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3. Does your facility record allegations ofinmate-on-inmate NONCONSENSUAL SEXUALACTS?6. Does your facility record allegations ofinmate-on-inmate ABUSIVE SEXUALCONTACTS? (See definitions on page 2.)01Yes ➔a. Do you record all reportedoccurrences, or only substantiatedones?01Yes ➔ Can these be counted separately fromallegations of NONCONSENSUALSEXUAL ACTS?0102AllSubstantiated only01 Yes02 No ➔ Skip to Item 9.b. Do you record attemptedNONCONSENSUAL SEXUAL ACTSor only completed ones?02 No ➔ Please provide an explanation in the spacebelow and then skip to Item 9.0102Both attempted and completedCompleted only02 No ➔Please provide the definition used by your facilityfor inmate-on-inmate NONCONSENSUALSEXUAL ACTS in the space below. Use thatdefinition to complete Items 4 and 5.4. Between January 1, 2009, andDecember 31, 2009, how many allegationsof inmate-on-inmate NONCONSENSUALSEXUAL ACTS were reported?Number reportedNone• If an allegation involved multiple victimizations, countonly once.5. Of the allegations reported in Item 4, how manywere — (Please contact the agency or office responsiblefor investigating allegations of sexual violence in order tofully complete this form.)7. Between January 1, 2009, andDecember 31, 2009, how many allegationsof inmate-on-inmate ABUSIVE SEXUALCONTACTS were reported?Number reportedNone• If an allegation involved multiple victimizations, countonly once.8. Of the allegations reported in Item 7, howmany were — (Please contact the agency oroffice responsible for investigating allegations ofsexual violence in order to fully complete this form.)a. Substantiated .......None• The event was investigated and determined to haveoccurred.b. Unsubstantiated .....None• Evidence was insufficient to make a final determinationthat the event occurred.a. Substantiated .......b. Unsubstantiated .....c. Unfounded .........NoneNoneNonec. Unfounded ..........None• The event was determined NOT to have occurred.d. Investigation ongoing .None• A final determination has not yet been made as towhether the event occurred.e. TOTAL (Sum of Items5a through 5d) .........Noned. Investigation ongoing . Nonee. TOTAL (Sum of Items 8athrough 8d) .......... NoneFORM SSV-4 (3-31-2010)Page 3

Section III – STAFF SEXUAL MISCONDUCTAND HARASSMENTDEFINITION OF STAFF SEXUAL MISCONDUCTThe definition of STAFF SEXUAL MISCONDUCT is based on"Training for Investigators of Staff Sexual Misconduct,"prepared by the National Institute of Corrections. STAFFSEXUAL MISCONDUCT includes any behavior or act of asexual nature directed toward an inmate by an employee,volunteer, contractor, official visitor, or other agencyrepresentative (exclude inmate family, friends, or othervisitors). Sexual relationships of a romatic nature betweenstaff and inmates are included in this definition.Consensual or nonconsensual sexual acts including:10. Between January 1, 2009, andDecember 31, 2009, how many allegationsof STAFF SEXUAL MISCONDUCT werereported?Number reportedNone• If an allegation involved multiple victims or staff, countonly once.11. Of the allegations reported in Item 10, howmany were — (Please contact the agency oroffice responsible for investigation allegations ofsexual violence in order to fully complete this form.)• Intentional touching of the genitalia, anus, groin, breast,inner thigh, or buttocks with the intent to abuse, arouse,or gratify sexual desire;OR• Completed, attempted, threatened, or requested sexualacts;OR• Occurrences of indecent exposure, invasion of privacy,or staff voyeurism for sexual gratification.a. Substantiated .......b. Unsubstantiated .....c. Unfounded ..........NoneNoneNoneDEFINITION OF STAFF SEXUAL HARASSMENTThe definition of STAFF SEXUAL HARASSMENT was alsodeveloped by the National Institute of Corrections. STAFFSEXUAL HARASSMENT includes repeated verbal statementsor comments of a sexual nature to an inmate by an employee,volunteer, contractor, official visitor, or other agencyrepresentative (exclude inmate family, friends, or othervisitors).• Demeaning references to gender or derogatorycomments about body or clothing;OR• Repeated profane or obscene language or gestures.9. Does your facility record allegations of STAFFSEXUAL MISCONDUCT?01Yes ➔ Do you record all reportedoccurrences, or onlysubstantiated ones?d. Investigation ongoing . Nonee. TOTAL (Sum of Items 11athrough 11d) .......... None12. Does your facility record allegations of STAFFSEXUAL HARASSMENT?01Yes ➔ Can these allegations be countedseparately from allegations ofSTAFF SEXUAL MISCONDUCT?02 No ➔0102YesNo ➔ Skip to Item 15.Please provide an explanation in the spacebelow and skip to Item 15.02 No ➔0102AllSubstantiated onlyPlease provide an explanation in the spacebelow and then skip to Item 12.13. Between January 1, 2009, andDecember 31, 2009, how many allegationsof STAFF SEXUAL HARASSMENT werereported?Number reportedNone• If an allegation involved multiple victims or staff, countonly once.FORM SSV-4 (3-31-2010)Page 4

14. Of the allegations reported in Item 13, howmany were — (Please contact the agency oroffice responsible for investigating allegations ofsexual violence in order to fully complete this form.)NOTESa. Substantiated .......Noneb. Unsubstantiated .....Nonec. Unfounded ..........Noned. Investigation ongoing . Nonee. TOTAL (Sum of Items 14athrough 14d) .......... NoneSection IV – TOTAL OF SUBSTANTIATEDINCIDENTS OF SEXUAL VIOLENCE15. What is the total number of substantiatedincidents reported in Items 5a, 8a, 11a,and 14a?Total substantiatedincidents ............. None➔ Please complete an Incident Form(Adult, SSV-IA) for each substantiatedincident of sexual violence.FORM SSV-4 (3-31-2010)Page 5