Page 18 of The Dream Hotel
Safe-X Security Questionnaire
(Basic-10)
If you check the Yes box on a question below, you must provide details on the pop-up screen.
Yes
No
1. Are you aware of any retainee who plans to harm someone at this facility?
?
?
2. Are you aware of any retainee who plans to harm someone outside this facility?
?
?
3. Are you aware of any retainee who plans to harm themselves at this facility?
?
?
4. Are you aware of any retainee (or retainees) planning to escape, riot, or encourage others to escape or riot?
?
?
5. Are you aware of any retainee (or retainees) planning to set fire or otherwise damage this facility?
?
?
6. Are you aware of any retainee who is using narcotics, alcohol, or any other controlled substance while at this facility?
?
?
7. Are you aware of any retainee who is in possession of contraband, including phones, smart devices, cigarettes, vape pens, lighters, or matches?
?
?
8. Are you aware of any retainee who is in possession of weapons, including guns, knives, blades, or sharp instruments?
?
?
9. Are you aware of any retainee who is in possession of prohibited documents or reading material?
?
?
10. Are you aware of any improper conduct by an attendant at this facility?
?
?
? I acknowledge that my answers are voluntary and have not been coerced by staff or visitors.
? I understand that answers to this questionnaire may lengthen or shorten the retention period of any named individual, including myself.
Name: _____-_____-_____-_____-_____-__
Signature: _____-_____-_____-_____-____