Title Page
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Audit Title:
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Location
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Conducted on
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Prepared by:
Facility Management Information
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Facility Director
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Assistant Director or Program Coordinator
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Type of Facility
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Total Number of Beds in the Facility
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Total DOC Beds:
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Number of current DOC residents:
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Number of current non-DOC residents
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Current Probation&Parole Officer assigned to the facilty:
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Probation & Parole Workspace:
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Public Information Officer
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Employee responsible for entering KOMS data
Site Visit
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Site Visit:
Facility Management Questionaire/Information
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Monthly Reports Sent to Coordinator
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Provide documentation of bed requests as per SB36.
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Employee Files
- Reviewed onsite
- Kept offsite - submitted electronically
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Employee Background Check (CPP 3.6) (Pre-employment)
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Employee - Code of Ethics and List of Prohibitions
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Employee Age Requirement (18 years old or older)
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Employee Compensation (at least minimum wage)
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24/7 Female Staff Supervision at Facilities w/Female Offenders
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Any employees on any type of supervision by any agency
- Yes
- No
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P&P Approval?
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24 Hour Awake Supervision
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Facility is in Good Standing with and complies with all PREA Standards?
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Facility has fully licensed and approved Medical Provider
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Access to a Legal Library provided
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Legal supplies provided as needed
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Facility shall comply with CPP 16.2 in regards to sending and receiving mail
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Facility has copies of Course Catalog available to all Residents
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Visitation List Utilized and how is it utilized
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No Residents in a position of authority
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No Residents perform security duties
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Resident Rights - Posted
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Grievance Procedures Posted
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Visitation Schedule Posted
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Tobacco Restrictions for DOC inmates posted
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Facility takes, updates, and uploads Offender photos into KOMS
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Special Dietary Options Offered to Residents
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Hygiene Products provided as needed
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Residents have access to the Facility Policies and Procedures
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AA and NA classes offered to all residents
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Provide documents for 3 residents who are employed. Documents to provide are Pay stubs, Resident obligation, and copy of money order of what was actually paid.
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Overall Facility Management review
Required Inspection Documentation (Place on thumb drive for review)
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Fire Department Inspection
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Kitchen Hood Inspection (fire code)
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Sprinkler System Inspection (fire code)
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Fire or Emergency Drills (fire code)
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Boiler Inspection (fire code)
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HVAC Inspection
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Elevator Inspection
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Certified Food Manager on Staff
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Menu with Approval from Dietician
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Serving 3 meals a day with at least 2 hot meals and with no more than 14 hour gap between dinner and breakfast.
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Health Department Inspection
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Vermin and Pest Control
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Current Certificate of Occupancy
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Facility Staffing Roster (Vacancies shown)
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Facility Work Schedule
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Facility Organizational Chart
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Employee Training Hours (16 hours annually required by KY DOC)
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Employee Orientation Training Program (training requirements)
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CPR & First Aid Certification
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Current Offender Recreation Schedule
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Daily Activity Log (48 hour period)
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Rounds Conducted (at least once per hour) Submit 48 hour time period
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Documented Head Counts (at least 3 counts per day)
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Arrival and Departure Log (computer or manual log accepted)
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Drug Screening Documentation (10% of State Population per month)
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Resident Orientation Program
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List of all Programming Available and Taught at Facility
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Provide schedule of when those programs are offered and who teaches each.
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Program Approval Certificate from the KY DOC
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Program Facilitator Certification for each program taught
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Religious Programming is available for Residents
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Key Control and Procedures - how are they accounted for
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No Weapons, Ammunition, Chemical Agents, or Related Security Equipment are allowed inside the facility unless properly Approved Law Enforcement Agency.
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Grievance log (computer or written log)
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Extraordinary Occurrence Report log (computer or written log)
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Overall review of facility documents
Onsite Walk Through
Food Service Inspection
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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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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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Other Kitchen Equipment Sanitation (Mixer, Tilt Skillet, Steamer, etc)
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Can Opener Sanitation
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Three Compartment Sink - Sanitation
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Automated Dishwasher - Area Sanitation
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Automated Dishwasher - Accurate Temperature 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 Issues (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 and Conspicuous
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Freezer - Correct Temperature (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 and shield
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Freezer - all food labeled properly, no spoilage, and No out of date food product
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Refrigerator - Correct Temperature (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 and 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 labeled properly
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Dry Storage - No food spoilage or out of date food product
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Kitchen Tool Accountability - knives secure?
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Kitchen Personnel - Clean clothing and 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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Choking Poster Displayed
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Insect & Rodent Control
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All Outer Openings Protected
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Garbage Cans Cleaned and Covered
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Janitor Equipment stored correctly and clean
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Toxic Items/Chemicals are properly stored and secured
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Overall Maintenance and Sanitation of Kitchen area
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Overall Maintenance and Sanitation of Dining area
Facilities Safety and Security
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Fire Extinguisher are Functional and up to date on monthly checks (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 and 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
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Facility Windows in good conditions & Working Order
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Tools, supplies, and equipment which are hazardous shall be used by Residents only - (under the direct supervision of center 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 area which is secure
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SDS - Safety Sheets are available, current, & easily accessible
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First Aid Kit - available & properly stocked
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Overall Safety and Security of Facility
Facility Sanitation Inspection
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Ceiling Sanitation & Condition (Fire Code)
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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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How many Toilets or Urinals are available for Resident use?
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1 to 8 Ratio - Toilets & 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, clogged)
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Telephones available for Resident use
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Adequate Laundry facilities
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Sanitation and cleanliness of Laundry facilities
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Overall temperature range of facility (65/85 degrees)
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Living area amenities provided (bed, sheets, pillow, storage, and chair)
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Living area square footage - 50 ft. per Resident
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Room Lighting & Night Lights are in place & functional
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Two separate entrances
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Overall Maintenance & Sanitation of Facility living areas
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Overall Maintenance & Sanitation of Facility restrooms
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Overall Maintenance & Sanitation of Facility showers
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Overall Maintenance & Sanitation of Common Areas
Summary of inspection
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Residents spoken with at time of inspection.
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Facility Visit Summary
Areas to Monitor/Follow-up (if needed)
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Follow-up #1
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Follow-up #2
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Follow-up #3
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Follow-up #4
