DOC 1952- NDOC Contractor and Volunteer PREA Questionnaire.pdf

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:______________________________________