CA Advancing PREA: Barriers to Access Reporting Form

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Advocates at CA RCCs can use this form to alert JDI and ValorUS to concerns regarding incarcerated survivors' access to confidential victim services. Please let us know if you become aware of instances in which
1) incarcerated survivors are unable to access your services
2) facilities are not treating your services confidentially, or
3) incarcerated survivors may be experiencing retaliation and/or harassment in connection with accessing your services or making a PREA report.

Please note, the information shared in this form does not result in an official grievance, report, or notice to any CDCR, county, or federal facility or agency. It helps us, as TA providers to identify issues, trends, patterns and should be used in addition to other processes or strategies. If you have any questions, please reach out to jsinor@valor.us.

Your name

Your agency *

Your phone number

Your email

Date of incident (if known)

YYYY

Time of incident (if known)

Time

If the exact date or time of the incident is not known, do you know when (approximately) it took place?

Name of Detention Facility

Type of Detention Facility

What are you reporting concerns about? *

Written correspondence

Hotline

Forensic exam accompaniment

Investigatory interview accompaniment

Staff retaliation and/or harassment

Retaliation from other prisoners/residents

Other:

Please describe the incident. (If you selected other, please explain further) *

Names of known corrections staff involved in the incident.

Is there anything else we should know about the incident?

How would you like for us to support you? *

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