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Wadoc Report Staff Sexual Misconduct Mikelson 2006

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CONJF1DENTIAL

State of Washington
Department of Corrections
Prisons Division

Special Investigations Unit
Case File
HQ 06-48-06-F'Ol

CONFIDJENTIAL

0319

STATE OF WASHII,GTOt,

DEPARTMENT OF CORRECTIONS
WASHINGTON CORRECTIONS CENTER FOR WOMEN
MS: WP-04· 9601 BUJ<lCICh Rd. H,W.• Gig Harbor', Wasninglon ~8;i:i2-B:'lOO

WARNING
THIS FILE IS THE PROPFRTY OF THE
WASHINGTON CORRECTIONS CENTER FOR WOMEN
INTELEGENCE & INVESTIGATIONS UNIT (IIU)
Content may be disclosed only to person whose official duties require access.
Contents may not be disclosed to the party(s)concerned nor to counsel, without
specific euthonzetior: of the superintendent.
CASE TOPIC:

Correctional Officer Terry Mikelsen Staff Custodial Misconduct
;
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r-: .: n
,T; tne --rrst uegree

rAC:E
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.....,.......,
,.

WCCW 06-106-06

DATE OPENED:

06-27-06

DATE CLOSED:

D
J

endiIng
Sign and date at time of review or receipt

L-_~

IN OFFICE REVIEW

I

~1.

--l...-

-1-

"Working Together for SAFE Communities"

_

0320

STATE OF WASHlhIGTOI'l

DEPARTMENT OF CORRECTIONS
OFFICE OF CORRECTIONAL OPERATIONS
WASHINGTON CORRECTIONS CENTER FOR WOMEN
P.O. Box 17. MS WP·04 . 960'l Bujacich Rd. 1\1 W . Gig Harbor. WA 98335·Q0l7

WASHINGTON STATE DEPARTMENT OF CORRECTIONS
INVESTIGATIVE REPORT
CASE NUMBER:

WCCW 06-106-06

DATE OPENED:

June 27, 2006

DATE CLOSED:

Pending

EMPLOYEE(S) INVOLVED:

Correctional Officer
Terry Mikelsen

TYPE OF INVESTIGATION:

Custodial Sexual Misconduct in
the First Degree

ORIGIN OF COMPLAINT:

LOCATION(S) OF OCCURRENCE(S):

Washington Corrections Center
for Women Close Custody Unit
(CCU)

DATE(S) OF OCCURRENCE(S):

June 26, 2006

INVESTIGATED BY:
POLICY AREAS ADDRESSED:

'\~;::J) ,,t,t(/
Chief Investigator KeliV~~J ~
Department of corrections,Pblicy:
850.020 - Investigation of Alleged
Custodial Sexual Misconduct
490.800 - Prison Rape
Elimination Procedures

0321
"lWorking Together for SAFE Communities 11

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11 , 2006
Page 2 of 10
SYNOPSIS:
On June 27, ~006 at 5:10am I was contacted at my residenc~
Lieutenant Gilbert Burton, Lt. Burton Indicated that Offende~
had been sexually assaulted by a Correctional Officer.
Superintendent Belinda D, Stewart requested that I report to the facility
immediately,

I arrived at the facility at approximately 7:15am, Upon my arrival, Associate
Superintendent Jane Parnell told me to report to the Superintendent's Office for a
briefing of the above incident. Present at the briefing was Superintendent
Stewart, Associate Superintendent Dianne Doonan, Associate Superintendent
Parnell and Head Quarters Investigator Steven Baxter.

,
At that time, Superintendent Stewart reported that on June 26, 2006 at
approximately 10:00pm Offende_ _eported to Correctional Officer Randy
Goodnite that Correctional Officer Terry Mikelsen had sex with her in the Close
Custody Unit (CCU) east pod property room, Offende~used a towel to
wipe the semen and a Q-tip to swab the inside of her vagina. All articles were
placed
in an evidence bag and placed in evidence locker number 3.
,
At 11 :50pm Correctional Officer Andrew Cozzolino and Correctional Officer
Verna Gardner escorted Offender_by State Vehicle to the Bremerton
Hospital for a sexual assault exam. Upon return to the facility, Offende_
was housed in the clinic. The Pierce County Sheriff's Office was notified.
Investigator Baxter stated that PREA would not accept the case. The case was
turned over to Pierce County Sheriff's Department.
At 8:15am Deputy T. Larson was the first responding Officer along with Forensics
Officer Steve Mel, both with the Pierce County Sheriff's Department. At that time
I escorted both officers to the Training Room where they were briefed and given
a complete packet of the incident. After the briefing, Deputy Larson and
Forensics Officer Mel were escorted to CCU where the incident had occurred. At
approximately 8:50am, Pierce County Sheriff's Detective Ray Shaviri arrived at
the facility and was escorted to CCU. Detective Shaviri was briefed and given a
complete packet of the incident.
At approximately 9:30am Deputy Larson departed the facility to Bremerton
Hospital to pick up the sexual assault kit. Correctional Officer Darren Gooding
remained in CCU with Forensics Officer Mel who processed the scene for
evidence. I escorted Detective Shaviri to the Medical Clinic to interview Offender
_
At approximately 10':38am Correctional Investigator Henry Keller,

0322

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11 , 2006
Page 3 of 10
Detective Shaviri, Forensics Officer Mel and myself went to the Hearings
Lieutenants' Office to sign out the evidence.
NARRATIVE:
The following interviews were conducted during the course of this investigation.
Offender
Detective Shaviri and I interviewed Victim Offender
_
The interview was audio taped with her consent. The following is a
brief summary of that interview.

Offender_old us that she had asked Officer Mikelsen if she could clean
because her cell was hot. Offende~stated that Officer Mikelsen told her
"sure", and then asked her to come into the CCU east pod property room to lift a
box. Offender~aid once inside the property room, Officer Mil<elsen was
standing behind the door and shut it. She stated that he stood in front of the
door. took off his radio and put it on the shelf. Offende~tated that Officer
Mikelsen then took off his belt, and began taking off his pants.
Offender.stated that she stared at Officer Mikelsen for a minute then asked
what he was doing. She stated that he told her that if she had sex with him she
will be allowed to have the rest of the night out of her cell and he would get her
drugs and a package. Offender"'tated that Officer Mikelsen pullec her grey
shorts down while turning her around to face the corner of the room. She said
that he told her she had a nice body and commented on her tattoo. Offender
•
stated that Officer Mikelsen then grabbed her around her stomach and
entered her vagina with his penis.. She stated after about two minutes he said "I
haven't had any in a long time, please excuse me." Offender. stated that
she told Officer Mikelsen that she wanted out. She stated that he told her to wait
until he put his cop gear back on and he would leave first so the booth Officer,
John Dunn would not see him. Offender.stated that he turned off the light
and told her if he closed the door behind him do not come out. She said he left
the door open and she came out.
Offender.said after the incident she felt violated and decided to use the
towel to wipe herself and also used a swab to preserve evidence in case no one
believed her. She said right before the 9:00pm count Office Mikelsen came to
her cell and asked "Have I been had? Are you going to tell?" She said she felt
violated and waited until the next shift of Officers arrived before she reported the
incident. (See attachment 13)

0323

wccw

06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11 , 2006
Page 4 of 10
Offender
Offender
as interviewed in the Main
Institution Visit room and was identified as o ender_cell mate. Offender
seemed ve reluctant and scared to makeany statements. She
stated that Offender
ntered their cell and a peared to be upset and was
crying. Offende
told Offende
that she was upset because
some of the other offenders wanted her (Offende
to have sex with Officer
Mikelsen so he could provide them with drugs and other privile es. Offender
stated that Offende~old her that Offender
ad told Officer Mikelsen that she (Offender
hada crush on
stated that she had this conversation with Offender
him. c:Hfehder
~fter she had sex with Mikelsen.

Offender
stated that Offende
came
into their room and told ~that she didn't think she would really do
this. She said Offende~ld Offender.o take a shower but
before doing so to wipe herself with the towel and swab her vaginal area to
preserve any evidence of the sex. Offender
said she saw
Offende"swab herself with a Q-tip and also wipe her vaginal area with a
towel.
Offende
.
Detective Shaviri and I re-interviewed fferi~cond time with the
new information we received from Offender~his time Offender
~ave us a second detailed, taped statement regarding what had happened.

Offenderlllt>tated that on June 26, 2006 she was hav~the Main
Institution Dining Hall with Offendel_ and O f f e n d e _ She
stated that Offende_ told them that Officer Mikelsen had asked her if she
would have sex with him at which time Offende~told him tha~ end
of the night she would find someone to have sex with him. Offender _tated .
that Offende_as\\ed her (Offende~ she would have sex with
Officer Mikelsen. Offende~ated that Offende~egan begging her
saying that afterwards she WOij'idmake him bring in tobacco, drugs and send her
a package. Offende_stated that at that point she told Offender_ she
would think about it hoping she would drop it. After they left the dining hall they
decided to go to the Gym because Offender_wanted to discuss the plan
further but were kicked o~orrectional Officer Presley because it wasn't
CCU gym time. Offende~aid they continued their talk and she finally
agreed to have sex with Officer Mikelsen.
Offende_ said Offende~ and Offender
tayed outside for
their hour out and she went inside to take a shower because she knew she was

0324

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
JUly 11 , 2006
Page 5 of 10
going to have sex with Officer Mikelsen. Offender. stated that once she was
finished with her shower she got dressed. She pushed her button and told the
booth officer that' she was coming down to clean. Offender.said she
approached Officer Mikelsen and asked if she could clean because her cell was
to hot. Offende~tated that they sat at the table and he asked what she
wanted to clean. Offendertlllstated that's when Offender_came and
sat with them. She stated that Offende~ began telling Officer Mikelsen
that Offende~ used to be her ex-girlfriend, that Offender. had a crush
on him and had been talking about having sex with him all night.

Offende~tated that Officer Mikelsen got u from the table and went inside
the property room. She stated that Offender
Id her (Offender_
"He's waiting for you to go in there." Offende
stated that she got up, went
inside and asked if she could come in. Offender
tated that she went inside
and closed the door. Offende. stated that she asked Officer Mikelsen what
she was supposed to do. She stated that he told her to take off her shorts, tum
around and bend over. Offender.stated that Officer Mikelsen then stuck his
penis inside her vagina. Offender
stated that she began to cry and Officer
Mikelsen said "I am almost done. I am an old man it does not take me very long."
Offende~aid it lasted about two minutes. Offender.stated that
Officer Mikelsen came inside of her and she turned around and pulled her shorts
up. She asked if she could leave and that's when he said that he would go first.
Offender.said Officer Mikelsenleft and then she walked out. When asked if
she was wearing any underwear Offende_ said, "No, it was hot that day".

Offende~stated that everyone in the pod was sayln~, I want some of
what you got" and that's when she told Offende~to go inside the cleaning
closet where Offende~ollowed them and asked what happened.
(Offender_ stated that _
is what the offenders commonly refer to
her as.) Offender. stated that she told her "What you told me to do".
Offender~tated that Offende~ started telling her that she was
better than that and that if Offender_ wanted it so bad she should have
done it. Offender. stated that while they were talking, Offender ~ was
telling Officer Mikelsen to say that I was lifting boxes in the property room.
Offende~ said she came out of the cleaning closet and told Officer Mikelsen
to stick to the story because everyone saw her come out of the property room.
Offender.stated that she went to her cell to do what Offender
had told her to, to preserve evidence by swabbing the inside of her vagina and
wiping herself on a towel and then taking a shower. Offender. stated that
Offende~told her if she did not receive the package from Officer
Mikelsen and if no body believed her she would have evidence.

-.~

...

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11, 2006
Page 6 of 10
Offende_stated she went to the third tier and took a shower. She stated
that later she went to mail call and Officer Mikelsen told her to cell up. She said
Officer Mikelsen later came to her cell door and asked her if he had been had,
then asked if she was going to tell, she stated that she told him "no." Offender
~tated that she felt guilty and threw her towel in the laundry bag.

Offende~stated that at approximately 10:30pm she could not stop crying,
and had to get It off her. chest. She stated that she pushed her intercom button
and told the booth officer that she had an emergency. At that time she was
informed that Officer Goodnight would be notified. Offende~stated that
while sitting with Officer Goodnight she was crying and after a few minutes she
told him she had sex with Officer Mikelsen. She stated that she was returned to
her cell until the Sergeant was notified.
Offende. said about ten minutes later she was told to report to the
conference room. She said that Correctional Sergeant Donald Wilson and
Correctional Officer Andrew Cozzolino were waiting in the conference room.
Offende_stated that after giving them an untrue statement she returned to
her cell and approximately fifteen minutes later the booth officer told her to get
dressed as she would be going to the clinic.

Offender~d that she had planned this with Offender_and

Offende~earlier during the day. She said she did not know when and
where this was going to take place. She said Offende~ had already
spokento Officer Mikelsen and told him that she (Offen~ would have sex
with him. ~er_said when Officer Mikelsen went into the property room,
Offender_ told her to follow him inside he'll be waiting. She said she went
into the room knowing she was going to have sex with Mikelsen.
(See attachment 14)

Correctional Officer Terry lVlikelsen
At approximately 2:45pm Correctional Officer Terry Mikelsen was in the training
room with Correctional Captain Michael Green and Investigator Henry Keller. In
the presence of Captain Green, Investigator Keller and I Detective Shaviri
advised Officer Mikelsen that he wanted to talk to him about some accusations
made against him in the facility. Officer Mikelsen immediately asked for his
Union Representation at which time Detective Shaviri informed him that this was
a criminal case and that The Department of Corrections was no longer involved.
Detective Shaviri advised Officer Mikelsen of his Miranda warnings which he said
he understood and said he did not wish to talk to him. At that time Detective
Shaviri told Officer lv1ikelsen that he was under arrest. Officer Mikelsen never
asked him what he was being charged with or who had accused him of
committing a crime. Officer Mikelsen only wanted to know if he was going to lose

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11, 2006
Page 7 of 10
his job over this. Detective Shaviri advised him not to discuss the incident since
he had asked for an attorney. Detective Shaviri notified Transport Officer Phil
Bernel who transported Mikelsen to the Pierce County Jail where he was booked
for Custodial Misconduct in the first degree.
Offende
Detective Shaviri and I interviewed Offender
Offende~told us that she did not plan anything and that Officer Mikelsen
was set up entirely b~ Investigator Keller informed me that Offender
_ h a d a track record of lying and introducing contraband into the facility.

