Title Page

  • Audit Title

  • Site Location

  • Conducted On

  • Prepared by:

Audit

Facility Management Questionaire/Information

  • Site visit narrative

  • Facility Director

  • Assistant Director/Program Coordinator

  • Public Information Officer

  • Employee responsible for KOMS data

  • Type of Facility

  • Total Number of Beds in the facility

  • Total Number of State Beds in the facility

  • Number of Current State Residents

  • Current Probation/Parole Officer Assigned to the Facility

  • Facility takes, uploads, and updates Offender photos in KOMS

  • Monthly Reports submitted to Coordinator (Admin Management)

  • 24/7 Female Staff Supervision at Facilities w/ Female Offenders

  • 24 hour awake supervision

  • Current visitation policy? Schedule posted?

  • Two separate entrances

  • Overall Maintenance & Sanitation of Facility Exterior

Administrative Documentation requested to be submitted within 2 business days after inspection

  • Hourly rounds conducted (at least 48 hrs shown)

  • Documented head counts (3 per day, 1 per shift)

  • Daily facility log ( at least 48 hrs)

  • Drug screening log (10% of DOC population)

  • Overall Administrative Compliance

Onsite Walk Through

  • FOOD SERVICE INSPECTION

  • Special dietary options offered

  • Serving Line Sanitation

  • Food Preparation Area Sanitation

  • Kitchen Utensils Clean and Properly Stored

  • Kitchen Tool Accountability (knives properly stored)

  • Kitchen Personnel - Clean clothing & Hair Restraints

  • Kitchen Personnel - No eating or drinking

  • Kitchen Personnel - Workers properly supervised

  • Ice Maker & Scoop Sanitation (Properly Stored)

  • Spice Bins & Scoop Sanitation (Properly Stored)

  • Stove Sanitation

  • Stove Hood Sanitation

  • Oven Sanitation

  • Deep fryer Sanitation

  • Meat Slicer Sanitation

  • Microwave Sanitation

  • Can opener Sanitation

  • Other Kitchen Equipment Sanitation (mixer, tilt skillet, steamer, etc)

  • Three Compartment Sink - Sanitation

  • Automated Dishwasher - Area Sanitation

  • Automated Dishwasher - Accurate Temp Reading

  • Automated Dishwasher - Sanitation Rinse Used

  • Kitchen Floors, Walls, Ceiling - Clean & in Good repair

  • Kitchen Plumbing Issue (leaking faucets, leaking pipes, etc.)

  • Hand washing - sink installed and maintained

  • Hand washing - soap available, drying device, and waste receptacle

  • Thermometers in Place & Conspicuous

  • Freezer - Temp (0 degrees or less)

  • Freezer - Sanitation

  • Freezer - All products off the floor

  • Freezer - Lighting & Shield

  • Freezer - all food labeled properly, No spoilage, no out of date food product

  • Refrigerator - Temp (40 degrees or less)

  • Refrigerator - Sanitation

  • Refrigerator - All products off the floor

  • Refrigerator - Lighting & Shield

  • Refrigerator - All food labeled properly, No spoilage, no out of date food product

  • Dry Storage - Sanitation

  • Dry Storage - All product off the floor

  • Dry Storage - Lighting

  • Dry Storage - All food containers properly labeled

  • No spoilage or out of date product

  • Choking Poster Displayed

  • Insect & Rodent Control - in kitchen and food storage

  • All Outer Openings Protected

  • Garbage Cans cleaned & Covered

  • Janitor Equipment in Kitchen Stored correctly and cleaned

  • Toxic items/Chemicals in Kitchen are properly stored & secured

  • Overall Maintenance & Sanitation of Kitchen Area

  • Overall Maintenance & Sanitation of Dining Hall Area

Onsite Walk Through

FACILITIES SAFETY & SECURITY

  • Fire Extinguishers are Functional and Up to date (Fire Code)

  • External Fire Escape Safety & Soundness (Fire Code)

  • Exits Free from Obstructions (Fire Code)

  • Emergency Lighting is in place & Functional (Fire code)

  • Exit Signage in Place & Functional (Fire Code)

  • Evacuation Plans Current & Posted (Fire Code)

  • Wiring issues & condition (Fire code)

  • Electrical Boxes & Light Switch Covers in Place & in good Condition (Fire code)

  • Facility Windows in Good Condition & Working Order

  • Ceiling Sanitation & Condition (Fire code)

  • First Aid Kits available and properly stocked

  • Tools, Supplies, and Equipment which are Hazardous shall be used by residents only - Under direct supervision of facility personnel

  • All tools, toxic, corrosive, and flammable substances, and other potentially dangerous supplies and equipment shall be stored in a locked and secured area.

  • Overall summary of Facility Safety and Security

FACILITY - LIVING & COMMON AREA

  • Hallways free from clutter & obstruction (Fire Code)

  • Living area housekeeping & clutter buildup (Fire Code)

  • Janitor Equipment - stored correctly & secured

  • Cleaning chemicals and supplies - stored correctly & secured

  • SDS sheets - available, current, and easily accessible

  • Living Area Amenities Provided - (bed, mattress, sheets, pillow, storage, chair)

  • Living Area Square Footage - 50 sq ft per resident

  • Room Lighting & Night light are in place & functional

  • How many Toilets or Urinals are available for Resident Use?

  • 1 to 8 Ratio - Toilets or Urinals

  • How many Showers are available for Resident Use?

  • 1 to 8 Ratio - Showers

  • How many Sinks are available for Resident Use?

  • 1 to 8 Ratio - Sinks

  • Restroom plumbing issues (leaking sinks, showers, etc)

  • Adequate Laundry Facilities

  • Telephones available for Resident use

  • Temperature Range - 65/85 degrees

  • Overall Maintenance & Sanitation of Living Area

  • Overall Maintenance & Sanitation of Facility Restrooms

  • Overall Maintenance & Sanitation of Showers in the facility

  • Overall Maintenance & Sanitation of Common Area

Resident Interview

  • Summary

Facility Visit Summary

  • Summary

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.