults/Adolescents,” or similarly comprehensive and authoritative protocols developed after 2011? (N/A if the agency/facility is not responsible for conducting any form of criminal OR administrative sexual abuse investigations.) Yes No NA 115.221 (c) Does the agency offer all residents who experience sexual abuse access to forensic medical examinations, whether on-site or at an outside facility, without financial cost, where evidentiarily or medically appropriate? Yes No Are such examinations performed by Sexual Assault Forensic Examiners (SAFEs) or Sexual Assault Nurse Examiners (SANEs) where possible? Yes No If SAFEs or SANEs cannot be made available, is the examination performed by other qualified medical practitioners (they must have been specifically trained to conduct sexual assault forensic exams)? Yes No Has the agency documented its efforts to provide SAFEs or SANEs? Yes No 115.221 (d) Does the agency attempt to make available to the victim a victim advocate from a rape crisis center? Yes No If a rape crisis center is not available to provide victim advocate services, does the agency make available to provide these services a qualified staff member from a community-based organization, or a qualified agency staff member? Yes No