(See attachment 16)
Offenc!e
Offender
was interviewed in the Segregation
agreed to give us a
Dayroom by Detective Shaviri and I. Offender
taped statement. Offende
was very detailed regarding what had
happened. She stated that she and Offende~had convinced Offender
to have sex with Officer Mikelsen. She said she never thought Offender
would actually go through with the act. Offende~said she told
•
Offende~o preserve evidence by swabbing her self and using the towel to
wipe herself. Offender
said Offende~was crying after the
incident and regretted doing it. (See attachment 15)
CONCLUSION:
Detective Shaviri, reviewed the video tape from the Close Custody Unit east pod
where the property room is monitored by video cameras. Detective Shaviri
reviewed the video tapes dated June 26, 2006 from approximately 7:11 pm. It
was discovered that Offender.was sitting next to Officer Mikelsen and
Offende_was seated across from them. At about 7:11:56pm Officer
Mikelsen got up and was walking towards the property room which was about 10
to 15 fee~. As Officer Mikelsen walked away from Offende~and_
Offende~e stopped briefly and looked in the direction of Offende~
He was then seen opening the door to the property room and entering inside.
Offende~followed him almost immediatel~o went into the same
property room. When this happened, Offende. . . . got up and started
sweeping the dayroom area around the property room but stayed in that area the
entire time. At 7: 15:48pm Officer Mikelsen was seen coming out of the property
room and Offende~came out a few seconds later. Offende~as seen
walking straight across the dayroom towards the area where her cell 207 is
located on the second tier. Officer Mikelsen came towards the camera then
walked away. A few minutes later he left the area. A copy of this tape was given
to Detective Shaviri for evidence. (See attachment 18)

0327

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11, 2006
Page 8 of 10
At approximately 12:30pm, Forensics Officer Mel notified Detective Shaviri by
cell phone and advised him that he had discovered biological fluids on some of
the personal items that belong to Offende~
Offender
On June 30, 2006 Intelligence and Investigation Unit received an ffender Kite
dated June 29, 2006 to Chief Investigator Kelly from Offender
The kite stated that it wasn't the first time Officer Mikelsen ha
approached someone and offered to~bacco in exchange for "favors." It
also stated that during her (Offender~t~gregation he approached
her several times and also gave her (Offende~his phone number to call,
which she still has. (See attachment 19)
I interviewed Offende_n the Segre~t which time she gave
me a piece of paper with a phone n u m b e r - " h a t had Monday &
Tuesday off, Wednesday - Sunday leave at noon. Offender_stated that
Officer Mikelsen opened her cuff port in Segregation, gave her his number with a
book and asked if she need anything to call him before noon, because that is the
time that he leaves his home to come to work. She stated that she has not called
him. Offender_said she would take a polygraph to prove that Officer
Mikelsen gave her the number.
She stated that he told her that when she is release, he could set her up real
good, she could live in one of his apartments.

Offende~said that Officer Mickelsen was the booth Officer and talked with
her on the intercom throughout his shift. She said during their conversation at
one point he told her that he was "Jacking off." She said that he would bring
tobacco inside the facility 'for her when she was released from segregation, she
could come to the clinic when he was working.
It was verified that the number Offender" had was Officer Mikelsen's home
number that was provided to the Human Resources Office. It was also verified
that no calls from offender's phone was placed to Officer Mikelsen's home.

POLYGRAPI-l:
On June 11, 2006 GSR Pol' raph Services William D. Tufts adrninlstered
polygraph to Offender
Prior to the polygraph the subject was advised of her Polygraph Rights and
waived these rights by signing the attached form.
(See attachment 25)

032<'3

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11, 2006
Page 9 of 10
Based on the physiological response produced by the subject on three (3)
polygraph charts, in the opinion of this examiner, she was not attempting
deception when she answered "yes" to the following relevant questions:
1. Did Officer Terry Mikelsen ever give you his home phone number while
you were in segregation?
Based on the erratic physiological response produced by the subject on three (3)
polygraph charts, in the opinion of this examiner, chart recording were not
adequate to form a definite opinion as to truth or deception when she answered
"yes" to the following relevant questions: (See Attachment 26)
2. Did Terry Mikelsen touch your stomach while you were in segregation?
ATTACHMENTS:
1. Incident Report from Correctional Officer Randy Goodnite date 06-26-06.
2. Incident Report from Correctional Sergeant Donald Wilson dated 06-26-06
3. lncident Report from Correctional Officer Verna Garner dated 06-26-06.
4. Incident Report from Correctional Officer Andrew Cozzolino
dated 06-26-06.
5. Incident Report Correctional from Officer Shannon Kriebel dated 06-27-06.
6. Search Report from Shannon Kriebel dated 06-27-06.
7. Incident Report from Correctional Officer Joe Luckett dated 06-27-06.
8. Harrison Hospital Sexual Assault Nurse Examiner Authorization Form
dated 06-27-06.
9. Authorization for Disclosure of Health Information dated 06-27-06
10. Tele-Incident Report No: 11899 dated 06-27-06.
11. Offender Sexual Assault Response and Containment Checklist dated 0627-06.
12. Authorization For Disclosure Of Health Information dated
13. Evidence Card Case number 2006-020 Offender
IIIIIIIIId e -27-06.
written Statement
14. Offender
dated 06- 6-06.
written Statement
15.0ffende
ri!ten Statement.
16. Offender
. ten Statement
17. Offender
dated 06-29-06
18.lnmate Kite Offender
19. Close Custody Unit Video Tape, Start/End a e -26-06 - 06-27-06.
20. Hand written piece of paper from Offender
Correctional Officer Terry Mlkelsen home phone number.
21. Pierce County Sheriff Department Supplemental Report Incident No.
061780244.3.

0329

WCCW 06-106-06
Terry Mikelsen
Custodial Sexual Misconduct
July 11, 2006
Page 10 of 10
22. Superior Court Of Washington for Pierce County State of Washington vs
Terry Mikelsen.
23. Pierce County Superior Court Criminal Case 06-1-02910-2.
24. State of Washin on De artment 0 Correction Primary Encounter Report
Offender
dated 6-27-06.
25~h Examination Statement of Consent 0 ender
~ated 06-11-06.
26. Polygraph Examination Report Offender
ated 06-11-06.

0330

08/28/2008 07:51 FAX

2537883ROl

PIERCE COUNTY PROS

,

~ 002/003

/

E·FILE
IN COUNTY CLE
PIERCE COUNTY.

B OFFICE
ASHINGTON

.Junl;f 2B 2008 1 :18AM

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SUPEJUOR COURT OF WASHINGTON FOR PIERCE COUNTY
STATEOFWASHlNGTON,
PlainlifCI

3

CAUSE NO. 06-1-02910·2

v~.

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KEVIN ST CK
COUNTY C !!RK

TERRYMICHAEL M[KELSON,

DBCLARATIONFOR DSTERMlNAT10N OF
PROBABLE CAUSE

6
Defendant.

7
MARY E. ROBNETT, declares undorpon.lly of perjury:

8

9
10

11

That1 am a deputy prosecuting attorney for Plerce County and I am famlllar with the police
report and/orinvestigation conducted by the PlERCECOUNTY SHERIFF, incident number 061780244;
That the police report and/or investlgationprovided me the following information;
That in PierceCounty, Wa~hlngloll, on or abou;the.2.6th dqy of June, 2006, the defendant,
TERRY MICHAELMTKELSON, did commltthe crime of Custodilll SexulllMi!lconduct in theFirat
Oegree.

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On June 26, 2006, Pierce Counly Sheriff'sDeputy Larson contacted Investigator Baxterat the
correction center.ln Purdy; Bm<ter reponedthat a female inmate had reporling beillg raped by a guard; the
female was taken to Harrison Hospital in Bremerton; the victim had used u Q.tip swab to collectevidence
from herself. which were placed into sn evidence room artbe correction center,
On June 27,'Detective Shavirl responded to thescene, 'with aforeaslc technician: Detective
Snavl1, contacted the female inmate. who reported thefollowing: the defendant,Terry Mikelson, is a
guardat the prison: he aaked her \0 go into the property room to assist with carryingsome boxes; while
she was in theroom. he told her he wouldallow her to have specialprivileges if she would have sex with
him: Rhe diuallow him to have sex with her.but afll.'rWBrds she fell violated; she wiped herself with a
towel and,thel1 she used a swab to collectevidence in cesenc one would believe her; she Interadmitted
that she and a couple other inmares,.
3 md _
wanted to get special privileges
from the defendnnt like getting drugs
told the JlefenJlnnt. would have Sex with him and set \'p
would meethim in the property room wbJoh she did,
'

Iba.

Detective Shaviri rcporta thalvideo surveillance corroborates thul the defendalttwent Into the
property room, immediately followed by. undthe third inmate, who fCported ,et up the sexual
encounter stayedoutside the room sweeping; taeforenslo technlclan with Detective Snavirl collected
porcntial evidence of biological flUid from tbe property room floor.
Detective Shaviri contacted the defendam who immediately askedfor an attorney. Detective
Shaviri then contaetod?
who denied setting' up any sexual encounterand he contactede
who cnnflrmed tbnt she and E
had convlnc• • ro have sex with the defendant,but

-iii••
she tlidn'L

24
Orfjl;lC tlr lht: Pro~ecilling AUQmq

DECLAF.AnON FOR DETllRMINATION

!1JU "rllcomll A,venut South. Rocm 946
Tacoma, WA !JS402-217L

OF PROBABLE CAUSE-I

Muin OfIlce (2.5:n i98.,400

PJTACHMENT

i~: ~

C7-'i3.,

0331

08/28/2006 07: 5 1 FAX

25878B8"0'1

)

PIERCE COUNTY PROS

Ii!J 003/003

On- 1-\1291 Q.2

1

actually thl~ would go through with it

.'

reported thatshe lol_ro preserve the

-evidence by wiping herself and she reported that afterwards. was crying and regrettlng doingthis.

2
3

1DECLAR.E UNDER PBNALTY OF PERlURY UNDER'l'H.E'LAWS OF TIlE sr ATE OF
WASH1I\IGTON THATTJ-IE FOREGOING 15 TRlJE AND CORRECT.

4

DATED: June28,2006
PLACE: TACOMA, WA

S
Is/MARYE.'ROBNETT
MARY E. ROBNETT, WS:B;II2.112.9

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DECLARATION FOR DETB.ltMINA'nON
OF PROBABLE CAUSE-2

Onlt:Cll( Lh.~ PrMt:cuting AlIomt'y
93U 1'UO;:lJmh Avenue Soum, Room 946

Teccm... WA 9S40Z.Z171
Muin Olnee(l.\31 798-7400

033~

Pierce County Superior Court

IminaJ Case 06-1-02910-2

/

Page 1 of2

..J

Pierce County Superior Court Criminal Case
Defendant:
Access:
Jurisdiction:
Initial Arrest Date:
Initial Bali Amount:

06-1- 0 2910-.2

TERRY MICHAEL MIKELSON
PubOc
SUPERIOR CT - PIERCE CTY
06/27/2006
$0.00

Attorneys

Type
Prosecutor

Name
MARY E, ROBNETI

Firm
Prosecuting Attorney

Role
LEAD COUNSEL

Charges

CountType
Description
RCW
Disposition Se
1 Original CUSTODIAL SEXUAL MISCONDUCT IN THE FIRST DEGREE 9A.44.160Cl)(a1

Filings [ e-file document I

Filing Date Filing
06/28/2006 Information
06/28/.2006

Affidavit/Determination for Probable Cause

Access
Public

Pages
2

Public

2

MI

Proceedings

Date
06/28/200601:30 PM

'Judge
CRIMINAL DIVISION 1

Dept. Type
COl
ARRAIGNMENT

Outcoi

ARRAl

Incidents

Incident 'Number
061780244

Law Enforcement Agency
PIERCE COUNTY SHERIFF

Offense Date
06/26/2006

Superior Court Co-Defendants

Cause Number

Defendant

Judgments

Cause #

Status

Signed

Effective

File

• Hearing and location Information displayed in this calendar is subject to change without not
changes to this information after the creation date and time may not display in current vers
• Confidential cases and Juvenile Offender proceeding information is not displayed on this caj
Confidential case types are: Adoption, Paternity, Involuntary Commitment, Dependency, an
• The names provided 'In this calendar cannot be associated with any particular individuais wi'
individual case research.
• Neither the court nor clerk makes any representation as to the accuracy and completeness
except for court purposes.
Created: Wednesday June 28, 2006 5:01PM

033

Pierce County Superior Court

. minal Case 06-1-02910-2

Copyright © 1995-2006 Pierce County Washington. All rights reserved.

Page 2 of2

Pierce County Public .Tail Ros

Pagelofl

Created: Wednesday June 28, 2006 5:04PM

Pier-ce County Corrections Inmate Listing for Terry Michael Mikelson
Your search returned 0 matches for Terry Michael Mikelson. The list includes all persons Who are in custody I
supervision of the jail.
Jail Name Booking lD Facility

* Booked LessThan

24 Hours Ago

Copyright © 1996-2006 Pierce County Washington, All rights reserved.

~

033

IBR Disposition:

Case--Marla-gemeni'

Arrest

_. , ..Pl~g_sWC?,~:.,'
Reporling By/Dule:

92-031~Shaviri, Ray 06/26/2006
00:37:00
-'-~ReviewedByIi5"le:~ -B1~011.~Adamson, Richard'
06/28/200609:50:51

Porenstcs:

Caser,epoli SIalus' Approved
.elateo Cases:
Case Ffeporl

Number-

Agency

Jon-Electronic Attachments
AtlachmentType

Count

.1

I

J
'i

Offense Details: 1103·· Sex Crirna- Forcible Rape· Strongarm
'Domestic Violence:
Completed:

! Child Abuse:
Completed

Yes

Gang Related:

crime Against:

Juvenile:

PE

Hate/Bias:
US·lng'.

.rtrninal Activity:

Localion Type: Corrections Facility/Jail
of Units

Total No.

Entered:

Type

_.__.._~ __ ._."._,_. ._.__ ._,

of Security:

None (No Bias)

Tools:

Evi'derlc;e ColieCied:
..

"_,_.

---=-

._.

.__,__.

._ ._..__.

._..

.

..\

-E~I~~~f:A=::--~:- ~~------ --~-------------_.----- ------------ -----~------- -------------.----- . -'' -1
Arrestee A1: Mikelsen, Terry Michael

PDA:

Call Source: ...Dls'pat~h",d.
."p}io'ne-Repo-rt:

Insurance Letter

Assisted By:

-- -~----'-""f,fOtifie(C'-'
.... -.-

-~-_.-

'EnleredBY'-92-()31-:Sh"vlri,Ray

-Enler.dOri, 06120/2006 08 :37: 16 ----·--------Approve;fBy:~E202i34-:-F;.eii:as:Kathy
. ---ApprovedOii:-06izs-'2006 1o:z'f:2S----- -------EXCBplionaICiearance:-· -------- - --- .----

Aduiv Juv'eniie'"Cleararlce: ;....-_._-- -,_._--",- ------.--..-._.. ._..__.- -. Exc-e'p'UonalC18aranc-e'Oate:
·-·p:dCil'tionai bistrlblitlon': .._--.------ --_._- ------....~-~-~--.- . -_.---- Other'DiS"tr-lbut'lon; ,--''c'PS-'--- ... sui;erv!s-or:
.JatTon -.. -blstrlbu'tlOri'"5i.ite:-·._.-,-- --- C:~~i~--·-'---· -.--.. _".! ~9:o~~TY-:-~?~~7~_~X:_~I.-'-:::·--J~Y_8Q~le-·- -_····-.. Ohl·er·;
Processing
Indexed Dale:
By:
Cay Pros, Atty.
i
Military
- : DSHS .,
PreTrial
For Law Enforcen"int Use Only - No Secondary Dissemination Aliowed
Printed: July 10, 2006 -12:32 PM
\

~::~~~:c~:: ~~:h~~~~~~~Y to ensure correct agency, CB/Grid/RD, and District/Sector are

Printed By: Shaviri, Ray

SSN:

botl~o:

Sf

FBI No:

·'LocalcH'No';--;

State io:

License I\.io:

Driver-LTcons'B"-';-- Was hi ngton

MIKELTM453JA

--" b"rlverLic's'lise

. Stale:

Hair Length:

Glasses:

Hair Style:

Teeth:

Hair Type:

Speech:

Appearance:

RighI! Lell Handed:

Country:

Facial Hair:
Facial Shape:

.;

I

Complexion:

..t._

SMT:

Alli,:e:

___ • • •

• __

~.__

L

I

I

-'---Body Build:
.ir-ibe"'Affii·(atlon;'·'
""fden'tifielrs;' "

Gangs:

Signifi'canl .
Trademarks:
Suspect Pretended

I

Facial Feature
Oddities:
Disljnctive:-F~~Iui:es:

I
I,

Modus Operandi: .

to Be:

Placebi SI,iii'

HablluaIOHaii,i'e,'----

Dateirini'e)\rreslecf· 0612712006-15:00: OO-'-Sooked

-Custody' Status:

Toeal,on:'· -..--

ArresI L.ocat(on: - 9601 Buja'Cich-Rd Hw -ReieasedTocaiiDri,: ---- --GiS Harbor, WA 98332
1103 . Sex-Crime~ForcibleR''-pe-=-stror;garm .---- -O;';:;;iewBooi<ed. r;,le;w-Prc;ilable Cause--------------

Arreill-lope

Unarme·d-----·----····

Armed With:

IViira'n-da-Read:

I

batetTi'm~e"Booked:­

!

