Skip to Main Content
Loading
Loading
About Us
Services
Divisions
How Do I...
Search
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
ATV Diversion Program
DCSO Forms
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Prison Rape Elimination Act (PREA) Incident Reporting Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Prison Rape Elimination Act (PREA) Incident Reporting Form
The Prison Rape Elimination Act of 2003 was enacted by Congress to address the problem of sexual abuse of persons in the custody of U.S. correctional agencies. The Act applies to all public and private institutions that house adult or juvenile offenders and is also relevant to community-based agencies. It addresses both inmate-on-inmate sexual abuse and staff sexual misconduct.
FILING A REPORT:
The Douglas County Sheriff's Office has zero tolerance toward all forms of sexual abuse and sexual harassment. The agency will not tolerate retaliation against any person who reports sexual abuse or sexual harassment or who cooperates with a sexual abuse or sexual harassment investigation. If you were the victim of a sexual assault while in the custody of any law enforcement agency or correctional facility, or if you know of an incident of sexual assault of a person in the custody of any law enforcement agency or correctional facility, you may report the incident by completing the Prison Rape Elimination Act form (PDF).
ANONYMOUS REPORTS:
Anonymous reports will be accepted and investigated, however, the Sheriff's Office may be limited in its options in investigating and/or resolving anonymous reports because of the unique challenges they present. There is no way to assess the author's accuracy and no ability to obtain additional information from the complainant if the complaint is unclear or confusing. Anonymous reports will be investigated to the best of our ability given the anonymous nature of the complaint.
Your First Name
Last Name
Address
City
State
Zip Code
Phone Number
Secondary Phone Number
Email Address
Incident Date/Time
Incident Date/Time Start Date
Incident Date/Time Start Time
—
Incident Date/Time End Date
Incident Date/Time End Time
Please provide the approximate date and time the incident took place.
Incident Narrative
Describe the incident. Please be specific.
Victim First Name
Victim Last Name
Suspect First Name
Suspect Last Name
Witnesses
Full names are preferred, however partial names or aliases may be helpful.
Where did this occurr?
Please list the facility and describe where the incident occurred such as "in cell A12" or "while in booking".
Leave This Blank:
Submit
* indicates a required field
Concealed Handgun License
& Fingerprinting
Jail Inmate Viewer
Submit a Crime Tip
Emergency Notification System
Sheriff Sales
Employment
Copyright Douglas County
Government Websites by
CivicPlus®
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow