Please read the following
notes before using the form.
Notes:
- You
don't have to answer questions that don't pertain to your situation,
and, of course, you don't have to answer any question(s) you don't
want to answer.
- Feel
free to put your comments, explanations, and things you want to
remember, in the spaces between the questions or in the space provided
at the end of the form.
Part I: The
Initial Police Response
(The officer to whom you first reported the assault)
1. Did the responding officer try to make you feel safe
and comfortable reporting the assault (were you given enough time, privacy,
encouragement, or whatever else you needed in order to explain what
happened to you)?
Yes____ No____
2. If you reported to
police within 72 hours of the assault, did the officer offer for you to
have a medical rape exam?
Yes____ No____ Doesn't Apply____
3. Did the responding
officer inform you of your right to have a victim advocate and a support
person present with you during the medical exam and during the interview
with detectives? (California Penal Code Sections 679.04 and 264.2 require
law enforcement to inform victims of these rights. Laws vary from state to
state.)
Yes____ No____ Doesn't Apply____
4. If English is not your
first language, did the officer offer you a professional translator (either
a fully bilingual officer or a telephone translator - not a family member
or neighbor)?
Yes____ No____ Doesn't Apply____
5. Did the responding
officer clearly explain to you what was happening at each step of his or
her response?
Yes____ No____
6. Did the officer ask if
you had any questions or concerns?
Yes____ No____
7. Do you feel the
responding officer answered your questions and concerns as you needed?
Yes____ No____
8. Did the responding
officer give you his or her contact phone number?
Yes____ No____
9. Did the responding
officer give you complete information about what would happen next, when it
would happen, and who you could contact at the police department in the
days to come?
Yes____ No____
10. Do you feel that the
responding officer in any way judged your behavior, or blamed you for the
attack, or disbelieved you?
Yes____ No____
Explain:_________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
11. If you knew someone
who wanted to report a rape or sexual assault to the police, would you
recommend them to this particular officer?
Yes____ No____
Why or Why Not?_____________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Part II:
The Victim Interview
1. In making arrangements
for the interview, did the detective or investigating officer offer to do
the interview at a location that was comfortable for you?
Yes____ No____
2. In making arrangements
for the interview, were you informed of your right to have a victim
advocate and a support person of your choosing present during the interview
by the detective or investigating officer? (California Penal Code Section
670.04 requires this advisement. The laws vary from state to state.)
Yes____ No____
3. If English is not your
first language, were you asked if you would feel more comfortable doing the
interview in your native language?
Yes____ No____ Doesn't Apply ____
4. If you wanted or
needed a translator, did the detective or investigating officer have a
professional translator available for you at the interview?
Yes____ No____ Doesn't Apply ____
5. Before beginning the
interview, did the detective or investigating officer ask if you felt
comfortable and safe?
Yes____ No____
6. In making arrangements
for the interview, did the detective or investigating officer ask if you
had any questions?
Yes____ No____
7. Did the detective or
investigating officer answer all your questions to your satisfaction?
Yes____ No____ Doesn't Apply____
8. Before the interview,
did the detective or investigating officer ask you if you had fears or
concerns about reporting the crime or about prosecuting the perpetrator?
Yes____ No____
9. If you expressed
concerns about reporting the crime (such as fear of retaliation, fear of
people finding out, fear of problems with family members, housing, job,
school, or problems with the law, etc.) did the detective or investigating
officer offer to help you deal with these problems?
Yes____ No____
10. Was your advocate or
support person made to feel comfortable and welcome at the interview by the
detective or investigating officer?
Yes____ No____ Doesn't Apply____
11. Were you informed
that the interview would be recorded?
Yes____ No____
12. Was the interview
recorded (either audio or video tape?)
Yes____ No____
13. Were you told that you
could stop the interview at any point to take a break or to ask questions?
Yes____ No____
14. Did the detective or
investigating officer ask you detailed questions about the perpetrator's
pre-rape behavior? (Any unusual pre-rape behavior by the perpetrator can be
important evidence, such as the rapist's pre-rape attempts to isolate you,
to close off escape routes, to get other people out of the way, or to give
bazaar explanations of things to you or others, etc.)
Yes____ No____
15. Did the detective or investigating
officer get complete information from you on how to contact people who may
have witnessed the rapist's pre-rape behavior?
Yes____ No____
16. Were you asked for a complete description of any weapons that were used
in the assault?
Yes____ No____ Doesn't Apply____
17. Did the detective or
investigating officer ask you for complete details about the sexual assault
itself?