H,MFor:

i,

-OatalTime--

----

I

Released:

--: JuYerill"blip"sllio,'---'--

·--·---·----·--·---_··---------,··--···----·------r-

!

I

Ad-uitPresenTi~ame : - -' ---

J

-- . -..-----.---- --..-."' ----.--.. ":"---'-iViTrancia-Waived-:-:---------···,--·-~--+-·---··Deteniion·Nam~:

.... --No~wa;;anti·-'···-··---------·-···-_=~:T __ Mutt~~cl,,~anc:=~~Not-~eilfc.abl~_T=::::.-:-Noii!':d..~ame:.=:~

- -"-'·Fi·ngerprin'is:-~·-'·_·--···-----·-··---·'----··
.---.'-··Typecif InjurY;------·-----------..-

1

Photos:

!

Medicaf Release i

Hospital Taken To:

----- -1

Taken By:

Obtaiflect: !

jfng-Phy-si-Cl~:in:'---------·---

I

~:_~~_____ .•_-::_~ ..

Previous Offender: 3
·-·-----------FireQept'Respons'e-:---)

I

-----------'-·---··--------------------------1

Hold Placed By: ;

I

New Charges
Arrest #

Book/Cite

000000

Book

Charge Description - RCW/Ordinance

Free Text Onarqe Description

F -- Custodial
" Misconduct 1 degree

Court

Count

Bait

Pierce County
Superior Court

1

Warrants
: Arrest #

1 Warrant

Free Tex'.'lC"-I~1a"_r~ge"-'=D""e~sc"_rl'!'P"!'tioern!.-__LC'.!_l"'~~

#

I

Court _ _.
~~~

Batt
-"~~

Arrest Notes:

'Pro'bable'Gause:

-.. __
.-

._~

--

J

~

J!.\!aapoo l' None
Offense:

1103 . Sell Crime· Forcible Rape ..
Strongarrn

.. offender

. Weapon·:"

a'thai- 'Weapon:
Action:
Manufacturer:
Make:

iITlporter'.

Model:

A1:Milielsen,ferry i\,4ichaei

None

., - - - -.-..-.---- - -".--.

-'-'-r_'''

Serial No: \

i

. ~ .•

_. __ •• __ .. __ ~ ..._ •••

OA":

_

I

I

'--",--"-- '-·Alitomat1C:·-';··

!

----Callber;"-' "

· · _. Gauge:'

I

Length:

. FStock:
~~:::.~.::_:PT'"J~,CL1MEJJTf)J)

; -apon 'I\fotes:"-

-j

,

"-D337
PDA:

For Law Enforcement Use Only - No Secondary Dissemination Allowed

Printed: July {O, 2006· 12;32 PIII'-:
D~:_4_~

c,,, (" ..._ .. :~;

t':l_ ..

,

I

Page

foT7!

J
Aliases: .

;

H~~~.:"1~~£"i~~iA9~~~2·4. ·~H~~~~I~~FjrE,,:.R~ce:·.W6h~

'Addresi:--

-_._'

cfty, State 'Zip:" - - . ----

·······--·------r·-·'Coulity;···\·····-- -'.-"- . .- ·--------··--'1--cou'j,lry:'-r- . .-

Phone:

::~::~i:
~~~~~~!~~i~~s~~e~~Gif~~u~~I~~~~fa~~B:~r~mate
ssif'\
.--...-.-...,--.-...

OtherP'holle: 253 65B-4200
EmplclyerlSchoal: . WCCW
'Place'of"Birth:

T'-.-'---.-.-.-.....- .. ,,------~'---"-

Driver License -i~o:'

.... "Eili"nicity: Non-I-Iispan ic.
Eye 'colo'i-";'- Green
Business Pho'ne: --,

Other

.- .6ri\;8f[rcense-:-'w~~ h ington

Driver

State:

ljcense'

country:

Attire:

Complexion:

SMT·.
Victim Of:
VictimType:

Facial Hair:

1103 - Sex Crime - Forcible Rape - Strongarm
individual
~ircu~st~~ces:.\
Other (not to be used
Testily: i
for simple assault)
Rape

Injury:
Type of Injury:

Facial Shape:
Weapon Used:

.1·· None

Reporting Statement
Obtained:

Fire Dept Response:

.-,...-- .--- --Take-ri-SY:

Police Vehicle

Type: \

Law

-ement
L
.Ir Killed or
Assaulted
Information

Assignm'ent:" .

i

._ _'~=_J

Attendingf'hysiclan:' ER

F

J

Justifiable Homicide ;
Circumstances: .

Activity:

Victim Notes: \ -

Witness W1: Kelly, Kelly Marie

PDA:

--Facfa:fHaYr':-~'" -

. SMT:

-TestifY:
'/~itne5S i~'otes:

.Jess W2

Yes

:,
----------

-----~---~----------------

Fa-CiafSha~pe:--;-----"'--

-'-

~

For Law Enforcement Use Only - No Secondary Dissemination Allowed

i.z:»:

_

Printed: July 10,2006 - 12:32 PNI]
1"J~:~4~..J

0 ...

C:-j.,~. . :~:

p~"

,

--'----'-A-11ases:--'-'~----'-----"

OOB:"983

!

Age

22

Weight: -

Height:

:' Sex:!F"mal,,'

'I

Black

RaG.:

Ethniclty:

. T~iafi: C'~jDr: i'"

Add,ess-_. 9601..$.;Jj~~icFfi~NW

- Part

.. ~:=:·:I~~u~~J=--=

'Pho'fle:

",!

-- .iiusiness' pi,orle:

·l, _. _ . . .

~ Time Reside:~.t. __ ._,~ ..?cC~~~·~_~~~~~~~~~~·.

._~

OtherPhone:
ErnpioyeriSchocii:
. -P(ace--bi'Sirlh: .

..• "1

'Drive-r-Ucensel~-'-c,

State;

I

Eye Color:

Cily, Stale Zip: ' Gig Harbor, WA 98332
Country: i
Other Address;
. -. . ... - ...
. .-_. --...- . _..-. -- ._ .. _..._--

R'esi~~~~~

Non-Hispanic

Drl\/ei-r-(jcElrls'e .

j

Country:

Attire:

Complexion:

SMT:

F'acfiii' Hai-r:

Testify: .

_ ._-

' .. __VI!it~':'~ I'J(Jt~~.s an;nmaiealihefaCili,t~y,--'_'
.,.,__-_-_,.._.._.._'__.,

--_

_

,

'F'acral .Shape:

.. -.

,

Witness W3:

I
I

.

~J

-.:.-...:....::.:.::.
PDA:

_

J,I
i

.J,
._----_ .. _._-\

Witness W 4 : _ _ . . r

-'PDA:
--"--'--"-

_

Aliases:

00B:~i982

i

Age:

23

i
Height:
Address:
City, Slate Zip:
Other Address:
Resident:

Femaie ':

Sex:

Race:'

White

··,,···,·,··.1.''''"1

Hair Color:

Weight:

Eye Color:

j

I

9601 Bujacich Rd N~
Gig Harbor, WA 98332

County',
.j
_
,_ ..
. Country:

Phone:
Business Phone:
Other Phone;

Occupation/Grade:

Emptoyer/School:
Place Of Birth:
Driver License
Counl'l':

SSN:
Driver License

Driver License No:

____ ~ .. _.~.

I

~.!~~~J_.

., ._.__

AUire:
SMT:
Testify:

Ethnicity:

:

..!Vitn:::.~~ an inmate at the facil,i"lyL.__

Comp"iexion:

F eclat Hair:
Facial Shape:

. . '-.'

'

'

.

_.

property Item NQ. 1011; 1312 • Recording· YCRNideo Tape
For Law Enforcement Use Only - No Secondary Dissemination Allowed
----

Printed: July 10, 200! - :2:32

r:,fV/i

.----------- --1- -,Page
- 5-6(7.
Pierce County Sherlff Depai _.•1-enT---.---------r.fncident No. vl61780244.3
§_upplemental Report

_

.j
i

-----6ther Common"llem: : -

Desc;:ip'U()rl;' Maxell VHS
.Quantity: 1

._~_!

-I

-~--------------

--'--'--'i- -·"-Conlenls'S"ampiE;ii:
-_ ..~

__ _ __ ___

I

Owner:
II

:

Mai('e/Srar;a:

Recovered Date: "j

·--·Modee·'

Recovered'Va'ilJe':"-i
.Field"Te"s'tscF"i
'Fi'e'lcl"Tesl Re"su'lhi:-r "

\

I

.-- -.----.--.' Ser1;:i-No:"

Vehi~:PI~;~;~~~f;~n:: .. Pc::~D/Tpprv1ain~r"t>ertyRoom
License:

LiceV:~i-3t~::~'T

.------~~~~~-.~~,-

rvtocfe-I':-":'

I

policyNo:

.1

Locked:

'j

I

·······Keys·in\iefiicfe:~ ,.

Slate:--' -

Make:-"]

I

-------·------··'OAN:
-''--In'sur~ilice-Compa'riy:-\

P-ro·p_~~ty_P!~~.?_~I.~~·~~~.-.:·,--~9,~I~~j-~~~-. ~.i~p'j~y__.

'-'ie-til'de-

~

E~Evidence-(lncludingOtherSeized--rValue:'
, Proporty AndTools)
i

status:

License

.

Photographed:

"'Fing"erprlnte'd:--' -

. _,- -----~'-I

~urcj_y_Co'rrections

Finding Location: -

L ...

._-------~

,

---.-

.-

. - -. . -....-=-~~~-~~·?~!nt¥c;f~'~!~:~+-~

..-.---------.

..--.- ·--··-··----·-----D!iveabTe:·..·--

...-..---,..---.--,------ .---.--..-"'--- ----.--.--.-..
-- ----.--.----.. ---.---------..----.-----.---- ·-:------··--·------Oamage: ~-- ... ~---.---....

-"1

j

-,·-··-------·~·--Estim-aiecj""oamage:-

§tYie':'~"---

i:

1

piimaryVehlcieCok;r:-;-·-·-·----·--·----------'-~---:---···----OamagedAreB:T-···'-·----··-·
.---.-..,..-.--...---- ·----1
.. §Eico'ndary-VehiC1e' bolor:"""1'-------··---·---·--·----------·--·-----·--~----·T-ow'CompanY:-'-·-····-··------·..-.--..-----.---.,.~
--·,,--·---·,·-·-·--,·-·..-,,·-··-·-VIN:~;· . --.. -·----··--'------"---..-------·------'---:-··---·--"1"owConsen~-- -..
. ----·----Sp-ecialFeaiui,;S:-----·---~---------- ---------HoiCF..Requ"stedBy"---------·----~------------.---.
---"I

i

..

-D!iJgl~fO!_01~i?il:~=~ ~.=:.:-:-=:===::_=_-

. ._.

E.~~_!~-P~~,--

Drug Quantity:

__.
.
.

_=_-_=_=_===-=--.---=-_
_._-=====-=-_-==::_:..-.:===---:]
:

