QUESTIONS TO ASK TO VICTIMS OF A SEXUAL ASSAULT



aTTACHMENT H

CALIFORNIA DCR PRISON RAPE ELIMINATION POLICY

POST-SEXUAL ASSAULT INFORMATION

|IR#/VICTIM’S NAME & CDC # |Interviewing Staff |Date of Interview |

Did you…

➢ Bathe/shower/wash YES NO

➢ Brush teeth YES NO

➢ Use mouthwash/gargle YES NO

➢ Eat YES NO

➢ Drink YES NO

➢ Urinate YES NO

➢ Have a bowel movement YES NO

➢ Change your clothes YES NO

Where did the incident take place?________________________________________________________

How did it happen? ___________________________________________________________________

What type of act(s) occurred? ___________________________________________________________

Was there any penetration of anus/vagina or mouth by:

➢ Penis YES NO

➢ Finger YES NO

➢ Object YES NO

Describe the object used: ______________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

How many times?_____________________________________________________________________

How long did it last?___________________________________________________________________

Were you threatened? YES NO

If yes, describe. ______________________________________________________________________

Were you forced? YES NO Did he/she help you? YES NO

Were you physically harmed in any other way? YES NO

If yes, describe. ______________________________________________________________________

Did he/she touch or fondle you anywhere else? YES NO

If yes, describe. ______________________________________________________________________

Did he/she use any type of lubrication? YES NO If yes, describe. ______________________________________________________________________

Where was it applied? _________________________________________________________________

Was he/she wearing any clothes? If yes, describe. YES NO ___________________________________________________________________________________

What were you wearing? _______________________________________________________________

___________________________________________________________________________________

Did you keep your clothes on? YES NO If no, why? __________________________________________________________________________

Were there any distinguishable marks on his/her body? YES NO If yes, describe where and location: ______________________________________________________

Were there any distinguishable marks on his/her genital area? YES NO If yes, describe where and location: ______________________________________________________

➢ Did you see any pubic hair? YES NO

➢ Is it the same color as the hair on his/her head? YES NO

➢ Was he circumcised? YES NO

➢ Was his penis erect when you saw it? YES NO

Did he ejaculate? YES NO

If yes, where? _______________________________________________________________________

Did you ejaculate? YES NO

If yes, where? _______________________________________________________________________

Do you know if he/she had anything to drink (inmate manufactured alcohol) or take any medication prior to the assault? YES NO If yes, what? _________________________________________________________________________

Did you have anything to drink (inmate manufactured alcohol) or take any medication prior to the assault? YES NO

If yes, what?_________________________________________________________________________

What happened after the assault? ________________________________________________________

Did you “clean up” afterwards? YES NO If yes, what did you use? _______________________________________________________________

What did you do with it? _______________________________________________________________

Where is it now? _____________________________________________________________________

What did you do with the clothes you were wearing? _________________________________________

Have you ever been threatened before? YES NO If yes, by whom, where, etc.? ___________________________________________________________

Have you ever engaged sexual activity with another individual of the same sex before? YES NO

Did you tell anyone else about this? YES NO If yes, who? _________________________________________________________________________

If longer than seventy-two hours (72), why did you wait to tell someone? _________________________

___________________________________________________________________________________

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