C. Questionnaire Reporting template on prison visits: Ill-treatment & Disciplinary measures Information about observers: No. 1. Name and Surname Title: 2. Monitored Prison:_______________ Date of the prison monitoring: ____________ Prison Capacity: _____ Number of Male prisoners: _____ Number of Female Prisoners: ____ Interviewed person (warden, guard, doctor, prisoner, other): __________________ I. General Information on the Visit What is the profile of the person interviewed (age, gender etc.)? o Family Name: ______________________________________________________ o First and other names: _______________________________________________ o Sex : Male Female o Date of birth (or age): ________________________________________________ o Nationality/Ethnicity: ________________________________________________ o Occupation: ________________________________________________________ o Sentenced for (for prisoners):__________________________________________ o Length of sentence (for prisoners):______________________________________ o Years of experience (for staff) _________________________________________ Please note: If the person interviewed alleges to have been subjected to ill-treatment himself, please fill out Annex 1 II. Ill-treatment 1. How would you describe the situation regarding ill-treatment of prisoners by staff? 27