(Governor's Name)
Governor / JUSTICE AND PUBLIC SAFETY CABINET
Department of Juvenile Justice
(FACILITY NAME)
(FACILITY ADDRESS LINE 1)
(FACILITY ADDRESS LINE 2)
(FACILITY CITY STATE ZIP)
(FACILITY PHONE NUMBER)
(FACILITY FAX)
www.kentucky.gov / (Secretary's Name)
Secretary
(Commissioner's Name)
Commissioner
CODE #
To: (Worker Name) (County)
From: (Compact Administrator Name)
(Compact Administrator Title)
Date: (Date)
Subject: Juvenile Sexual Offender Tracking System – Part II
RE: (Juvenile Name)
(Race) / (Gender) / DOB: (Date of Birth)
DJJ #: (DJJ Number) County #: (County Number)
The above named juvenile has been entered into the Juvenile Sexual Offender Tracking System. Effective July 16, 1994, it was mandated that a system be implemented to provide basic demographic and tracking information regarding sexual offenders. Please complete the attached form and return it to my office within ten (10) days.
The basic instructions for this form include:
1. Pre-printed Heading Information: Please make any necessary corrections.
2. Post-Disposition Placement Data: Include each placement by “type” (e.g. parent, emergency shelter, facility, etc.) after the juvenile was committed as a juvenile sexual offender and the date placed.
3. Prior Legal History: In items 1-4, include only those situations where the juvenile was formally probated or committed for status or public offenses. Item 5 should reflect any and all instances in which a petition was filed for a sex offense. (Note: The offense(s) resulting in current disposition is/are excluded.)
4. Victimization History: Items 1-3 do not require that a DSS-115 has been filed. Item 4 reflects situations in which the perpetrator was in a non-caretaker role. Not that it may be necessary to question the juvenile to obtain a “yes” or “no” answer.
5. Items that are not completed will invalidate this form and it will be returned to your office for completion.
The statute requires that reviews be held every sixty (60) days in Juvenile Sexual Offender cases. You will receive a reminder notice of when a review is to be held with instructions for updating the tracking system information.
Please feel free to contact me at (###) ### - #### if you have any questions or require assistance in completing this form.
DEPARTMENT OF JUVENILE JUSTICE
Juvenile Sexual Offender Tracking System
Reporting Form: Part II
Code #:City:
Region: / DJJ #:
Court: / Youth Name:
Worker: / Youth ID: / Race:
Gender:
DOB:
Post-Disposition Placement Data
Placement / Date
Placement / Date
Placement / Date
Placement / Date
Prior Legal History
1. Has youth ever been placed on probation for a status offense? YES NO
2. Has youth ever been placed on probation for a public offense? YES NO
3. Has youth ever been committed as a status offender? YES NO
4. Has youth ever been committed as a public offender? YES NO
5. Has youth previously been charged with a sex offense? YES NO
Victimization History*
1. Was youth a victim of child neglect? NO YES – approximate age at occurrence
2. Was youth a victim of physical abuse? NO YES – approximate age at occurrence
3. Was youth a victim of sexual abuse? NO YES – approximate age at occurrence
4. Was youth a victim of sexual assault
excluding child abuse? NO YES – approximate age at occurrence
* Only mark “Yes” if the incident(s) has been substantiated by the Cabinet for Health and Family Services.
KRS 635.545505 KAR 1:160 /
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