NDOC PREA Volunteer-Contractor (DOC 052) ~3.docx

State of Nevada Department of Corrections

PREA Contractor and Volunteer Questionnaire Form

The Nevada Department of Corrections, 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 not enlist the services of any contractor or volunteer who may have contact with inmates. Agency policy requires all contractors and volunteers complete this questionnaire.

Providing false or misleading statements, including material omissions regarding such misconduct shall be grounds for termination from entry into all NDOC institutions and volunteer/contractor status will be rescinded.

1. Have you engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution, or have you 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, or have you been civilly or administratively adjudicated to have engaged in the activity described in any part of this question?

YES |_| NO |_|

2. Have you been adjudicated as having engaged in any type of inmate Sexual Harassment, which includes as a staff member, volunteer, contractor, or as any type of service provider coming in contact with an inmate in the facilities mentioned in question 1? Sexual Harassment includes but is not limited to:

· Repeated verbal comments of a sexual nature to an inmate; or

· Demeaning references to gender; or

· Derogatory comments about body or clothing; or

· Repeated profane or obscene language or gestures

YES |_| NO |_|

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DOC 052 (12/16)

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