._.

~~~~~~~re: _.

,

.

.__.__.._._, ..,_._..

.. .__._-\

' Drug Measure Type: :

j

.

~lcYT;;formation:----------·--~.----~---

1

'---~'----------------=~==I

.·-~~=~~-~~i:I~~~:j-:~-==~-=~=~-=--==------===~-=-~~::r~-=:::--=--==~-=-~-::'==-~~-----j

·.. . _-_-=:.-~=·.~~~~.:o~e ~~lor:J.-.=,=.=·~==~=_~=~=.=Firearm Information:

cam,",,-

-- .-

~.--

i

~nera~y Wor.n B_~.~ __=--==~~=_-=--=-~~~~==~~:.==~=.=·:~J
,

....----------------- -------------:--------- Lenglh:'---------- -----.-

·-·-----------·-,·-····Action: ---..-,---.-.---..- - - . - - - - - - - - - -

'--,--- i'rrlrJ'orter: .,..-.-.-_.---

.

~----,.

- .

Grips:-~--·-·--·-·

..-----,-----,-.--,.--. - -

·-···---·-·---··-----·~---·----,··----_·--Sto-ck:

.====~-=::=------::\

. -·-··

----··,--·--'----Gauge:·l-----·--------·-------------~-"---....,--------Rilish:-'------··-·--·--·--

..- ·------"-- .._---_.__ ._-_.,,'_.'.-

.!

Ii

. ··

I

_....
Enter

WACIC

Time

Date

.

' LESA

Inllial

Clear

Release

Inlo.

Dale

Owner
Notified

Time

Release

I

...

J

\ Release

No.

Authority

Operators

Name

Investigative information
-----

Vehicle Activity:
. ·----·---Synopsis:

-_ .. _._-_._---_.

-_· __·_·------------_·_·_ .."1

····DiieCIiOriVehICleT;a~::~:;.~;~~,~T=i£J,_pag~P·7-- ~

Means:

..- - - - - - - - - .

----.~---

__ _------------_.-. - - - - - - - - - - - - - - - - -

I

..

0340

Lt. Rick Adamson regarding this case -Hea~-~~d me -I
for women regarding a rap.!"_._..
~~
._.
.. .J

,·jarralive: --On 06/27/06 at about 0715 hours, I received a page from
to

re~ond

to the Purdy

Corre~tion's fa~

For Law Enforcement Use Only - No Secondary Dissemination AI/owed

Printed: July 10, 2006 .. 12:32
D,-i"~L>ri &:I". (:1>",,,.,-,

PM I
c;.",,, \

pferea-County Sheriff-Oepal ..•lent
_~upplemental Report

'W~~-~:he fl~~~'~:~';:'~':,~~'"

I arrived at the facility at about 0850 hours On arriving, I mel Deputy T. Larson
Officer and also Forensics Officer Steve Mel, both With the Pierce County Sheriff's Department I also met
· Chief Investigator Kelly IZeily With the Departmenl of Corrections

"I'
I

~

!

. ell
•advised me that the allegations were made by an inmate n a m e d _ with an AKA O f "
was currently In the facility c1inic.~ad notified the Prison st~night at about 2200
· ours and Since then they had taken h~ hospital in Bremerton to have a sexual assault exam done. Kelly
said that_ad used a towel to wipe the semen off her and had also swabbed herseif after the incident.

1

The incident occurred in a storage room which is used to slore ilems belonging to the inmates. Kelly told me
that no inmates are allowed inside this storage room.The room is in the Closed Custody Unit's East Pod
commonly referred to as the CCU's east pod. This is a common area where the Inmates are allowed to
· interact during certain hours. Forensics Officer Mel processed the scene for evidence. (See sup report by
· Steve Mel)
Deputy Larson toid me that he would pick up the sexual assault kit from the hospital in Bremerton and book iI
into evidence (See sup report by Deputy Larsen)
· Ms. Kelly and I first interviewed victim _ _ The interview was audio taped with her consent. The
following is a brief summary of that int~ us that Correction's Officer Terry Mikelsen had asked
her to come into the property room in question to assist her with carrying some boxes. She said while she was
in the room he told her that if she had sex with him she wili be allowed to have special privileges~aid
: she did as she was told and had sex with Officer Mikelsen. She said after the incident she felt vi~nd
· decided to use the towel to wipe hersetf and also used a swab to preserve evidence in case no one believed
· her. She said she felt violated and waited untii the next shift of Officers arrived before she reported this. (See
attached transcripts of the taped statements)

I
!

\
!

I
I,,!,

I

I

I

Next we interviewed.s roommate
seemed very reluctant and scared to
• make any statements ..She did say tha sea ear rom
a some of the other inmates wanted her to i
, have sex with Corrections Officer Mi~ould pro I e em with drugs and other privileges. She said
_ o l d her that an inmate named_had told Officerl'
elsen that she had a crush on him to
!
~te this. She said she had this conv
ion with _
after
had sex with Mikelsen. She s a i d " !
, was upset and crying. She said she saw
wab hem with a -tip and also wipe her vaginal area with a . I
: towel. She said an inmate named
came into their room and told _ h a t she didn't think she !
i, would really do this. She then tal
e a shower but before doing that w"TPe"herseif with the towel and \
:
, swab her vaginal area to preserve_vidence olthe sex.
or a second time with this new information we had. This time'" !
: Investigator Kelly and I confronted
· gave us a second detailed statement on ta e regarding what had happened. She said she had planned this
:
i with Inmates~nd
arlier during the day. She said she did not know when and
e said
ad already spoken to Officer Mikelsen ~ him that
where this w~e pi e.
w en Mikelsen went into the property room ~Id her to
· she-"'ould have sex with him,
: follo~nside since he was waiting.
e said she went into the room and had sex with MiI\elsen. (See
· attached transcripts of the taped statement)

't

I

C'""-t
I-v<-

1..,.1

::.:.::

..,

Investigator Kelly also advised me that the area of this property r o o
is . onitored by video cameras. We
viewed the tapes from the approximate times as a related to us by
nd discovered that on 06/26/06 at
, about 1911 hours, she was sitting next to Officer Mikelsen and across rom them seated was _
At
was walking towards the property room which wa~ 5
about 1911.56 Officer Mikelsen got
feel away. As he walked away from
an~e stopped briefly and looked in the direction o~e
: was then seen opening the door to t e prope~m and entering inside
allowed him almos~
immediately and also went into the same property room. When lhis happene ,
at up off her seat and
.t
hours
started sweeping the area around the property room b~ed in that area the entire t i m e1915.48
as seen
Officer Mikelsen was seen coming out of the room an~ame out a few seconds later
walking straight across the common room towards the area her own room was located. 0 cer Vlikelsen came
towards the camera then walked away and a few minutes later left the area. A copy of this taParl'''P 41fed
II1to evidence.
V-,.)

lid

At about 1230 hours, Forensics Officer Mel called me over the phone and advised me that he had discovered

"._-

--'--'---'

biological fluids on some of the personal items thai belonged to the vicUm that he had taken Into evidence-:-(See attached report by Officer Steve Mel)

-'---1

At about 1445 hours, we were advised thai Officer Mikeisen had corne to work at the facility. Captain Green
had him wait for us in their training room, I advised Mikelsen that I wanted to talk to him about some
, accusations made against him in the facility. He immediately asked for his attorney. I advised him of his
Miranda warnings which he said he understood and said he did not wish to talk to me. I told Mikelsen that he
was under arrest. Mlkelsen never asked me what he was being charged with or who had accused him of
committing a crime. He wanted to know if he was going to lose his job over this, I advised him not to discuss
tile incident since he had asked for an attorney.

I

I
ii

Transport Officer Phil Bernel transported Mikelsen to the Pierce County Jail where he was booked for
Custodial Misconduct in the 'first degree.
I\lext, investigator Kelly and I interviewed
Officer Mikelsen was set up entirely by
and introducing contraband into the facil y.

. . .Old us that s h l lnot
' plan anything and that
vestigator Kelly told me that
ad a track record of lying
ee detailed report by mvestrpa or Kelly)

After Kelly, we interviewed". She a~o give usa taped statemen.was very detailed
s and"'ad convlnce~Into h i l i
x With Officer
. regarding what had happened. She SMld
Mikelsen. She said she never though
would actually go throug~he act
she tol~o
preserve evidence by swabbing her se and using the towel to wipe herself. She sai
was cr~er
the incident and regretted doing this, (See attached transcripts of the taped statemen

I
\

1
i

I
I

I

Case forwarded to Prosecutors Office lor review.

Reviewed By:

Reviewed Date: 1

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0343

Photo Display

Page 1 of

J

DOC Number:
Name:
Date of Photo: 7/19/2005 7:31 :51 AM
Source of Photo: TAS

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~

D URGENT!

Date

_

_

:::~:::::::::::::

f!i")if.A
·"'j~i4t~.t

06/27/06

;'<>oHINGTON DEPARTMENT OF CORRECTIG•. ~

IIS0100

PAGE

LEGAL FACE SHEET

TIME 07 :48

(IIAAll)
D O C N O : . NAME:
BED NO:
COUNSELOR, 1131 CAMPOS, MONIQUE

CURRENT LOCATION: W.C.C.WOMEN
24
FBI NO:
SEX; F
AGE:
RACE: WHITE
SID NO:
HISP ORIG;
NO
HEALTH RECORD REVIEW ; NOT REQUIRED
NJ.I..MES:

1

STATUS: ACTIVE

MXED: 11/25/2007
MNED: 08/26/2006
ERD : 08/18/2007
ADJ.: 08/18/2007
NRD : 07/28/2006
SCORE: 00
CUS.: CLO
MFED: 04/14/2005
COMM. CONCERN: N
RMI: RMB
VICTIM WRAP AROUND:
N
VW ELIGIBLE:NO COMM.PLACEMENT: NO

(AYJ<)

LSI-R:
44 AND LSI LEVEL: HIGH
SSA NO: . . . . . . . . . . . .BIRTH: """/1982
P. WTR:
P. REL: NO ACTION TAKEN
P~GISTERABLE OFFENDER : N

-:rr;::- .

P. PREL: DENY INST INFRACTION
P. MFED: DENY INST INFRAC
DATE
P U L H E S D X 'I'
1 1 1 1 1 2 211 05/03/2005

COM.
COUNTY
GTL TIME START P~CElVED OC MIN. TERM CC CS
#AA#N SNOHOMISH
33
04/14/2005 04/14/05 01
2Y 9M OD
CMP. CO./CAUSE OFFENSE DESC.
V OC CNTS MIN.TERM CC CS
2Y 9M OD
~ND CRIM ASSISTAN N 01 lC

REL.DATE STATUS
08/18/2007 AC
MANDATORY JAIL
1Y 6M OD
66

TOTAL MONETARY OBLIGATION: ORDERED $***1500.00 ,AS OF 07/01/05 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
ST1>.T MAX:
02/23/2010
****************************************************** * * * * * * * * * * * * * * * * * * * * * * * ~ *

COMMENTS: l1797 11 01/23/06 FOI
MOVEMENT
04/14/05
06/21/05
09/29/05
10/17/05
11/10/05
01/23/06
01/23/06

DATE & TYPE
NEW COMMITMENT
TRANSFERRED TO
TRANSFERRED TO
OUT TO COURT
RET.FM.COURT
ESCORTED LEAVE
RET. FI~.AUTH. LV.

HOUSING.DATE & LOCATION
06/09/06
DATE
04/24/06
04/25/06
04/25/06
04/25/06
E~~ED

11899 32 06/26/06 FOI

DESTINATION
W.C.C.WOMEN
PINE LODGE CC
W.C.C.WOMEN
SNOHOMISH
W.C.C.WOMEN
KITSAP
W.C.C.WOMEN

REASON FOR
INITIAL CLASSI.
REDIRECTED
POOR ADJUSTMENT
COURT ORDER
RETURN FR COURT
MEDICAL NEEDS
MEDICAL COMPLTD

COUNSELOR
CAMPOS, MONIQUE

PROGRAM-POSITION
J326GlO3 CUSTODIAN I
C027COOS JOB HUNTER
V900E10S YOVTP VOCATIO
V900F103 YOVTP VOCATIO

- -WEEK-1 2 3 4
1 2
1 2 3 4
1 2 3 4

EARLY RELEASE DATE & TYPE

DOC

Sl~OHOMISH

W.C.C.WOMEN
KITSAP

WORK ASSIGN.

------DAY-----SU M
TH F S
M T W TH F
M
W
M
W
ISRB

ORIGIN
SNOHOMISH
W.C.C.WOMEN
PINE LODGE CC
W.C.C.WOMEN

SUPERVISOR

---TIME---- STATUS
08:00-14:00
ASG
09:00-12:00
DRP
13: 00-13; 50
ASG
14: 00-14: 50
ASG

STATUS LOCATION

0345

06/27/06

NO_

1•••

dHINGTON DEPARTMENT OF CORRECTI"••"

IIS0100

DOC

LEGAL FACE SHEET
NAME:
DOC
B.OO
8.00
30.50

AA

EARNED TIME

30.50
5.17

AA

12/01/05--01/01/06

EARNED TIME

5.17

AA

INFRACTION DATE & TYPE
07/04/05 505 FIGHTING

CELL
1'1

2

TIME 07: 48

IIM11}

EARNED EARLY RELEASE DATE & TYPE
04/14/05--06/01/05 EARNED TIME
06/01/05--12/01/05

PAGE

ISRB
0.00
0.00
0.00
0.00
0.00
0.00

DOC

ISRB

5

5

STATUS: ACTIVE
STATUS LOCATION
PENDING WCCW
PENDING

WCCW

PENDING

WCCW

STATUS
APPLIED

SANCTIONS
DENY GCT

LOCATION
PLCCW

2L SUSPEND

05
30

*

STRUCK #748783 IN THE HEAD.
08/02/05 559 GAMBLING

N

09/03/05

N

5

5

APPLIED

ATTEMPTED TO SEND OUT PERSONAL I~IL
OOFFENDER' S NAME WRITTEN ON IT
09/03/05 657 4 GENERAL INFPA.
N
15

15

APPLIED

605 IMPERSONATING

*

DENY GCT
PLCCW
PREV.SUSP.
EXTRA DUTY
40
20
20 APPLIED DENY GCT
PLCCW
2L SUSPEND
10
60
IN AN ENVELOPE WHICH HAD ANOTHER

*

DENY GCT
TRANSFER

GUILTY OF 5 MINOR INFRACTIONS W/I 6 MONTHS.
09/21/05 605 IMPERSONATING
1'1
20
20 APPLIED DENY GCT
ATTEMPTED
TO
MAIL
OUT
LETTER
TO
A
WCCW
OFFENDER
VIA A 3RD PARTY.
*
09/21/05 72 7 COMl"!lJN. MISUSE
0
APPLIED
TRANSFER
0
1'1
11/19/05 714 POSSESSING > $10
