| QUESTIONNAIRE
|
DATE:
|
| PROJECT:
|
| LOCATION:
|
This
form has been prepared to assist Domes International, Inc. in obtaining
the vital data required to further develop a program and feasibility
study for your building.
Please
provide the following information as completely as possible. Any additional
information you wish to supply is welcomed. |
| A.
Owner/contact for the project. |
Name:
|
| Address:
|
| City,
ST, Zip:
|
| Phone:
|
| Email:
|
| B. Is this a private
project or public project? |
Private
|
Public
|
| C. Is funding in
place for this project? |
Yes
|
No
|
| D. What is the
budget for this project? |
$
|
| E. Is this an addition
to an existing facility? |
Yes
|
No
|
| F. Is the facility
to be expandable? |
Yes
|
No
|
| G.
What is the scope of the project? |
Number
of beds, Male
, Female
, Total
|
| Security
level:
Maximum,
Medium,
Minimum or
combination |
| Number
of segregation units: Male
, Female
, Total
|
| Size
of the segregation units, 2 bed, 4 bed, 6 bed etc.
|
| Size
of dorm units: Male
, Female
(i.e. 2 @ 48 beds) |
| Classrooms:
Number
, Size
(i.e. 16 students) |
| Library:
Size
(i.e. 500 volumes) |
| Administration |
Offices
, Size
|
| |
Offices
, Size
|
| |
Office
cubicles
|
| |
Conference
room for
people |
| |
Break
room for
people |
| |
Locker
room for
people |
| |
Training
room and office for
people |
| |
Records
vault, size
|
| |
Weapons
vault, size
|
| Other required
spaces |
|
| Medical area |
Number
of exam rooms
|
| |
Number
of dental rooms
|
| |
Number
of trauma rooms
|
| |
Segregated
waiting (male/female)?
|
| |
Wards
, if so how many beds
|
| |
Holding
cells
|
| |
Staff
offices
|
| Kitchen |
Number
to serve
|
| |
Will
service be
delivered to inmates or
via dining hall? |
| Laundry |
How
many washers
|
| |
How
many dryers
|
| Maintenance |
Vehicular?
Yes
No |
| |
Attached or
free standing? |
| |
Special
requirements
|
| H. Has a site been
selected for this facility? |
If
so, Location,
|
| Has a site survey
been performed? |
Yes
No |
| Has a soils investigation
been performed? |
Yes
No |
| What is the acreage? |
|
| Are required utilities
available? |
Yes
No |
Is there anything
else we need to know about property or its
surroundings which would have an effect upon its use? |
|
For initial inquiries about price,
plans, etc., click here
to submit |
|
