44DOC-S3975 Contractor and Volunteer PREA Questionnaire.pdf
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- Attached to
- Commissary and Supplemental Services
- Solicitation number
- 44DOC-S3975
- Issued by
- Nevada
About this file
This is a PREA (Prison Rape Elimination Act) questionnaire form issued by the Nevada Department of Corrections (NDOC) Compliance with 42 U.S.C. 15601 et seq. and 28 C.F.R. 115.17(a). The form must be completed by all contractors and volunteers who may have contact with offenders before authorization to enter NDOC institutions, facilities, or work release centers. The questionnaire requires disclosure of any history of sexual abuse in detention facilities, convictions or civil/administrative adjudications for sexual activity involving force, coercion, or non-consent, and any incidents of sexual harassment in community or confinement settings. Applicants must answer yes or no to four screening questions and provide detailed explanations for any affirmative responses on attached pages if necessary.
Applicants must affirm under penalty of perjury that all responses are true and complete to the best of their knowledge. The form explicitly states that providing false or misleading statements, including material omissions regarding misconduct, constitutes grounds for denial of the application. The questionnaire requires the applicant's signature, date, and printed name and serves as a mandatory pre-authorization screening mechanism for the NDOC's compliance with federal prison rape prevention standards.
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Text version
Nevada Department of Corrections PREA Management Division
DOC 1952 (revised 1/2023)
§115.17
Contractor and Volunteer PREA Questionnaire
The Nevada Department of Corrections (NDOC), in compliance with the Department of Justice, National Standards to Prevent, Detect, and Respond to Prison Rape 42 U.S.C. § 15601, et seq. and
28 C.F.R., §115.17 (a) shall require contractors and volunteers who may have contact with offenders to complete this form before they can be authorized to have any contact with any offenders or entry into any of the agencies institutions, facilities or work release centers. Please answer the following questions.
Have you ever:
• Engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or any other place of detention?
☐ Yes ☐ No
• Been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?
☐ Yes ☐ No
• Civilly or administratively adjudicated to have engaged in the activity described above?
☐ Yes ☐ No
• Engaged in sexual harassment of any person in the community or confinement setting?
☐ Yes ☐ No
If you answered yes to any of the previous four questions, provide details regarding the incident.
Attach additional pages if necessary.
I affirm that all my responses are true and complete to the best of my knowledge. I also understand that providing false or misleading statements, including material omissions regarding such misconduct shall be grounds for denial of my application.
Signature: Date: ___________________
Print Name:______________________________________
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