Yes____ No____
18. Did the detective or
investigating officer seem comfortable in asking you detailed questions
about the assault?
Yes____ No____
NOTE: In order to prosecute a sexual
assault, the authorities need to show how you were forced to have sex or
how you were unable to give consent. So the detective or investigating
officer needs to get an accurate statement from you describing exactly what
it was that made you feel forced to have sex.
19. If no form of
physical force was used in your assault (i.e. if there were no weapons or
physical restraints) did the detective or investigating officer ask exactly
what the suspect said or did that made you feel forced to have sex?
Yes____ No____ Doesn't Apply____
20. If you didn't
physically resist, did the detective or investigating officer ask you to
describe what you thought might happen if you had resisted or if you
refused to submit to the sex?
Yes____ No____ Doesn't Apply____
21. Did the detective or
investigating officer ask you to describe your fears before and during the
rape?
Yes____ No____
22. Were you asked if you
recalled any marks, tattoos, or scars on the perpetrator's body?
Yes____ No____
23. Did the detective or
investigating officer ask you for any and all statements made by the
perpetrator during the attack?
Yes____ No____
24. Did the detective or
investigating officer ask you about any and all threats made by the
perpetrator at any time?
Yes____ No____
25. Did the detective or
investigating officer ask you detailed questions about your behavior after
the assault? (Any change in your routine behavior following the rape can be
important evidence - changes such as missing work or classes, changing
locks, avoiding specific people or groups, seeking counseling, making
unusual excuses for your behavior, canceling scheduled activities, etc.)
Yes____ No____
26. Did the detective or
investigating officer ask you for complete information about how to contact
all the people you told about the assault and the people who witnessed your
post-rape behavior?
Yes____ No____
27. Did the detective or
investigating officer ask you to try and think about any others who might
also be a victim of the same perpetrator?
Yes____ No____
28. If you knew the
perpetrator, did the detective ask if you wanted to make a pretext call? (A
pretext call is a phone call, tape recorded by police, made by you to the
perpetrator with the goal of tricking the perpetrator into talking about
the crime.)
Yes____ No____
29. Did you feel the
detective or investigating officer prepared you well for the pretext call?
Yes____ No____
30. Did you do a pretext
call?
Yes____ No____
31. Did the detective or
investigating officer ask you to keep thinking about what might be
additional evidence or additional witnesses in the case?
Yes____ No____
32. Were you asked by the
detective or investigation officer to contact him or her immediately if you
were being harassed, intimidated, or threatened in any way by the suspect
or by others?
Yes____ No____
33. Did the detective or
investigating officer explain to you that it is a crime if any one tried to
get you to change your story or to not testify, and that you should report
it to police immediately?
Yes____ No____
34. Did the detective or
investigating officer give you his or her work phone number?
Yes____ No____
35. Did the detective or
investigating officer tell you when he or she would get back in touch with
you?
Yes____ No____
36. Do you feel that the
responding officer in any way judged your behavior, or blamed you for the
attack, or disbelieved you?
Yes____ No____
Explain:________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
37. At any point, did the
officer's questions feel hostile to you?
Yes____ No____
Part
III: Investigation Follow-Up
1. Were you kept informed
about the progress of the investigation and the status of the case by the
detective or investigating officer?
Yes____ No____
2. Were all the witnesses
you know of interviewed by the detective or investigating officer?
Yes____ No____
3. Were your phone calls
to the detective or investigating officer returned by the officer in a
timely manner?
Yes____ No____
4. Do you feel the
detective or investigating officer was concerned about your safety
throughout the investigation?
Yes____ No____
5. If the perpetrator was
not arrested soon after the assault, or was never arrested, did the
detective give you a careful explanation of why the suspect wasn't
arrested?
Yes____ No____
6. If you knew someone
who wanted to report a rape or sexual assault to the police, would you
recommend them to this particular detective or investigating officer?
Yes____ No____
Why or Why
Not?_________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Additional Comments:
(Please feel free to use this space for any comments you wish to make
regarding the general feeling of the experience of reporting the crime,
specific comments to your case, things that the responding and/or
investigating officer did that helped you, or suggestions on how law
enforcement officials can improve to responding to, investigating, and
meeting the needs of victims of cases involving rape and sexual assault.)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
*Reminder: all questions
are optional, you are not required to answer any questions you don't want
to answer.
Today's
Date:___________________________________
Name of Police Department:________________________
Date and Approximate Time of Call to Police:___________
______________________________________________
Your Name:_____________________________________
Crime Report #:__________________________________
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