PREA Incident Report Form 

PREA Administration & Compliance Services Program

If you would like to report an incident of sexual assault, sexual abuse or sexual harassment involving an offender in a DOC or private prison or community corrections, please complete the following form. 

If you would like to be contacted, please provide your contact information at the bottom of the form. If you leave the contact information blank, your incident report will be anonymous.

Name of offender: 

DOC #, if known: 

Type of incident (check all that apply):



Facility where incident occurred, if known: 

Date of incident, if known:   [None] Select a Date Delete the Date

Reporter Contact Information (optional)



Phone Number: