Title Page
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Audit Title
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Site Location
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Conducted On
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Prepared by:
Audit
Facility Management Questionaire/Information
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Site visit narrative
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Facility Director
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Assistant Director/Program Coordinator
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Public Information Officer
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Employee responsible for KOMS data
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Type of Facility
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Total Number of Beds in the facility
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Total Number of State Beds in the facility
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Number of Current State Residents
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Current Probation/Parole Officer Assigned to the Facility
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Facility takes, uploads, and updates Offender photos in KOMS
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Monthly Reports submitted to Coordinator (Admin Management)
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24/7 Female Staff Supervision at Facilities w/ Female Offenders
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24 hour awake supervision
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Current visitation policy? Schedule posted?
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Two separate entrances
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Overall Maintenance & Sanitation of Facility Exterior
Administrative Documentation requested to be submitted within 2 business days after inspection
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Hourly rounds conducted (at least 48 hrs shown)
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Documented head counts (3 per day, 1 per shift)
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Daily facility log ( at least 48 hrs)
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Drug screening log (10% of DOC population)
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Overall Administrative Compliance
Onsite Walk Through
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FOOD SERVICE INSPECTION
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Special dietary options offered
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Serving Line Sanitation
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Food Preparation Area Sanitation
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Kitchen Utensils Clean and Properly Stored
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Kitchen Tool Accountability (knives properly stored)
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Kitchen Personnel - Clean clothing & Hair Restraints
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Kitchen Personnel - No eating or drinking
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Kitchen Personnel - Workers properly supervised
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Ice Maker & Scoop Sanitation (Properly Stored)
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Spice Bins & Scoop Sanitation (Properly Stored)
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Stove Sanitation
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Stove Hood Sanitation
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Oven Sanitation
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Deep fryer Sanitation
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Meat Slicer Sanitation
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Microwave Sanitation
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Can opener Sanitation
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Other Kitchen Equipment Sanitation (mixer, tilt skillet, steamer, etc)
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Three Compartment Sink - Sanitation
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Automated Dishwasher - Area Sanitation
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Automated Dishwasher - Accurate Temp Reading
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Automated Dishwasher - Sanitation Rinse Used
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Kitchen Floors, Walls, Ceiling - Clean & in Good repair
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Kitchen Plumbing Issue (leaking faucets, leaking pipes, etc.)
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Hand washing - sink installed and maintained
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Hand washing - soap available, drying device, and waste receptacle
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Thermometers in Place & Conspicuous
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Freezer - Temp (0 degrees or less)
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Freezer - Sanitation
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Freezer - All products off the floor
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Freezer - Lighting & Shield
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Freezer - all food labeled properly, No spoilage, no out of date food product
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Refrigerator - Temp (40 degrees or less)
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Refrigerator - Sanitation
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Refrigerator - All products off the floor
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Refrigerator - Lighting & Shield
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Refrigerator - All food labeled properly, No spoilage, no out of date food product
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Dry Storage - Sanitation
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Dry Storage - All product off the floor
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Dry Storage - Lighting
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Dry Storage - All food containers properly labeled
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No spoilage or out of date product
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Choking Poster Displayed
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Insect & Rodent Control - in kitchen and food storage
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All Outer Openings Protected
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Garbage Cans cleaned & Covered
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Janitor Equipment in Kitchen Stored correctly and cleaned
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Toxic items/Chemicals in Kitchen are properly stored & secured
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Overall Maintenance & Sanitation of Kitchen Area
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Overall Maintenance & Sanitation of Dining Hall Area
Onsite Walk Through
FACILITIES SAFETY & SECURITY
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Fire Extinguishers are Functional and Up to date (Fire Code)
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External Fire Escape Safety & Soundness (Fire Code)
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Exits Free from Obstructions (Fire Code)
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Emergency Lighting is in place & Functional (Fire code)
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Exit Signage in Place & Functional (Fire Code)
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Evacuation Plans Current & Posted (Fire Code)
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Wiring issues & condition (Fire code)
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Electrical Boxes & Light Switch Covers in Place & in good Condition (Fire code)
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Facility Windows in Good Condition & Working Order
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Ceiling Sanitation & Condition (Fire code)
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First Aid Kits available and properly stocked
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Tools, Supplies, and Equipment which are Hazardous shall be used by residents only - Under direct supervision of facility personnel
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All tools, toxic, corrosive, and flammable substances, and other potentially dangerous supplies and equipment shall be stored in a locked and secured area.
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Overall summary of Facility Safety and Security
FACILITY - LIVING & COMMON AREA
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Hallways free from clutter & obstruction (Fire Code)
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Living area housekeeping & clutter buildup (Fire Code)
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Janitor Equipment - stored correctly & secured
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Cleaning chemicals and supplies - stored correctly & secured
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SDS sheets - available, current, and easily accessible
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Living Area Amenities Provided - (bed, mattress, sheets, pillow, storage, chair)
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Living Area Square Footage - 50 sq ft per resident
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Room Lighting & Night light are in place & functional
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How many Toilets or Urinals are available for Resident Use?
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1 to 8 Ratio - Toilets or Urinals
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How many Showers are available for Resident Use?
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1 to 8 Ratio - Showers
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How many Sinks are available for Resident Use?
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1 to 8 Ratio - Sinks
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Restroom plumbing issues (leaking sinks, showers, etc)
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Adequate Laundry Facilities
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Telephones available for Resident use
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Temperature Range - 65/85 degrees
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Overall Maintenance & Sanitation of Living Area
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Overall Maintenance & Sanitation of Facility Restrooms
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Overall Maintenance & Sanitation of Showers in the facility
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Overall Maintenance & Sanitation of Common Area
Resident Interview
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Summary
Facility Visit Summary
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Summary
