Perf-Based Stds, Juvenile Correctional Facilities, 5th Ed_DEC 2024

Appendix D

Facility Name:_______________________________________________________________ Reporting Period: ___________________________________________________________

Total for Reporting Period

Months →

Incident Type

Escapes

Disturbances* Sexual Violence

Offender Victim Staff

Homicide*

Victim Other Victim

Offender/ Offender Offender/ Staff

Assaults

Suicide Non-Compli ance with a Mandatory Standard*

Fire*

Natural Disaster*

Unnatural Death

Other*

*May require reporting to ACA using the Critical Incident Report as soon as possible within the context of the incident itself.

210 Juvenile Correctional Facilities, Fifth Edition