In accordance with Texas Administrative Code Section 358.800, an Internal Investigation Report (IIR) shall be completed at the conclusion of all internal investigations resulting from alleged abuse, neglect, exploitation or death of a juvenile. GENERAL INFORMATION TJJD Case Number: County Case ID#: County: Department / Program / Facility: Date of Alleged Incident: Alleged Victim(s): Alleged Perpetrator(s): #1: #2: #3: #4: Alleged Perpetrator’s Current Mailing Address First Person of Knowledge: (including address, city, state and zip code): Perpetrator #1: Date Allegation Reported to First Person of Knowledge: Perpetrator #2: Perpetrator #3: Date Allegation Reported to TJJD: Perpetrator #4: LAW ENFORCEMENT INFORMATION Name of Law Enforcement Agency: Date Reported to Law Enforcement: Law Enforcement Report Number: DEPARTMENT / PROGRAM / FACILITY EMPLOYMENT SEPARATION In accordance with Texas Administrative Code Section 358.720, if during the internal investigation the Subject of Investigation resigns or is terminated from employment, the TJJD shall be notified no later than the second business day after the resignation or termination: Type: Date of Resignation / Date TJJD Notified: Name of Individual Who Notified TJJD: Termination: Perpetrator #1: Resignation Termination Type: Date of Resignation / Date TJJD Notified: Name of Individual Who Notified TJJD: Termination: Perpetrator #2: Resignation Termination Type: Date of Resignation / Date TJJD Notified: Name of Individual Who Notified TJJD: Termination: Perpetrator #3: Resignation Termination Type: Date of Resignation / Date TJJD Notified: Name of Individual Who Notified TJJD: Termination: Perpetrator #4: Resignation Termination WITNESSES In accordance with Administrative Code Section 358.740, diligent efforts shall be made to obtain written or electronically recorded oral statements from all persons with direct knowledge of the alleged incident. If more space is needed for additional witnesses, please include in the "Additional Information" section on Page 2. Please provide a list of all persons who provided a written and/or oral statement. Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Type: Oral Written Name: Title: Type: Oral Written
In accordance with Texas Administrative Code Section 358.800, an Internal Investigation Report (IIR) shall be completed at the conclusion of all internal investigations resulting from alleged abuse, neglect, exploitation or death of a juvenile. GENERAL INFORMATION TJJD Case Number: County Case ID#: County: Department / Program / Facility: Date of Alleged Incident: Alleged Victim(s): Alleged Perpetrator(s): #1: #2: #3: #4: Alleged Perpetrator’s Current Mailing Address (including address, city, state and zip code): Perpetrator #1: Perpetrator #2: Perpetrator #3: Perpetrator #4: First Person of Knowledge: Date Allegation Reported to First Person of Knowledge: Date Allegation Reported to TJJD: LAW ENFORCEMENT INFORMATION Name of Law Enforcement Agency: Date Reported to Law Enforcement: Law Enforcement Report Number: DEPARTMENT / PROGRAM / FACILITY EMPLOYMENT SEPARATION In accordance with Texas Administrative Code Section 358.720, if during the internal investigation the Subject of Investigation resigns or is terminated from employment, the TJJD shall be notified no later than the second business day after the resignation or termination: Perpetrator #1: Type: Resignation Termination Date of Resignation / Termination: Date TJJD Notified: Name of Individual Who Notified TJJD: Perpetrator #2: Type: Resignation Termination Date of Resignation / Termination: Date TJJD Notified: Name of Individual Who Notified TJJD: Perpetrator #3: Type: Resignation Termination Date of Resignation / Termination: Date TJJD Notified: Name of Individual Who Notified TJJD: Perpetrator #4: Type: Resignation Termination Date of Resignation / Termination: Date TJJD Notified: Name of Individual Who Notified TJJD: WITNESSES In accordance with Administrative Code Section 358.740, diligent efforts shall be made to obtain written or electronically recorded oral statements from all persons with direct knowledge of the alleged incident. If more space is needed for additional witnesses, please include in the "Additional Information" section on Page 2. Please provide a list of all persons who provided a written and/or oral statement. Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Title: Type: Oral Written Name: Type: Oral Written Name: Title: Type: Oral Written
TJJD_AID_005.docx