Tracking and reporting inmate deaths within jail facilities is a critical aspect of maintaining transparency and accountability in the criminal justice system. The CJ-10 form, officially known as the Deaths in Custody – 2008 Quarterly Report on Inmates in Private and Multi-Jurisdiction Jails, serves as a foundational tool for this purpose under the purview of the U.S. Department of Justice Bureau of Justice Statistics, with the U.S. Census Bureau acting as the collection agent. Required to be filled out by jails nationwide, this form demands meticulous data on each inmate's death during custody, including their demographic information, the circumstances surrounding their death, and the outcomes of any post-mortem examinations. By disaggregating deaths into various categories—ranging from natural causes to homicides—it allows for a granular analysis of in-custody deaths. The form places a significant responsibility on facilities to report accurately and promptly, within 30 days of the end of each quarter, with specific instructions on how to address cases where no deaths occurred or when detailed follow-up information is pending due to ongoing investigations. This process not only fulfills a legal obligation but also contributes to broader efforts aimed at reforming and improving jail conditions, underscoring the systemic importance of such data collection instruments in upholding justice and human rights.
| Question | Answer |
|---|---|
| Form Name | Form Cj 10 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | Washington, cj 9 form, govs, MRI |
OMB No.
FORM
DEATHS IN CUSTODY – 2008
QUARTERLY REPORT ON INMATES IN PRIVATE AND
U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT
U.S. DEPT. OF COMMERCE
Economics and Statistics Admin.
U.S. CENSUS BUREAU
DATA SUPPLIED BY
Name
Title
OFFICIAL |
Number and street or P.O. box/Route number |
City |
|
State |
ZIP Code |
|||
ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TELEPHONE |
Area code |
Number |
FAX |
Area Code |
Number |
|||
|
|
NUMBER |
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reporting Quarter (Mark only one.)
First (January 1 – March 31)
Second (April 1 – June 30)
Third (July 1 – September 30)
Fourth (October 1 – December 31)
(Please correct any error in name, mailing address, and ZIP Code)
What deaths should be reported?
•Include deaths of ALL persons –
CONFINED in your jail facilities, even if housed for another jurisdiction;
UNDER YOUR SUPERVISION but housed in special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms); or on transfer to treatment facilities;
UNDER YOUR SUPERVISION while out to court;
IN TRANSIT to or from your facilities while under your supervision.
•Exclude deaths of ALL persons –
UNDER YOUR SUPERVISION but on AWOL, escape, or
Burden Statement
During the reporting quarter marked above, how many persons died while under the supervision of your jail?
MaleFemale
Number of inmate deaths
Instructions:
•IF NO DEATHS, please disregard.
•IF A DEATH OCCURRED, complete a JAIL INMATE DEATH REPORT. Please complete items 1 through 15 for each inmate death.
•If more than 1 death reported above, make copies of pages 2 and 3 for each additional death.
•Return this quarterly report and each associated INMATE DEATH REPORT by FAX or MAIL within 30 days of the end of each quarter.
FAX
MAIL: U.S. Census Bureau, P.O. Box 5000, Jeffersonville, IN
•If you need assistance, call Peggy Ferguson of the U.S. Census Bureau
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.
JAIL INMATE DEATH REPORT
INMATE DEATH # OUT OF QUARTERLY TOTAL OF
1. What was the inmate’s name?
Last |
|
First |
MI |
|
|
|
|
|
|
|
|
|
|
|
2.On what date did the inmate die?
Month Day Year
2 0 0 8
3.What was the inmate’s date of birth?
Month Day Year
4.What was the inmate’s gender?
01 Male
02 Female
5.What was the inmate’s race/ethnic origin? Mark ( X ) all that apply.
01 White, not of Hispanic origin
02 Black or African American, not of Hispanic origin
03 Hispanic or Latino
04 American Indian/Alaska Native, not of Hispanic origin
05 Asian, not of Hispanic origin
06 Native Hawaiian or Other Pacific Islander, not of Hispanic origin
07 Additional racial category in your information system – Specify
6.On what date had the inmate been admitted to your jail facility?
Month Day Year
7.For what offense(s) was the inmate being held?
a.
b.
c.
d.
e.
8.What was the inmate’s legal status at time of death?
•For persons with more than one status, report the status associated with the most serious offense.
01 Convicted
02 Unconvicted
03 Other – Specify
9. Where did the inmate die?
01 In general housing within jail facility or on jail grounds
02 In segregation unit
03 In special medical unit/infirmary within your jail
04 In medical facility outside your jail
05 While in transit
06 Elsewhere – Specify
FORM |
Page 2 |
Name of deceased inmate ____________________________________________
10.Did a medical examiner or coroner conduct an evaluation (such as an autopsy,
01 |
|
Yes ➔ 10a. Are results available? |
01 |
|
|
|
02 |
02 No ➔ 10b. Is an evaluation planned? 01 02
Yes – Complete items 11 through 15.
No – Skip remaining items; you will be contacted later for these data.
Yes – Skip remaining items; you will be contacted later for these data. No – Complete items 11 through 15.
11. What was the cause of death?
01 Illness/natural cause
•Exclude
13.Had the inmate been receiving treatment for the medical condition after admission to your correctional facilities?
•EXCLUDE emergency care provided at time of death.
Specify illness/cause
02 Acquired Immune Deficiency Syndrome (AIDS)
03 Alcohol/drug intoxication
04 Accidental injury to self – Describe events
Yes
01
02
03
04
No
07
07
07
07
Don’t know
08 Evaluated by physician/medical staff
08 Had diagnostic tests (e.g.,
08 Received medications
08 Received treatment/care other than medications
05 Accidental injury by other (e.g., positional asphyxiation during cell extraction) – Describe events
06 Suicide (e.g., hanging, knife/cutting instrument, intentional drug overdose) – Describe events
07 Homicide committed by other inmate(s)
08 Other homicide – Describe events
09 Other causes – Specify causes
12.Was the cause of death the result of a
01
02 Inmate developed condition after admission
08 Could not be determined
09 Not applicable – cause of death was accidental injury, intoxication, suicide, or homicide
05 |
|
07 |
|
08 |
|
Had surgery |
06 |
|
|
08 |
|
Confined in special medical unit |
|
|
07 |
|
|
|||
|
|
|
||||
09 Not applicable – cause of death was accidental injury, intoxication, suicide, or homicide
14.When did the incident (e.g., accident, suicide or homicide) causing the inmate’s death occur?
01 Morning (6 a.m. to noon)
02 Afternoon (noon to 6 p.m.)
03 Evening (6 p.m. to midnight)
04 Overnight (midnight to 6 a.m.)
09 Not applicable – cause of death was illness/natural causes, intoxication, or
15.Where did the incident (e.g., accident, suicide or homicide) take place?
01 In the inmate’s cell/room
02 In a temporary holding area/lockup
03 In a common area within the facility (e.g., yard, library, cafeteria, day room, recreational area, or workshop)
04 Outside of the jail facility (e.g., while on work release or on work detail, under community supervision, or in transit)
05 Elsewhere – Specify
09 Not applicable – cause of death was illness/natural causes, intoxication, or
Notes
FORM |
Page 3 |