1'1
0
0 APPLIED REPRIMAND
* DID HAVE POSSESSION OF A RADIO THAT DID NOT BELONG TO HER
11/24/05 714 POSSESSING > $10
N
0
0 APPLIED WKEND CONF
01
* DID BORROW A PAIR OF JEANS FROM ANOTHER INMATE
01/10/06 657 4 GENERAL INFRA.
N O D APPLIED WKEND CONF
02
* FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 10/13/05 AND 1/2/06
06/03/06 558 STAFF INTERFER.
1'1
0
0 APPLIED MAX SECUR.
07
* DID NTERFERE WITH STAFF DUTIES BY BEING IN AN UNAUTHORIZED p~EA.

*

HOLDS: DATE
01/19/06

REASON FOR HOLD
TRANSFER
YOP - YOUTHFUL OFFENDER PROG
Y

LOC
F01

STAFF
GB96

PLCCW

PLCCW
PLCCW
WCCW
WCCN

WCCN

WCCN

UNTIL
08/1S/07

06/27/06

NO:_

l...dHINGTON

IIS0100

DOC

DEPARTMENT OF CORRECTI0.,,,

PAGE

3

LEGAL FACE SHEET
NAME:

CUSTODY DATE SCORE TYPE
04/18/2005
51
INITIAL
S7
PLAN RVW
07/08/2005
09/27/2005
00
PLAN RVW
12/14/2005
DO
PLAl' RVW
I CC ACTION: CONCUR WITH FRMT.

STATUS: ACTIVE

ASSIGNED
05/02/2005
07/08/2005
09/27/2005
01/11/2006

CUSTODY
MINIMUM
MINIMUM
MEDIUM
CLOSE

OVERRIDE

LOCATION
W.C.C.WOMEN
PINE LODGE CC
PINE LODGE CC
W.C.C.WOMEN

01/27/2006
00
REVIEW
01/27/2006 CLOSE
W.C.C.WOMEN
F P.MT CID.IRED BY CUS BROWN. CC3 NEWSOM AND CC2 BUCKNER MEI>"J13ERS. P WAIVED PRESEN
C E. 'R' REVIEW. MAIWrAIN CLOSE CUSTODY AND HOUSING DUE TO CONTINUED INFRACTION
BEllAVIOR. ANY CHANGE IN CUSTODY POINTS WILL BE ADDRESSED BY A CUSTODY PROMOTI
ON/DEMOTION AND/OR CHANGE IN HOUSING UNIT.

IISUI012 NO WARRANTS OR DET1'.INERS FOUND

0347

Photo Display

Pagc] of]

DOC Number.:

Nam·
Date of PIJOto: 9/26/2003 12:30:30 I'M
Source of Photo: TAS

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"'.,. Developed and Maintained by DOC's IT Web Application Unit.
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please refer to !blSJi,<'9."',

0348

07/12/06

W~oHINGTON

IIS0100

DEPARTMENT OF

CORRECTION~

LEGAL FACE SHEET

(

It

AC II )

(llAD")
(IIAHU)

(AleA)

1

TIME 09:07

D O C N O : _ NAME:
(UAGII)
BED NO: FOIC332B COUNSELOR: GB87 NEWSOM, leATHERINE
CURRENT LOCATION: W.C.C.WOMEN
FBI NO:
SEX: F
AGE: 29
RACE : WHITE
SID NO:
HISP ORIG: NO
HEALTH RECORD REVIEW : OPEN

PAGE

STATUS: ACTIVE

MXED: 08/15/2008
MNED:
ERD : 05/15/2007
ADJ.: 05/15/2007
NRD : 06/20/2006
SCORE: 00
CUS.: CLO
MFED: 09/26/2003
COMM. CONCERN: N
RMI: RMA
VICTIM WRAP AROUND:
N
VW ELIGIBLE:YES COMM.PLACEMENT: NO
LSI-R:
SSA NO:

44 AND LSI LEVEL: HIGH
BIRTH: ~1977

(AICA)

(AlCAl

P. PREL: DENY INST INFRACTION
P. MFED: DENY INST INFRAC
P U L H E S D X T
DATE
2 3 1 1 1 3 131 10/02/2003

P. WTR: DENY INST INFRACTION
P. REL: N/A
REGISTERABLE OFFENDER : N

COM.
COUNTY
GTL TIME START RECEIVED OC MIN.TERM CC CS
5Y OM OD
#AG#N COWLITZ
09/26/2003 09/26/03 81
33
V OC CNTS MIN. TERM CC CS
CMP. CO./CAUSE OFFENSE DESC.
DRUG POSSESSION
N 81 lC
5Y OM OD
5Y OM OD 0
BAIL JUMPING
N 01 lC

REL.DATE STATUS
01/08/2007 AC
MANDATORY JAIL
OY OM OD
273
OY OlQ OD
273

TOTAL MONETARY OBLIGATION: ORDERED $***3708.50 ;AS OF 04/28/06 PAID $******0.00
SET BY:
SPECIAL CONDITIONS: YES
SCHEDULE:
o
03/02/2008
STAT MAX:
*******************************************************************************

#AH#N COWLITZ
33
09/26/2003 09/26/03 52
CMP. CO. / CAUSE OFFENSE DESC.
V OC CNTS
ROBBERY 2
Y 52
lC

5Y 3M OD AG
MIN.TERM CC CS
5Y 3M OD

05/15/2007 AC
MANDATORY JAIL
OY OM OD
175

TOTAL MONETARY OBLIGATION: ORDERED $***2834.28 ;AS OF 07/12/06 PAID $******0.00
SET BY:
SPECIAL CONDITIONS: YES
SCHEDULE:
o
STAT MAX:
05/16/2013
*******************************************************************************

DETAINER TYPE
AUTHORITY
01/13/00 WC WACIC/NCIC
03/09/00 WC WACIC/NCIC
04/16/02 WF WACIC/NCIC CUST OR
07/24/02 WF WACIC/NCIC
09/11/02 HC THURSTON CO
09/12/02 HC THURSTON CO
09/13/02 HC THURSTON CO
09/14/02 HC THURSTON CO

CHARGE(S)
CCI ESCAPE- TACOMA
CCI ESCAPE- CHEHALIS
CC CCJ FTR OLYMPIA
CC CCJ FTR OLYMPIA
98114273 PROB VIOL
98115199 PROB VIOL
9913474 PROB VIOL
9914551 PROB VIOL

CLOSED
01/15/00
03/09/00
05/07/02
08/27/02
10/18/02
10/18/02
10/18/02
10/18/02

0349

07/12/06

WAbHINGTON DEPARTMENT OF

IIS0100

2

LEGAL FACE SHEET
NAME:

STATUS: ACTIVE

AUTHORITY
DETAINER TYPE
01/14/03 WF WACIC/NCIC

CHAI<GE (S)
CC CCJ FTR OLYMPIA

COMMENTS: 3/22/96 SPEC FROM CALIF RS
CPR PKT TO CHEHALIS 021400 DVH
08853 01 03/09/00 362
11287 63 09/26/04 F01
MOVEMENT
09/26/03
03/16/04
03/16/04
04/01/0.4
04/01/04
04/13/04
04/13/04
11/16/04
11/16/04
06/15/05
06/15/05
06/21/05
09/06/05

PAGE

CORRECTION~

DATE & TYPE
READMISSION
ESCORTED LE1WE
RET.FM.AUTH.LV.
ESCORTED LEAVE
RET.FM.AUTH.LV.
ESCORTED LEAVE
RET.FM.AUTH.LV.
ESCORTED LEAVE
RET.FM.AUTH.LV.
TRANSFERRED TO
IN TRANSIT AT
TRANSFERRED TO
TRANSFERRED TO

HOUSING DATE & LOCATION
07/08/06

EARNED TIME
AG
AH

06/01/05--09/01/05

REASON FOR
INITIAL CLASSI.
MEDICAL NEEDS
MEDICAL COMPLTD
MEDICAL NEEDS
MEDICAL COMPLTD
MEDICAL NEEDS
MEDICAL COMPLTD
MEDICAL NEEDS
MEDICAL COMPLTD
ACPTD IN PREREL
ACPTD IN PREREL
ACPTD IN PREREL
DISC. PROBLEM

COUNSELOR
NEWSOM, KATHERI

AH

02/01/05--06/01/05

0008 09 09/22/99 F01
10010 02 03/09/00 ~01
08855 02 03/09/00 362
ACCEPT AT ECHWR 6/27/05. JB

DESTINATION
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PINE LODGE CC
W.C.C.WOMEN
PINE LODGE CC
W.C.C.WOMEN

EARNED EARLY RELEASE DATE & TYPE
09/26/03--01/01/04 EARNED TIME
AG
AR
01/01/04--02/01/05 EARNED TIME
AG

EARNED TIME
AG
AH

09/01/05--12/01/05

EARNED TIME
AG

12/01/05--01/01/06

ET NOT EARNED
AG

AH

CLOSED
04/01/03

DOC
16.17
16.17
16 .17
66.17
66.17
66.17
20.00
20.00
20.00
15.33
15.33
15.33
15.17
15.17
15.17
5.17
5.17

ORIGIN
COWLITZ
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN
wecw MINIMUM
wecw MINII"illM
PINE LODGE CC

WORK ASSIGN.

ISP.B
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.17

SUPERVISOR

STATUS LOCATION
PENDING WCCW

PENDING

wccw

PENDING

WCCW

PENDING

WCCW

PENDING

PLCCW

APPLIED

WCCW

0350

07/12/06

NO:_

WA~HINGTON

IIS0100

DOC

DEPARTMENT OF CORRECTIONb

LEGAL FACE SHEET
NAME:
DOC
5.17
9.83
9.83
9.83
20.33

AH

03/01/06--07/01/06

EARNED TIME
AG
AH
~,ED TIME
AG

20.33
20.33

AH

INFRACTION DATE & TYPE
10/26/03 710 TATTOO/PARA.

CELL
N

3

TIME 09:07

(IiAGn)

EARNED EARLY RELEASE DATE & TYPE
01/01/06--03/01/06

PAGE

STATUS: ACTIVE
STATUS LOCATION

ISRB

5.17
0.00
0.00
0.00
0.00
0.00
0.00

DOC

ISRB

o

o

PENDING

WCCW

PENDING

WCCW

STATUS
l.PPLIED

SANCTIONS
SECUR.
15

!'lAX

* DID ADMIT TO POSSESSING TATTOO PARAPHERNALIA
12/20/03 555 THEFT
N O D APPLIED MAX SECUR.
* DID ADMIT TO STEALING PAINT FROM THE SCHOOL FOR TATTOO PURPOSES
12/20/03 710 TATTOO/PARA.
N
0
0 APPLIED MAX SECUR.
25
* DID ADMIT TO ASSISTING OTHER INMATES TATTOO THEMSELVES
04/01/04 714 POSSESSING> $10
N
0
0 APPLIED WlCEND CONF
03
* DID ADMIT TO BORROWING A TV AND CLAMP LAMP FROM ANOTHER INMATE
04/03/04 710 TATTOO/PARA.
N
0
0 APPLIED MAX SECUR.
30
* WAS CAUGHT TATTOOING ANOTHER INMF_TE ON HER SHOULDER.
06/03/04 509 REFUSE TO LEAVE
N O D APPLIED MAX SECUR.
05
* DID REFUSE TO DISPERSE AFTER BEING TOLD TO DO SO
07/06/04 506 THRE1'-TENING
N O D APPLIED MAX SECUR.
15
* DID ADMIT TO THREATENING ANOTHER INMATE OVER STOLEN PROPERTY
10/10/04 657 4 GENEPAL INFRA.
N O D APPLIED WKEND CONF
02
* I~~TE WAS FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 5/24/04
* 9/28/04.
20 APPLIED DENY GCT
07/04/05 505 FIGHTING
N
20
2L SUSPEND
10
60
* ADMITTED TO FIGHTING W
08/24/05 752 POSITIVE DRG TST
N
60 APPLIED DENY GCT
60
* U.A. TESTED POSITIVE FOR COCAINE @ PLCCW.
12/22/05 554 DESTROY PROPERTY
N
10
10 APPLIED DE1'fY GCT
MAX SECUR.
12

LOCATION
WCCW

WCCW
WCCW

WCCW

WCCW

WCCW

WCCW

WCCW
AND
PLCCW

PLCCW
WCCW

0351

07/12/06

WASHINGTON DEPARTMENT OF CORRECTIONb

IIS0100
DOCNO,_

LEGAL FACE SHEET
NAME

INFRACTION DATE & TYPE

STATUS, ACTIVE

SANCTIONS
LOCATION
RESTITUT.
* DID ADMIT TO TAMPERING WITH FOOD IN THE KITCHEN Tr~T SHE WAS PREPARING
12/22/05 557 REFUSE TO PROG.
N
10
10 APPLIED DENY GCT
WCCW
MAX SECUR.
RESTITUT.
* WAS TERMINATED FROM KITCHEN FOR TAMPERING WITH FOOD ITEMS
03/02/06 752 POSITIVE DRG TST
N
60
60 APPLIED DENY GCT
WCCW
I"!AX SECUR.
30
* UA SAMPLE SUBMITTED BY INMATE DETERMINED TO BE DILUTED BY THE LAB RESULTS
03/03/06 603 POSS. CONT. SUB.
N
100
0 APPLIED
2L SUSPEND WCCW
60
* ADMITTED TO BEING IN POSSESSION OF COCAINE POWDER
06/09/06 603 POSS. CONT. SUB.
N
100
0 APPLIED
2L SUSPEND WCCW
90
MAX SECUR.
30
* DID USE A TUBE FP.SHIONED OUT OF PAPER TO "SNORT" HER MEDICATIONS
06/20/06 657 4 GENERAL INFRA.
N
0
0 APPLIED WKEND CONF WCCW
03
* FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 2/20/06 AND 6/1 /06
HOLDS: DATE
06/09/05
07/2l/05
06/28/06
07/12/06

DOC

STATUS

REASON FOR HOLD
TRANSFER
MIl - MINUMUM 1 TARGETED
N
CDT - CHEMICAL DEPENDENCY TR
Y
INF - INFRACTION HOLD
Y
INF - INFRACTION HOLD
Y

CUSTODY DATE SCORE TYPE
ASSIGNED
09/29/2003
30
INITIAL 10/15/2003
02/11/2004
37
PLAN RVW 02/20/2004
02/18/2005
PLAN RVW 03/09/2005
44
I CC ACTION: CONCUR WITH FRMT.

F
E
D
D

ISRB

4

TIME 09,07

( uAGtI)

CELL

PAGE

CUSTODY
MEDIUM
CLOSE
MEDIUM

LOC
FOl
UOl
F01
F01

OVERRIDE
INSTITUT

STAFF
0015
CH22
GC41
GC41

UNTIL
07/01/06
12/06/06
07/28/06
08/12/06

LOCATION
W. C. C . WOMEN
W.C.C.WOMEN
W. C. C. WOMEN

06/08/2005
57
PLAN RVW 06/13/2005 MINIMUM
W.C.C.WOMEN
07/08/2005
52
PLAN RVW 07/13/2005 MINIMUM RISK MAN PINE LODGE CC
09/13/2005
00
PLAN RVW 09/13/2005 MEDIUM
W.C.C.WOMEN
01/19/2006
42
REVIEW
01/27/2006 MEDIUM
W. C. C. WOMEN
RMT CHl'.IRED BY CUS BROWN. CC3 NEWSOM, CC2 BUCKNER MEMBERS. MEMBER WAIVED PRES
NCE. 'R' REVIEW. NO Cr~GES. MAINTAIN MEDIUM CUSTODY AND HOUSE IN MSU WHEN BE
S ARE AVAILABLE. ANY CHANGE IN CUSTODY POINTS WILL BE ADDRESSED BY A CUSTODY
EMOTION OR PROMOTION AND/OR CHANGE IN LIVING UNIT.

WASHINGTON DEPARTMENT OF

07/12/06

LEGAL FACE SHEET

IIS0100

(IiAGlI)

NAME:

DOCNO:_

PAGE

CORRECTIO~o

5

TIME 09: 07
STATUS: ACTIVE

CUSTODY DATE SCORE TYPE
ASSIGNED
CUSTODY OVERRIDE
LOCATION
03/22/2006
00
REVIEW
03/22/2006 CLOSE
W.C.C.WOMEN
F RMT CHAIRED BY CUS BROWN. CC3 NEWSOM AND SGT BELFOUR MEMBERS. P WAIVED PRESEN
C E. 'R' REVIEW WITH A CUSTODY DEMOTION TO CLOSE. DEMOTE TO CLOSE CUSTODY AND H
o USE IN THE CLOSE CUSTODY UNIT. ANY CHlU"GE IN CUSTODY POINTS WILL BE ADDRESSED
BY A CUSTODY PROMOTION OR DEMOTION Al~/OR CHANGE IN LIVING UNIT.
·07/05/2006

00

REVIEW

IISUI016 NO RPM DATA FOUND
IISUI016 NO RPM DATA FOUND

00/00/0000

W.C.C.WOMEN

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0354

WhoHINGTON DEPARTMENT OF

07/12/06

PAGE

CORRECTIO~~

TIME 09,06

LEGAL FACE SHEET

NO'_
IIS0100

{IiMI I

DOC
BED NO, F01C313B

STATUS: ACTIVE

MNED:
MXED: 10/18/2008
ADJ.: 12/19/2007
ERD : 12/19/2007
SCORE: 47
NRD :
MFED' 05/05/2006
CUS.: MED
COMM. CONCERN: N
N
VICTIM WRAP AROUND:
VW ELIGIBLE:YES COMM.PLACEMENT: NO
BIRTH, ~950
SSA NO,

CURRENT LOCATION, W.C.C.WOMEN
SEX, F
AGE, 55
FBI NO,
RACE : WHITE
SID NO:
HISP ORIG: NO
HEALTH RECORD REVIEW : NOT REQUIRED
NAMES: . . . . . . . . . . . (AKA)

_'~ (AKZ\~

P. PREL: N/A
P. MFED' N/A
P U L H E S D X T
322 113 2 2 1

1

P. WTR: N/A
P. REL: NO ACTION TAKEN
REGISTERABLE OFFENDER : N

DATE
05/09/2006

REL.DATE STATUS
12/19/2007 AC
MANDATORY JAIL
OY OM OD
53

COM.
COUNTY
GTL TIME START RECEIVED OC I"lIN. TERM CC CS
2Y 7M OD
#AA#N LEWIS
33 05/05/2006 05/05/06 51
CMP. CO./CAUSE OFFENSE DESC.
V OC CNTS MIN.TERM CC CS
2Y 7M OD
_OBBERY 1
Y 51 lC

TOTAL MONETARY OBLIGATION: ORDERED $***3873.50 ;AS OF 07/12/06 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
STAT MAX: LIFE
*******************************************************************************

COMMENTS: VW LTR TO OLY 061001898
MOVEMENT DATE & TYPE
05/05/06 NEW COMMITMENT

DESTINATION
W. C. C. WOI"lEN

HOUSING DATE & LOCATION
07/07/06 F01-C313B
CUSTODY DATE
05/08/2006

SCORE TYPE
47
INITIAL

IISUI004 NO INFRACTION FOUND

REASON FOR
INITIAL CLASSI .

COUNSELOR
CAMPOS, MONIQUE
ASSIGNED
OS/26/2006

IISUI012 NO WAPJU1NTS OR DETAINERS FOUND
IISU1016 NO RPM DATA FOUND

SENT 05/30/06 JJ.

CUSTODY
MEDIUM

ORIGIN
LEWIS

WORK ASSIGN.

OVERRIDE

SUPERVISOR

LOCATION
W.C.C.WOMEN

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Date of Photo: 2/20/20033:29:42 PM
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0356
,;nqnOOIi

PAGE

WASHINGTON DEPARTMENT OF CORRECTIONS

06/29/06

-

NAME:
.
(IIAA")
DOC NO:
MONIQUE
BED NO: F 01SA227M COUNS~,

