This is the Johannesburg Security Check sheet further amplified by myself. This is the roughest Security Check in Scientology. We will call it the “Jo’burg Security Check”. It does not necessarily replace other check sheets but it is probably the most thorough one we have now.

In reprinting this form use legal (foolscap) length and double-space everything except directions.

_________________________________ _____________________

Name of Person Date

_________________________________

Name of Security Checker

Directions: Attempt to clear any fall observed. Mark any fall observed or any meter reaction change elicited by the question. Then write what it cleared on. Mark largely if the fall could not be cleared since this constitutes a failure to pass. Only fail somebody if there is no needle motion of any kind even with sensitivity at 16 on any question. If they are failing because it is hard to clear a question, work very thoroughly on it in an effort to clear it. In all cases complete the test.

If an important question fails to clear even after Security Checker has worked very hard to get it off, the test is flunked.

The following statement should be read or quoted to the person being Security Checked:

“We are about to begin a Security Check. We are not moralists. We are able to change people. We are not here to condemn them. While we cannot guarantee you that matters revealed in this check will be held forever secret, we can promise you faithfully that no part of it nor any answer you make here will be given to the Police or the State. No Scientologist will ever bear witness against you in Court by reason of answers to this Security Check. This Security Check is exclusively for Scientology purposes. The only ways you can fail this Security Check are to refuse to take the test, to fail to answer its questions truthfully or if you are here knowingly to injure Scientology. The only penalty attached to failure of this check is processing or our refusal to employ you or issue you a certificate, and this will only happen if we find that you are trying knowingly to injure Scientology. You can pass this test by (l) agreeing to take it, (2) answering each question truthfully and (3) not being a member of a subversive group seeking to injure Scientology.”

The first questions are nul questions to determine your reaction pattern.

We will now begin –

1. Are you sitting in a chair?
2. Are you on the moon?
3. Are all cats black?
4. Am I an ostrich?
5. Is this Earth?
6. Have you ever drunk water?
7. Are you holding up a tree?
8. Am I an elephant?
9. Are you a table?
10. Is this a Security Check?

1. Have you ever lived or worked under an assumed name?
2. Have you given me your right name?
3. Are you here for a different purpose than you say?
4. Have you ever stolen anything?
5. Have you ever forged someone else’s signature?
6. Have you ever blackmailed anybody?
7. Have you ever been blackmailed?
8. Have you ever smuggled anything?
9. Have you ever been in prison?
10. Have you ever indulged in drunkenness?
11. Have you ever done any reckless driving?
12. Have you ever burglared any place?
13. Have you ever embezzled money?
14. Have you ever assaulted anyone?
15. Have you ever been in jail?
16. Have you ever told lies in Court?
17. Have you ever had anything to do with Pornography?
18. Have you ever committed Arson?
19. Have you ever been a Drug Addict?
20. Have you ever peddled Dope?
21. Have you had any dealings with stolen goods?
22. Do you have a Police Record?
23. Have you ever raped anyone?
24. Have you ever been involved in an abortion?
25. Have you assisted in any abortion?
26. Have you ever committed adultery?
27. Have you ever practised Homosexuality?
28. Have you ever had intercourse with a member of your family?
29. Have you ever been sexually unfaithful?
30. Have you ever practised Sodomy?
31. Have you ever consistently made a practice of sexual perversion?
32. Have you ever slept with a member of a race of another colour?
33. Have you ever committed culpable homicide?
34. Have you ever bombed anything?
35. Have you ever murdered anyone?
36. Have you ever kidnapped anyone?
37. Have you ever done any illicit Diamond buying?
38. Have you ever betrayed anyone for money?
39. Have you ever threatened anyone with a fire-arm?
40. Have you been in illegal possession of fire-arms?
41. Have you ever been paid for giving evidence?
42. Have you ever destroyed something belonging to someone else?
43. Have you ever been a spy for an Organization?
44. Have you ever had anything to do with Communism or been a Communist?
45. Have you ever been a newspaper reporter?
46. Have you ever had intercourse while under the influence of drugs?
47. Have you ever had intercourse while under the influence of alcohol?
48. Have you ever used drugs or blackmail to procure sex?
49. Have you ever ill-treated children?
50. Have you ever taken money for giving anyone sexual intercourse?
51. Have you ever had any connection with a brothel?
52. Have you ever had anything to do with a baby farm?
53. Have you ever been a spy for the Police?
54. Are you afraid of the Police?
55. Have you ever done anything you are afraid the Police may find out?
56. Have you ever falsified the books in any firm you worked for?
57. Have you ever done anything your Mother would be ashamed to find out?
58. How could you help yourself generally?
59. What represents yourself?
60. How could you help your family?
61. What represents your family?
62. How do you feel about sex?
63. What represents (the Org (others (a group to you?
64. How could you help (the Org? (others? (a group?
65. How could you help mankind?
66. Have you ever controlled people?
67. How do you feel about being controlled?
68. What represents mankind to you?
69. How could you help animals and plants?
70. What represents animals and plants to you?
71. How could you help material things?
72. What represents Matter, Energy, Space and Time to you?
73. How could you help Spirits?
74. What represents Spirits to you?
75. How could you help God or Infinity?
76. What represents God or Infinity to you?
77. What is Communism?
78. Do you feel Communism has some good points?
79. Have you ever been a member of the Communist Party?
80. Have you ever been a member of any group with similar ideals as the Communist Party?
81. Do you know any Communist personally?
82. Have you ever injured Dianetics or Scientology?
83. Have you ever committed any overts on a Scientology Organization?
84. Have you ever stolen anything from a Scientology Org?
85. Do you have any overts on LRH?
86. Have you ever had unkind thoughts about LRH?
87. Do you have any overts on Mary Sue?
88. Have you ever had any unkind thoughts about Mary Sue?
89. Have you ever injured any Scientologists?
90. Have you ever had any unkind thoughts about Scientologists?
91. Have you ever betrayed Scientology?
92. Do you know of any secret plans against Scientology?
93. Have you ever taken money to injure Scientology?
94. Have you ever used Dianetics or Scientology to force sex upon someone?
95. Do you know of any plans to injure a Scientology Organization?
96. Are you upset about this Security Check?

____________________________

Passed ____________________________

Failed

____________________________

Why?

___________________________

Signed by Examiner