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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