~~~:~

22
HISP ORIG:
YES
HEALTH RECORD REVIEW

NOT REQUIRED

NAMES:

P. PREL: DENY
P. MFED: DENY
P U L H E S D
1 1 1 1 1 4 2

INST INFRACTION
INST INFRAC
DATE
X 'I'
1 1 09/27/2005

STATUS: ACTIVE

MXED: 05/30/2007
MNED: 10/29/2004
ERD : 07/19/2006
ADJ.: 10/30/2006
NRD : 07/02/2006
SCORE: 39
CUS.: CLO
MFED: 02/20/2003
COMM. CONCERN: N
RMI: RMA
VICTIM WRAP AROUND:
1'1
VW ELIGIBLE:YES COMM.PLACEMENT: NO

CURRENT LOCATION: W.C.C.WOMEN

:~~ ~ OT~~~:

TIME 09:46

LEGAl FACE SHEET

IIS0100

1

32 AND LSI LEVEL: MODEHATE
LSI-R:
SSA NO:
BIRTH: " 1 9 8 3
P. WTR: DENY INST INFRACTION
P. REL: N/A
REGISTERABLE OFFENDER : N

GTL TIME START RECEIVED OC MIN.TERM CC CS
COM.
COUNTY
4Y 7M OD
33
#AA#N SNOHOMISH
02/20/2003 02/20/03 51
V OC CNTS MIN. TEP-M CC CS
CMP. CO. / CAUSE OFFENSE DESC.
ROBBERY 1
Y 51 1C
4Y 71'1 OD

REL.DATE STATUS
10/30/2006 AC
HA.NDJ>.TORY JAIL
2Y OM OD
113

TOTAL MONETl'.RY OBLIGATION: ORDERED $****500.00 ;AS OF 10/07/04 PAID $******0.00
SET BY:
SPECIAl CONDITIONS: YES
SCHEDULE:
o
LIFE
STAT MAX:
*******************************************************************************

COMMENTS: 11150 11 06/06/04 F01
11381 11 12/13/04 F01
BEGIN HBR WR SCP~ENING PROCESS
DENY HBR WR REDIRECT TO RAP
12/21/05 HCSC CONCURS WITH
MOVEMENT
02/20/03
06/09/03
06/09/03
06/11/03
07/03/03
07/03/03
08/14/03
08/27/03
11/26/03
12/04/03
02/23/04
02/26/04
03/23/04
03/30/04

DATE & TYPE
NEW COMMITMENT
ESCORTED LEAVE
RET.FM.AUTH.LV.
TRANSFERRED TO
ESCORTED LEJ>.VE
RET.FM.AUTH.LV.
ESCORTED LEJ>.VE
RET. FM.AUTH .LV.
TRANSFERRED TO
TRANSFERRED TO
ODT TO COURT
RET.FM.COURT
TRANSFERRED TO
TRANSFERRED TO

DESTINATION
W.C.C.WOMEN
PIERCE
WCCW MINIMUM
WCCW MINIMUM
PIERCE
WCCW MINIMUM
STEVENS
WCCW MINIMUM
W.C.C.WOMEN
WCCW MINIMUM
SNOHOMISH
WCCW MINIMUM
W.C.C.WOMEN
WCCW MINIMUM

11215 13 08/01/04 POI
11659 69 08/27/05 POI
9/27/05 LWF
11/30/05 LWF
DENIAL TO HBR W/R. GFW
REJ>.SON POR
INITIAl CLASSI.
MEDICAL NEEDS
MEDICAL COMPLTD
INITIAL CLASSI.
MEDICAL NEEDS
MEDICAL COMPLTD
DNR/FIRE CREW
DNR/FIRE CREW
INITIAL CLASSI.
INITIAL CLASSI.
COURT ORDER
RETURN FR COURT
DISC. PROBLEM
INITIAl CLASSI.

ORIGIN
SNOHOMISH
W.C.C.WOMEN
PIERCE
W. C. C. WOMEN
WCCW MINIMUJ~
PIERCE
WCCW MINIMUM
STEVENS
WCCW I~INIMUM
W.C.C.WOMEN
WCCW MINIMUM
SNOHOMISH
WCCW MINIMUM
W.C.C.WOMEN

0357

1'10:_

MOVEMENT
04/28/04
05/06/04
06/02/04
06/06/04
06/06/04
06/09/04
06/09/04
06/22/04
06/22/04
07/08/04
07/08/04
07/23/04
07/23/04
07/28/04
12/l3/04
12/14/04

HOUSING DATE
06/27/06

&

STATUS: ACTIVE

NAME:

DATE & TYPE
OUT TO COURT
RET.FM.COURT-NS
TRANSFERRED TO
ESCORTED LEAVE
RET.FM.AUTH.LV.
ESCORTED LEAVE
RET. FM.AUTH.LV.
TRANSFERRED TO
IN TRANSIT AT
ESCORTED LEAVE
RET.FM.AUTH.LV.
ESCORTED LEAVE
RET.FM.AUTH.LV.
TRANSFERRED TO
ESCORTED LEAVE
RET. FM. AUTH. LV.

W.C.C.WOI~EN

KITSAP
WCCW MINIMUM
KITSAP
WCCW MINIMUM
W.C.C.WOMEN
KITSAP
W.C.C.WOMEN

COUNSELOR
CAMPOS, MONIQUE

EARNED EARLY RELEASE DATE & TYPE
02/20/03--04/01/04 EARNED TIME.
EAP.NED TIlvIE

DOC
67.67
67.67
20.33

AA

20.33

EARNED TIME
PA
EARNED 1'IME

14.83
14.83
35.83
1. 95
5.00
40.50

AA

08/01/04--10/29/04
10/29/04--06/01/05

AA

06/01/05--07/01/05
07/01/05--03/01/06

ORIGIN
REASON FOR
WCCW MINIMUM
COURT ORDER
RETURN FR COURT SNOHOMISH
WCCW MINII'1UM
DISC. PROBLEM
W. C. C. WOMEN
MEDICAL NEEDS
MEDICAL COMPLTD PIERCE
W.C.C.WOMEN
MEDICAL NEEDS
MEDICAL COMPLTD KITSAP
ACPTD IN PREREL W.C.C.WOI~EN
ACPTD IN PREREL WCCW MINIMUM
WCCW MINIMUM
MEDICAL NEEDS
MEDICAL COMPLTD KITSAP
WCCW MINIMUM
MEDICAL NEEDS
MEDICAL COMPLTD KITSAP
INITIAL CLASSI. WCCW MINIMUM
W.C.C.WOMEN
MEDICAL NEEDS
MEDICAL COMPLTD PIERCE

DESTINATION
SNOHOMISH
WCCW MINIMUM
W.C.C.WOMEN
PIERCE
W. C . C . WOI~EN
KITSAP
W.C.C.WOMEN
TPR (CLOSED)

LOCATION

04/01/04--08/01/04

2

TIME 09:46

LEGAL FACE SHEET

IIS0100

DOC

PAGE

WASHINGTON DEPARTMENT OF CORRECTIONS

06/29/06

EARNED TIME
EAP.NED TIME

INFRACTION DATE & TYPE
06/02/04 724 REF. CELL ASSIGN

DID REFUSE A CELL ASSIGNMENT
07/28/04
509 REFUSE TO LEAVE

CELL
N

WORK ASSIGN.

ISRB
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

SUPERVISOR

STATUS LOCATION
PENDING WCCW
PENDING

WCCWMSC

PENDING

WCCW

PENDING

WCCW

PENDING
PENDING

WCCW
WCCW

DOC
0

ISRB
0

STATUS
APPLIED

SANCTIONS
MAX SECUR.
05
21 SUSPEND
10
30

LOCATION
WCCW

0

0

APPLIED

MAX SECUR.
10

WCCW

0

0

APPLIED

MAX SECUR.

WCCW

*

N

INMATE REFUSED DIRECTIVE TO CELL UP.
07/28/04 710 TATTOO/PARA.
N

*

0358

06/29/06

NO:_

WASHINGTON DEPARTMENT OF

STATUS: ACTIVE

NAME:

INFRACTION DATE & TYPE

CELL

DOC

INMATE WAS TATTOOED WHILE INCARCERATED.
0
N
08/01/04 717 REFUSAL/SAFETY

*

3

TIME 09:46

LEGAL FACE SHEET

I1S0100

DOC

PAGE

CORRECT10N~

ISRB

STATUS

0

APPLIED

SANCTIONS
05

LOCATION

SECUR.

WCCW

MAX SECUR.

WCCW

MAX

10
INMATE RESISTED ORDERS FOR ASSISTED MOVEMENT.
0
0 APPLIED
N
09/16/04 509 REFUSE TO LEAVE

*

J.O

*

INMATE REFUSED DIRECT ORDER TO RETURN TO HER CELL.
02/13/05 657 4 GENERl,L INFRA.
N
0
0 APPLIED

WKEND CONF WCCW
02
* WAS FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 10/28/04 AND 1/31/05
03/01/05 724 REF. CELL ASSIGN
N
0
0 APPLIED MAX SECUR. WCCW
10
* REFUSED TO MOVE INTO A CELL IN THE CLOSE CUSTODY UNIT AFTER BEING TOLD TO
* DO SO
03/07/05 563 TAMPER FIRE EQU.
N
o
o APPLIED MAX SECUR. WCCW
07
* DID ADMIT TO SETTING OFF THE FIRE ALARM IN HER CELL
06/15/05 657 4 GENERAL INFRA.
N
0
0 APPLIED WKEND CONF WCCW
02
* WAS FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 4/27/05 AND 6/10/05
06/30/05 657 4 GENERAL INFRA.
N
0
0 APPLIED WKEND CONF WCCW
02
* Im~TE FOUND GUILTY OF FOUR MINOR INFRACTIONS BETWEEN 4/7/05 ro~ 4/30/05.
08/27/05 505 FIGHTING
N
0
0 APPLIED MAX SECUR. WCCW
10
* WAS INVOLVED IN A PHYSICAL ALTERCATION WITH ro~OTHER INMATE
10/31/05 658 FAIL TO PERFORM
N
0
0 APPLIED 2I SUSPEND WCCW
03
30
* INMATE FOUND GUILTY OF FAILING TO COMPLY WITH SANCTION OF CELL CONFINEMENT.
11/04/05 506 THREATENING
N
0
0 APPLIED MAX SECUR. WCCW
10
* DID THREATEN ANOTHER INMATE IN THE KITCHEN
11/27/05 509 REFUSE TO LEAVE
N
0
0 APPLIED INVOK PREV WCCW
MAX SECUR.
* FAILED TO DISPERSE TO HER CELL WHEN TOLD TO DO SO BY STAFF
11/27/05 657 4 GENERAL INFRA.
N
0
0 APPLIED WKEND CONF WCCW
03
* FOUND GUILTY OF FOUR I~INOR INFRACTIONS BETWEEN 10/23/05 AND 11 /22/05
11/27/05 658 FAIL TO PERFORM
N
0
0 APPLIED INVOK PREV WCCW
MAX SECUR.
03

0359

06/29/06

( IlAAII)

NAME:

INFRACTION DATE & TYPE

CELL

• DID VIOLATE HER CELL CONFINEMENT
01/07/06 509 REFUSE TO LEAVE
N

DOC

o

4

TIME 09:46

LEGAL FACE SHEET

IISOlOO
DOCNO:_

PAGE

WASHINGTON DEPARTMENT OF CORRECTIOl%

ISRB

STATUS: ACTIVE
STATUS

o APPLIED

SANCTIONS
MAX SECOR.
lO

LOCATION

MAX SECUR.
20
21 SUSPEND
10
30

WCCW

*

REFUSED TO RETURN TO HER CELL WHEN TOLD TO DO SO
03/l2/06 657 4 GEl,ERAL INFRA.
N
0
0 APPLIED

WKEND CONF WCCW
04
* FOUND GUILTY OF FOOR MINOR INFRACTIONS BETWEEN l2/lS/0S AND 3/1/06
04/l4/06 558 STAFF INTERFER.
N
0
0 APPLIED MAX SECUR. WCCW
05
* DID INTERFERE WITH STAFF DUTIES DURING COUNT
WCCW
04/14/06 658 FAIL TO PERFORM
N
0
0 APPLIED MAX SECOR.
05
* DID VIOLATE HER "DISRUPTIVE BEHAVIOR" CONTRACT
04/lS/06 509 REFUSE TO LEAVE
N
0
0 APPLIED MAX SECOR.
WCCW
30
* FAILED TO DISPERSE WHEN TOLD TO DO SO BY STAFF
OS/2l/06 610 POS MED > 1 DOSE
N
0
o APPLIED MAX SECOR. WCCW
* DID Sl'.VE MEDICATION ISSUED AT PILLLINE SO SHE COULD PASS IT TO ANOTHER
* OFFENDER
OS/21/06 716 DRUG/ALCOHOL USE
N
o
o APPLIED MAX SECOR. WCCW
15
DID
ATTEMPT
TO
PASS
HER
MEDS
TO
N,OTHER
Im~TE IN THE SEGREGATION UNIT
*
CUSTODY DATE SCORE TYPE
ASSIGNED
CUSTODY OVERRIDE
02/24/2003
41
INITIAL 03/14/2003 MINIMUM MENTAL H
67
PLN< RVW 05/01/2003 MINIMUM
04/16/2003
ICC-PROMOTE TO MI2/MSC. TARGET MIP/TPR ON 071904.

LOCATION
W.C.C.WOMEN
W.C.C.WOMEN

04/20/2004
67
PLN< RVW 04/22/2004 I~INIMUM
WCCW MINIMUl~
F RMT MET FOR REVIEW. P WAIVED HER APPEARANCE. RECOMMENDATIONS: PROMOTE TO MIP
CUSTODY, MAINTAIN PRE-RELEASE REFERP~ AND PROG~ AS DIRECTED BY THE FRMT.
08/10/2004
00
PLAN RVW 08/24/2004 MEDIUM
W. C. C. WOMEN
I CC ACTION: DEI~OTE TO MEDIUM CUSTODY N'!IJ ASSIGN APPROPRIATE HOUSING AND PROGRA
M MING. CANCEL TARGET FOR 709.
03/07/2005
52
REVIEW
03/07/2005 MEDIUM
W.C.C.WOMEN
F RMT. CUS BROWN, CC3 CAMPOS N'!IJ CC2 NEWSOM MEMBERS. P PRESENT. MAINTAIN MED CU

06/29/06

WASHINGTON DEPARTMENT OF

IISOI00

DOC

NO,.-

PAGE

CORRECTION~

5

LEGAL FACE SHEET
STATUS, ACTIVE

NAME,

ASSIGNED
CUSTODY OVERRIDE
LOCATION
CUSTODY DATE SCORE TYPE
S TODY AND TRANSFER TO MEDIUM CUSTODY UNIT WHEN BEDS ARE AVAILABLE. MAINTAIN CU
R RENT PROGRAMMING.
07/19/2005
52
PLAN RVW 07/27/2005
I CC ACTION: CONCUR WITH FRMT.

MEDIUM

W.C.C.WOMEN

01/27/2006
00
REVIEW
02/13/2006 CLOSE
W. C. c. WOMEN
F RMT CHAIRED BY CUS BROWN. CC3 NEWSOM AND CC2 BUCKNER MEMBERS. P WAIVED PRESEN
C E. 'R' REVIEW FOR CUSTODY DEMOTION. DEMOTE TO CLOSE CUSTODY AND HOUSE IN CLOS
E CUSTODY UNIT. ANY CHANGE IN CUSTODY POINTS WILL BE ADDRESSED THROUGH A CUSTO
D Y PROMOTION/DEMOTION AND/OR C}UU<GE IN LIVING UNIT.
03/22/2006
39
REVIEW
03/22/2006 CLOSE
W.C.C.WOMEN
F RMT CHAIRED BY CUS BROWN. CC3 NEWSOM AND CC2 SHERIDAN MEMBERS. P PRESENT. 'R'
REVIEW TO ~.INTAIN CLOSE CUSTODY DUE TO INFRACTION BEHAVIOR. MAINTAIN CLOSE C
U STODY AND HOUSING. ANY CHANGE IN CUSTODY POINTS WILL BE ADDRESSED BY A CUSTOD
Y PROMOTION OR DEMOTION AND/OR CHANGE IN LIVING UNIT.

II8UI012 NO WARRANTS OR DETAINERS FOUND
II8UI016 NO RPM DATA FOUND
II8UI016 NO RPM DATA FOUND

0361

Photo Display

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DOCNu
Name:
Date of Photo: 9/16/2005 8:07:37 AM
Source of Photo: TAS

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0362

PAGE

WASHINGTON DEPARTMENT OF CORRECTIONS

06/29/06

TIME 09:46

LEGAL FACE SHEET

IIS0100

STATUS: ACTIVE

DOCNO:_

NAME:

BED NO: F01SB135

COUNSELOR: 1131 CAMPOS, MONIQUE

(IIADI!)

CURRENT LOCATION: W.C.C.WOMEN
FBI NO:
SEX: F
AGE: 23
RACE : WHITE
SID NO:
HISP ORIG: m,K
HEALTH RECORD REVIEW : 1'101' REQUIRED
NAMES:

( "AE")

1

MXED: 05/05/2010
MNED:
ERD : 11/24/2007
ADJ.: 11/24/2007
NRD : 08/23/2006
SCORE: 00
CUS.: CLO
MFED: 04/14/2005
COMM. CONCERN: 1'1
RMI: RMD
VICTIM WRAP AROUND:
1'1
VW ELIGIBLE:NO COMM.PLACEMENT: NO

(lIAFII)
(lIAGI1 )

( "AH")

P. PREL: DENY INST INFRACTION
P. MFED: DENY INST INFRAC
P U L H E S D X l'
DATE
2 3 112 3 3 2 1 04/26/2005

LSI-R:~LEVEL:
LOW/MOD
SSA NO: _ _ IRTH:"1982

P. WTR: N/A
P. REL: NO ACTION TAKEN
REGISTEPJffiLE OFFENDER : 1'1

GTL TIME START RECEIVED OC MIN.TERM CC CS
COM.
COUN'fY
5Y 8M OD
#AD#N SKAGIT
50
04/14/2005 04/14/05 78
V OC CNTS
MIN. TERM CC CS
CMP. CO./CAUSE OFFENSE DESC.
POSSESS STOLEN FIR 1'1 78 5C
5Y 8M OD

REL. DATE STATUS
11/24/2007 AC
MANDATORY JAIL
OY OM OD
300

TOTAL MONETARY OBLIGATION: ORDERED $****610.00 ;AS OF 05/31/06 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
STAT MAX:
09/04/2014
*******************************************************************************

#AE#N SKAGIT

50

04/14/2005 04/14/05 79
V OC CNTS
~ F E N S E DESC.
1'1 79 1C
~HEFT2

1Y10M OD AD
MIN.TERM CC CS
1Y10M OD

02/08/2006 EX
MANDF_TORY JAIL
OY OM OD
149

TOTAL MONETARY OBLIGATION: ORDERED $****610.00 ;AS OF 06/29/06 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
STAT MAX:
12/22/2009
*******************************************************************************

#AF#N SKAGIT
50 04/14/2005 04/14/05 79
CMP. CO. / CAUSE OFFENSE DESC.
V OC CNTS
IDENTITY THEFT
1'1 79
4C

3Y 7M OD AE
MIN. TERM CC CS
3Y 7M OD

01/27/2007 AC
MANDATORY JAIL
OY OM OD
141

TOTJ,L MONETARY OBLIGATION: ORDERED $***<610.00 ;AS OF 06/29/06 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
STAT MAX: 12/28/2009
*******************************************************************************

#AG#N KI~G
50 04/14/2005 04/14/05 81
CMP. CO./CAUSE OFFENSE DESC.
V OC CNTS

2Y OM OD 1'.F
MIN.TERM CC CS

03/15/2006 EX
MANDATORY JAIL

0363

PAGE

WASHINGTON DEPARTMENT OF CORRECTIONS

06/29/06

LEGAL FACE SHEET

IISOI00
DOC NO: _

NAME:

TIME 09:46
STATUS: ACTIVE

(IIAD")

v OC CNTS

CMP. CO./CAUSE OFFENSE DESC.
DRUG POSSESSION

N 81

MIN.TERM CC CS
2Y OM OD

1C

2

MANDATORY JAIL
OY OM OD
139

TOTAL MONETARY OBLIGATION: ORDERED $****500.00 ;AS OF 06/02/06 PAID $******0.00
SCHEDULE:
a
SET BY:
SPECIAL CONDITIONS: YES
01/10/2010
STAT MAX:
*******************************************************************************

GTL TIME START RECEIVED OC MIN.TERM CC CS
COM.
COUNTY
#AHI(N KING
5004/14/2005 04/14/05 76
4Y 2M OD AG
V OC CNTS MIN.TERM CC CS
CMP. GO. / CAUSE OFFENSE DESC.
IDENTITY THEFT
N 79 1C
4Y 2M OD
FORGERY
N 76 2C
2Y 5M OD 0
POSS STOLl' PROPERT N 78 lC
2Y 5M OD 0

REL. DATE STATUS
06/08/2007 AC
I"lANDA:rORY JAIL
OY OM OD
90
OY OM OD
90
OY OM OD
90

TOTAL MONETARY OBLIGATION: ORDERED $***2563.78 ;AS OF 06/29/06 PAID $******0.00
SCHEDULE:
o
SET BY:
SPECIAL CONDITIONS: YES
STAT MAX:
02/12/2010
*******************************************************************************

MOVEMENT
04/14/05
05/17/05
06/14/05
09/20/05
05/02/06
05/02/06

DATE & TYPE
NEW COMMITMENT
TRANSFERRED TO
TRANSFERRED 1'0
TRANSFERRED TO
ESCORTED LEAVE
RET.FM.AUTH.LV.

HOUSING DATE & LOCATION
06/27/06
DATE
01/19/06
03/22/06
03/22/06
04/19/06

DESTINATION
W.C.C.WOMEN
WCCW MINIMUM
PINE LODGE CC
W.C.C.WOMEN
PIERCE
W.C.C.WOMEN

COUNSELOR
CAMPOS, MONIQUE

PROG~~-POSITION

V750C204
V900E106
V900FllO
J326DI03

COSMETOLOGY (
YOVTP VOCATIO
YOVTP VOCATIO
CUSTODIAN I

--WEEK-1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4

RARNED EARLY RELEASE DATE & TYPE
04/14/05--06/01/05 EARNED TIME
AD
AE

AF
AG
AH

REASON FOR
INITIAL CLASSI.
INITIAL CLASSI.
REDIRECTED
POOR ADJUSTMENT
MEDICAL NEEDS
MEDICAL COMPLTD

DOC
8.00
B.OO
8.00
B.OO
B.OO
8.00

ORIGIN
KING
W.C.C.WOMEN
WCCW MINIMUM
PINE LODGE CC
W.C.C.WOMEN
PIERCE

WORK ASSIGN.

- -- -- -DAY -----MTWTHF
M T W TH
W
M
SU M T W TH
ISRB
0.00
0.00
0.00
0.00
0.00
0.00

SUPERVISOR

- --TIME---- STATUS
ASG
14:00-20:20
RSH
~3: 00-13: 50
~4:00-14:50
RSH
TER
08:00-14:00

STATUS LOCATION
PENDING WCCW

0364

06/29/06

NAME,
DOC
45.50
45.50
45.50
45.50
45.50
45.50

AD
AE

AF
AG
AH

INFRACTION DATE & TYPE
OS/17/05 603 POSS. CONT. SUB.

STATUS, ACTIVE

(ITADII)

EARNED EARLY RELEASE DATE & TYPE
06/01/05--03/01/06 EARNED TIME

CELL
N

DOC
15

ISRE
0.00
0.00
0.00
0.00
0.00
0.00
ISRB
15

3

TIME 09,46

LEGAL FACE SHEET

IIS0100
DOC NO, _

PAGE

WASHINGTON DEPARTMENT OF CORRECTIONS

STATUS LOCATION
PENDING WCCWMSC

STATUS
APPLIED

SANCTIONS
DENY GCT
2L SUSPEND
05
CUST ./PGM

LOCATION
PLCCW

*

ADMITTED POSSESSING DRUGS NOT PRESCRIBED TO HER.
09/10/05 555 THEFT
N
0
0 APPLIED WP.ITEN ORD PLCCW
* FOUND IN POSSESSION OF MAGAZINES STOLEN FROM ISC LIBRARY.
09/10/05 610 POS MED > 1 DOSE
N
20
20 APPLIED DENY GCT
PLCCW
* WAS NOT TAKING PRESCRIBED MEDS AS ORDERED.
09(10/05 72B OBSCENE ~~TERIAL
N
5
5 APPLIED DENY GCT
PLCCW
PREV.SUSP.
* FOUND IN POSSESSION OF SEXUALLY EXPLICIT MATERIALS.
12/27/05 710 TATTOO/PARA.
N
0
0 APPLIED MAX SECUR. WCCW
06
21 SUSPEND
04
30
* RECEIVED NEW TATTOO RIGHT UPPER 1'.RM "LIFE"
WCCW
05/14/06 606 POS.TOBACCO PROD
N
30
30 APPLIED DENY GCT
MAX SECUR.
30
* DID HAVE HER GRANDMOTHER BRING TOBACCO INTO THE INSTITUTION DURING A
* FFAMILY FRIENDLY EVEN
HOLDS: DATE
01/19/06
03/22/06
06/06/06

REASON FOR HOLD
TRANSFER
YOP - YOUTHFUL OFFENDER PROG
Y
VED - VOC - ED
Y
MED - MEDICAL HOLD
Y

LOC
F01
POl
F01

STAFF
GB96
GB96
HBS9

UNTIL
OB/15/0B
03/22/0B
09/06/06

CUSTODY DATE SCORE TYPE
ASSIGNED
CUSTODY OVERRIDE
LOCATION
04/19/2005
51
INITIAL 05/03(2005 MINIMUM
W.C.C.WOMEN
OB/23/2005
47
PLAN RVI'l 09/19/2005 MEDIUM
PINE LODGE CC
03/06/2006
00
PLC ELIG 03/06(2006 CLOSE
W.C.C.WOMEN
F RMT CHAIRED BY CUS BROWN. CC3 NEWSOM AND CC2 SHERIDAN MEMBERS. 'X' REVIEW FOR
CUSTODY DEMOTION. DEMOTE TO CLOSE CUSTODY AND HOUSE IN CLOSE CUSTODY UNIT DUE

0365

~6/29/06

NO:_

WASHINGTON DEPARTMENT OF CORRECTIONS

1IS0100

DOC

PAGE

4

LEGAL FACE SHEET
NAME:

STATUS: ACTIVE

ASSIGNED
CUSTODY DATE SCORE TYPE
CUSTODY OVERRIDE
LOCA'I'ION
TO INFRACTION BEHAVIOR. ANY CrlANGE IN CUSTODY POINTS WILL BE ADDRESSED BY A C
U S'I'ODY DEMOTION OR PROMO'l'ION AND/OR A CHANGE IN LIVING UNIT.

IISUIOl2 NO WARRANTS OR DETAINERS FOUND

0366

~~\",,'10l"r.C'

lrttrit:\
E..I..JE"
~IACE

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

INCIDENT REPORT

I AREA OCCURRED

E T
DATE /TIME OF INCIDENT

- () b

;;I. ;;.

USE OF FORCE INCIDENT

YES

@

WITNESSES

C c

DETAILS: Who was involved, what took place, how did it happen, description of any injuries, damage, use of force, etc. Atlach
additional sheet, if necessary.

c/o

ljIa$EK2 CAI.d.£P ME O..:l THE

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Pa.nergTy Room

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SElIt', jAJlTfj ~ JI

.MMEDIATE ACTION TAKEN:

NoTIFieD »aei: SeA/.

4.511--5D,;)

DATE

TITLE

INCIDENT NUMBER

DATE /TIME RECEIVED

INVESTIGATION ASSIGNED TO

BY

Distribution by Associate Superintendent:
Superintendent
Intelligence Officer
Shift Commander
Clinical Director
Safety Officer
Other

DATE

Other
Other
Other

The contents of this document may be eligible for public disclosure, Social Security Numbers are considered confidential information and
Nill be redacted in the event of such a request. This form is governed by Executive Order 00-03, REW 42.17, and RCW 40.14.

0367
DOC 21-"158 (O2l19/03) WCCW

~

c:/

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

INCIDENT REPORT

AREA OCCURRED

(1.-1

DATE I TIME OF INC/~NT

;; -z: -0 (

02.:1 'f i/

USE OF FORCE INCIDENT

YES

@)

WITNESSES

DETAilS: Who was involved, what took place, how did it happen, description of any injuries, damage, use of force, etc. Attach
additional sheet, if necessary.

-rr:
~ uo/4.S'

/../[,+1

,

1'-I'.Ly

Cr • »>
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n1-<.+

(.:J""r(17ITZ

I

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ifl/l

I

TITLE

DATE

~~ 1

d0/T

DATE /TIME RECEIVED

IINESTIGATION ASSIGNED TO

INCIDENT NUMBER

BY

Distribution by Associate Superintendent:
Superintendent
Intelligence Officer
Shift Commander
Clinical Director
Safety Officer
Other

DATE

Other
Other
Other

The contents of this document may be eligible for public disclosure. Social SecurIty Numbers are considered confidential informatIon and

will b. redacted In the event of ouch a request. This fonn 15 governed by Executlv~r~~r0~,~.3~R~: 4~.17~and RCW 40.14.

DOC 21-458 (02/19/03) WCCW

t . ,~: ,.,,:J.~&::7!:

I v, -

0) 68

i- ---

STATE OF WASHINGTON
OEPARTMENT OF CORRECTIONS

INCIDENT REPORT

o Confidential
DATEfTlME OF INCIDENT

CCU

OFFENDERS
INVOLVED

06/26/06 2325

LOCATION/
WCCW Clinic/Transport to Harrison

C/O Tanner & C/O Cozzolino

USE OF FORCE INCIDENT? 0 YES x NO
DETAILS: Who was involved, what took place, how did it happen, description of any injuries, damage, use

of 'force, etc. Attach additional sheet, if necessary.
On 6/26/06 at 23251 was notified by Sgt. Wilson to assist C/O Tanner with a transport strip in the clinic.
After strip search was
A strip search was completed on.lnrnate
completed, I assumed transport duties with C/O Cozzolino. Cozzo mo and I departed WCCW at 2350
hours with inmat~rr:=tHarrison Memorial Hospital in Bremerton at 0024 hours. Upon
arriving at hospita~at~comPleted intake paper work. Social worker talked wit~and
informed her RN Shea Brimas would be in to talk with her and would be also condu~er
ex.amination. RN Shea Brinias in at 0220 hours and completed examine with inmat~at 0310
hours. C/O Cozzolino and I departed Harrison Memorial Hospital with inmate_at an arrival at
.
WCCW at 0415 hours.

IMMEDIATE ACTION TAKEN:
Assisted with strip search on Inmate.ook inmate to hospital; completed incident report+

STAFF SIGNATURE

TITLE

DATEITIME RECEIVED

I"ICIDENT blUMBER

INVESTIGATIOI, ASSIGNED TO

DATE

BY

..

The contents of tnis document may be efJglble for publiC diectozure. SOCial Security Numbers are coneiaered confidential tntormetion and will be
redacted in the event of such a request. This form Is governed by Executive Order 00-03, RCW 42.17, and RCW 40.14.

/1.
0369
Distribution:

WHITE - Chief Investigator

DOC 21-917 109/10/04\

CANARY - Executive Team Member

PINK - Originator

GOLDENROD - Immediate Supervisor

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

INCIDENT REPORT

o Confidential

-

DATEfTlME OF INCIDENT

DOC NUMBER

06-26-06/2350 06-27-06/0415
LOCATION

WlmEsSES

Transport

CIO V. Garner

USE OF FORCE II~CIDEI~T?

0

YES

LIVING UNIT

CCU East 307

IZl NO

DETAILS: Who was involved, what took place, howdid it happen, description of any injuries, damage, use afforce, etc. Attach
additional sheet, if necessary.
On June 26, 2006 at 2350 I was assigned as the transport officer with Officer Garner to escort O f f e n d e r - . - r
to the Harrison Hospital in Bremerton. At 2350 we departed~titution, at 0024 we arrived at the Ha~
Bremerton. After.ing the intake paperwork, Offende~et with a social worker. At 0220 RN Shea Brinia
examined Offend
the exam was competed at 0310. We departed Harrison Hospital Bremerton at 0340 and
arrived at the institution at 0415.

IMMEDIATE ACTION

TAKEI~:

Wrote an Incident Report

06-27-06

C/02
STAFF SIGNATURE (Please Prinl)

TITLE

DATE

DATEfTlME RECEIVED

INVESTIGATIOl' ASSIGI'ED TO

INCIDENT NUMBER

BY

DATE

The contents of th,s document may be ell.glbfe for public dIsclosure. SoCIal Security Numbers are conSidered confidential mformatlon and will be

ecacteo in the event of such a request. This form is governed by Executive Order 00-03, R~!:~~~~!?,. ~~.~;~~T40';,12J

A

Distribution:

WHITE· Chief Investigator

CANARY· Executive Tearn Member

I' ,_. ll,,;.JI!JI

Pll\lf( - Originator

"(

f)

37 n

r!~

GOLDENROD - Immediate Supervisor

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

INCIDENT REPORT

o Confidential

DATE(fIME OF IhICIDEI"T

LIVING UNIT

06-27-06 I Approx 0500
LOCATION

WlmESSES

Sgt. D.M. Wilson
USE OF FORCE INCIDENT?

0

YES

I2'J NO

DETAILS: Who was involved, what look place, how did it happen, description of any injuries, damage, use of force, etc. Atlach
additional sheet, if necessary.
On 06-27-06 at approximately 0500 Hours Sgt. Wilsonand I escorted 11M
rom the Clinic to CCU cell
207 to retrieve lhe clothing that I/~ales that she was wearing during a sexual assault. I/~ISO gave me a
towel and a Q-tip that she states was usee 10 wipe her genitals.

,vlMEDIATE ACTION TAKEN:
I bagged the evidence and completed necessary paperwork.
I escorted

I/~m

CCU to the Clinic, room H-139.

06-27-06
DATE

C/O
STAFF SIGNATURE (Please Print)

TITLE

DATE(fIME RECEIVED

II"CIDE'"T NUMBER

INVESTIGATION ASSIGNED TO

BY

DATE

The contents of this document may be elIgible for publIC ellse/asure. Social Security Numbers are constdereo confident/a/Information and will be
redacted in the event of such a request. This form is governed by Executive Order 00-03, RCW 42.17, and RCW 40.14.

0371

u:':

. I

Distribution:

WHITE

~

Chief Investigator

CANARY· Executive Team Member

, .. ".-,-~.

._": ;'. ~:-, '

PINK - Onqinator

;

/"'_7

GOLDENROD - Immediate Supervisor

,,""""'-/· e

,'\
i
l'DBC'

~

STArE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

SEARCH REPORT
DATE

TIME

O~-;:;'7-0u,

12.0

OS-DO

REASON FOR SEARCH:

(Please Print)

OFFENDER NAME

DOC
NUMBER

DESCRIPTION OF ITEM (INCLUDE
QUANTITY, TYPE, SERIAL NUMBER,
CONDITION)

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DESCRIPTION OF CONFISCATED PROPERTY

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SIGNATURE OF SEARCH STAFF MEMBERS

.: -Iff{(didJ,J
The contents of this document may be eligible for public disclosure,

Social Security Numbers are considered confidential information and will be redacted in the event of such a request.
This form is governed by Executive Order 00-03, RCW 42.17, and RCW40.14.

Distribution: WHtTE-Evidence Copy

CANARY-CUS/Shift Supervisor

GOLDENROD-Offender

PINK Captain

DOC 05-384 (Rev 11/25/2002) POL
I .----.

.J'~

t'

0372

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

INCIDENT REPORT

ACE / AREA OCCURRED

J~I 7.)(;7 (~ £ '"

OFFENDERS INVOLVED

DOC NUMBER

/ ScJ.m"i ,

LIVING UNIT

DATE /TIME OF INCIDENT

06 -

:z

r::

rr - CJ

0800

USE OF FORCE INCIDENT

YES

NO

WITNESSES

DETAiLS; Who was involved, what look place, how did It happen, description of any injuries, damage, use of force, etc. Attach
additional. sheet, if necessary .

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IMMEDIATE ACTION TAKEN;

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REPORTING STAFF SIGNATURE

DATE

TITLE

6

-S, Lu« leFT!
DATE /TIME RECEIVED

INVESTIGATION ASSIGNED TO

DOC 21-458 (02119/03) wccw

.:>. 7- o£

INCiDENT NUMBER

BY

DATE

Harrison Hospital
Sexual Assault Nurse Examiner (SANE)
Authorization Form

I fUlly understand that the above requested forensic examination and information may be used by Law Enforcement
Officials. In the event of an investigation of a crime, I hereby consent to the release of sexual assault information to Law
Enforcement Officials and release of the Forensic chart and evidence to the Prosecuting Attorney's Office.

I hereby authorize the SAI~E Program to request all past medical records
that may be needed related to this present examination of abuse I assault.

1IIIIi 1111111111 ~I~ IIIIIII~ 1111111111111111111 MIIII

The SANE Program has permission to Lise the photography for
quality assurance and teaching purposes. Patient confidentiality will be
maintained by the SAI~ E program for all patient data.

SEX,

06178-00003
JVlR#:

Patient Signature: (Age 14+, patient must sign form)

Lock Number

o Scheduled
Arrived Via:

State

o Consult

~olice

fvr~

0 Ambulapfe
0 CarlPOV
C.oIV~G<A-,I,J, D \-hc...Q..("S

o Walked

City

o Follow-Up

0 Friend

0 Advocate

Time of Assault:

Zip

Phone # (With Area Code):

o Native
American
SANE Discharge Time:

Examiner's Signature:

o

I

o Asian

o Hispanic

o

SANE exam explained

Rape Kit Complete?
es 0 No 0 Patient Declined
Checklist of Forensic Ev'tlence? 0 Yes 0 No

es
0
Copy of Report sent with Rape Kit?
0 Pt Deciined
Cloliling Sent? 0 Yes ( _ # Bags) o N/A
o Blood 0 Pt Declined
Olher Sent
0 UA
o Non Genital Photos o Other

~~

Date Sent

For Medical Records Use Only:
Prosecutor:

0 Kitsap

o Mason

o Jefferson

0 Other

Law Enforcement Case #:

Officer's Name.

SANE introduced to palient

0 African American

0 Pierce

initials

o King

o Clallam

Law Enforcement Agency:

,I Other:
Harrison Hospital, Bremerton WA
Sexual Assaulll Abuse Forensic Exam

0374

Rev. 1/2006

Page 1 of 12

•. G.

,

I

OFFENDER LD 01-.1f.

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

82

AUTHORIZATION FOR DISCLOSURE
OF HEALTH INFORMATION
I.

____ , hereby authorize the use or disclosure 01 my health iniorrnauon
The iollowlng individual or orqanization
I,AIvIE:
ADDRESS:

IS

authonzec to make the disclosure:

_~jATrl'C;M) l-!-o<;(J,,4, I
~~~~~~

------

..~~~.. ~~~--~~~~-

~J

T[18 t pe and date(s) of Information to be used or disclosed Is as follows:

<v.

/'. .

d Ii

)11.f'(!r (C(

(

1::'(7 Ct

I

cll-l···/..

" ,/V'

,I

~

Purpose for disclosure:
I understand that the information in my health record may include information relating to sexually transmitted
infections, Acquired Immunodeficiency Syndrome (AIDS), or Human Immunodeficiency Virus (HIV). 1\ may also
Include information about behavioral or mental health services and treatment for alcohol and drug abuse.
This information may be disclosed to and used by the following individual 0
NAivE:

ADDRESS:

Washington Correction Center for Women

9601 Bujacich Rd NW
Gig Harbor, WA 96332
Fax # 253..658..4258

I understand that I have a right to revoke this authorization at any time. I understand that If I revoke this
authorization I must do so in writing and present my written revocation to the Health Information Management
Department. I understand that the revocation will not apply to information that has already been released in
response to this authorization. Unless otherwise revoked, this authorization will expire on the following date, event,
or condition:
(if left blank, authorization will expire six (6) months from signing).
I understand that authorizing the disclosure of this health Information is voluntary. I can refuse to sign this
authorization. I need not sign this form in order to assure treatment. I understand that I may inspect or copy the
intorrnation to be used or disclosed, as provided in CFR 164.524 and RCW 70.02. 1 understand that any disclosure
of intorrnau on carries with it the potential for an unauthorized redisclosure and may not be protected by federal or
state confidentiality rules. If I have questions about disclosure ot my health information, I may coni act the
RHITldesignee ot the Jacility: J

/ . I (;
vl2'7

'

(p

I-.rrDale

~=-

DOC Number

L~GA!..

OTS0310

WASHINGTG.. DEPARTMENT OF CORRECTIONS
INCIDENT REPORT

NO:11899 TYPE,ALLEGED RAPE
OCCURRED ON, 06/26/06 AT 07,30PM
LOCATION, W.C.C.WOMEN
PLACE, DOP-INSTITUTION
OFFENDERS INVOLVED

..TE' 06/27/06
TIME: 00,34.15

STAFF REPORTING,LT G.G.BURTON
REPORTED ON, 06/27/06 AT 12,16AM
CONFIDENTIAL: NO
WCCW CCD CLOSE CUSTODY UNIT
INJ HOS
N

N

STAFF INVOLVED
C/O COZZOLINO
C/O GARNER

INJ HOS
N

N

N

N

DESCRIPTION,
AT APPRO~ SHIFT SGT WAS NOTIFIED BY CCD STAFF THAT
OFFENDER"""""""', STATED THAT SHE HAD BEEN SEXUALLY ASSUALTED
BY A STAFF MENBER, ON SHIFT 3. DUTY OFFICER STEWART WAS NOTIFIED, AND
SHE WANTED THE OFFENDER TAKEN TO THE HOSPITAL FOR EXAMINATION. A STATE
CAR WAS READIED, AND C/O COZZOLINO, AND C/O GARNER , ESCORTED THE
OFFENDER TO HARRISON HOSPITAL BRE~~RTON, FOR THE EY~. THIS WAS A
UNSCHEDULED OUTING.
PROPERTY DAMAGE, NO
APPROXIMATE COST: $
o
OTHER AGENCIES CONTACTED: DATE, 06/26/06
TIME: 11: 45PM
LOCAL LAW ENFORCEMENT
HOSP NAME: HARRISON HOSP BREMME FOLLOWUP RPT: NO AGAINST, INMATE
------------.----------.- OFFENDERS INVOLVED -.---.------------------NAMES
DOC NO: _
CLASS, CLOSE
LAST KNOWN ADDR:
MARYSVILLE
WA
DOB: liliiii1982 SEX, F RACE, WHITE
HISP.ORIG, N REL.DATE: 08/18/2007
MSC, OTHER FELONY
COUNTY, SNOHOMISH
RECEIVED WCCW : 04/14/05
TRANSFER TO PRESENT FACILITY, 09/29/05
VIC/WIT ELIGIBLE, NO
FBI NO, _
SSA NO,
SID NO:

/D

Offender Sexual Assault Response and Containment Checklist
Sexual Assault Preservation
Location:
Washinoton Corrections Center for Women
Incident Commander:
Lt Gilbert Burton

Date:
06-27-06
Time:
2230 P.M.

Required Actions'
Time

Initial

N/A

1. Notify Intelligence and Investigations Office of
allegations.
0510

GGB.

0600
2245

GGB
GGB

0415

GGB

0415

GGB

2. Notify local Law Enforcement agency that an alleged
sexual assault has occurred.
3. Secure location(s) where it is believed that the sexual
assault occurred:
• Post an individual at the scene(s) if the area
cannot be completely sealed and secured.
4. Collect ALL clothing that the complainant and alleged
victim are wearing.
• Use trace evidence collection sheet. Require
each offender involved to stand on sheet while
? removing clothing.
• Place each piece of clothing in a separate brown
paper bag (no plastic bags).
• Document offender's name, date, time, total
number of bags and item enclosed.
• Place bags in a secure location.
• Ensure chain-of-evidence is maintained on
evidence card.
5. Take digital picturesivideo of injuries to victim and
suspect offenders immediately to record discolor and
severity.

6. Transport offenders separately to Infirmary for a
preliminary medical examination.

D
/

5
0377

Rev 5/06

DOC 490.800 Attachment 2

Offender Sexual Assault Response and Containment Checklist

7. If 96 hours or less, transport offender to the local
hospital for evidence collection and possible medical
examination.

Time
2350

Initial
GGB

0520

GGB

N/A

If more than 96 hours, if Law Enforcement requests
evidence collection, complainant will be transported
to the local hospital.
• Hospital staff make final determination if Rape Kit
will be. completed or not.

8. Ask Law Enforcement if the suspect should be
transported to local hospital for evidence collection
(e.g., penis swab, fingernail check, etc.).
9. Place alleged suspect in Segregation/IMU pending an
investigation.
10. Notify Mental Health staff so complainant has support
available.
11. Ensure the following are correctly completed and
secured in evidence lockers:
• Administrative Segregation paperwork,
• Tele-incident reports,
• Incident reports,
• Staff memos,
• Videotapes of crime scene,
• Pictures of crime scene and injuries, and
• Additional evidence.
Notes'

'cr\
J

.s

.
U ~ 78
Rev 5106

2

DOC 490.800 Attachment 2

Sexual Assault Investigation Protocols Checklist
Location:
Washinqton Corrections Center for Women
Incident Commander:
Lt. Gilbert Burton

Date:
06-27-06
Time:
2230 P.M.

Required Actions:

Facilitv

Time Initial
a. Assign an Investigator(s)
NOTE: Any staff who investigate offender on
offender sexual assault or related incident will be
required to have successfully completed
Washington State Department of Personnel Core
lnvestlcator Traininq/Executive Order 98-02.
b. Process Crime Scene
0415
GGB
• Gather Evidence from Crime Scene
• Pictures
0515
GGB
• Video
• Stills
• Unit Security Tapes
• Physical Evidence
• Logbooks
• Clothing (place in paper bag)
• Paperwork (Offender
Correspondence, Kites, etc.)
• Weapons
• Beddinq (place in paper bac)
c. Identify Witnesses (staff and offender)
2240
GGB
d. Interview Alleqed Offender Victim(s)
e. Interview Offender Witness( es)
f. Obtain Staff Incident Reports
GGB
2240
g. Interview Involved Staff as Needed
• Custody Staff
• Transportation Staff
• Medical Staff
• Other Identified Staff
h. Interview Alleqed Suspect(s) Offender
i. Re-interview Witnesses and Offender Victim(s) as
needed,
j. Place offender suspect(s) and offender victim(s)
on the facility mailroom monitoring list.
• Hotmail

N/A

0379
Rev. 5/06

1

DOC 490.800 Attachment 3

Sexual Assault Investigation Protocols Checklist
k. Reporting
• Document the investigative process using the
report format.
• Superintendent approves report and forwards
to HQ Special Investigative Unit.
• Assigned Investigator forwards report and
supporting evidence/documentation to Law
Enforcement once report has been approved
by the Prisons Deputy Secretary/designee.

2310

GGB

Headquarters
a. Reporting
• The HQ Special Investigative Unit assigns an
HQ case number to the investigative report
and forwards the packet to Prisons Deputy
Secretarv/desiqnee.
Notes'
2240: Notified of incident.
2245: Notified Duty Officer, directed to send Offender out to Harrison Hospital for
evaiuation.
2350: Offender departed Institution
0415: Offender returned from Harrison Hospital and placed in Clinic per directive
from Superintendent.
0415: Offender escorted to cell to obtain evidence ie clothinq and cue tip swab .

.

Ii

Rev. 5/06

2

DOC 490.800 Attachment 3

Sexual Assault Investigation Protocols Checklist

~/n r 0 u
0381
Rev. 5/06

3

DOC 490.800 Attachment 3

STATE OF WASHINGTON
DEPARTMENT OF CORRECTIONS

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