Title Page

  • Inspection Title

  • Location

  • Prepared by

  • Conducted on

ADMINISTRATIVE INFORMATION FOR MANAGMENT AND STAFF

  • Facility Director

  • Assistant Director / Program Coordinator

  • Probation and Parole Officer Assigned to Facility

  • Type of Facility

  • Total Number of Beds in Facility

  • Current Number of Total Residents

  • Total Number of DOC Beds

  • Current Number of DOC Residents

  • Population Report Submitted Daily and Accurately (Capacity, Current DOC/Non-DOC, and Number Requested)

  • Monthly Reports Sent to Contract Management Branch by the 5th of Each Month

  • Employees On Supervision Approved by P&P, No Access to KOMS, and not at a RSC

ADMINISTRATIVE REQUIREMENTS FOR RESIDENTS

  • 24 Hour Awake Supervision (must be female at a facility with female residents)

  • Residents Not Placed in Position of Authority or Assigned Security Duties

  • Facility has Fully Licensed and Approved Medical Provider

  • Special/Alternative Dietary Options Offered

  • Hygiene Products Provided as Needed

  • Residents have Access to Legal Library and Legal Supplies as Needed

  • Facility Takes, Updates, and Loads Offender Photos in KOMS per CPP 25.6

  • Telephones Available for Residents

  • Adequate Laundry Facilities

  • Facility Temperature between 65 and 85 Degrees

POSTED DOCUMENTS

  • Facility Rules and Regulations

  • Resident Rights Posted

  • Grievance Procedures Posted

  • Visitation Schedule Posted

  • Evacuation Plans Current and Posted

  • Tobacco Restrictions for DOC Inmates Posted

  • Choking Poster Posted (in Kitchen)

FOOD SERVICE

  • At least 3 meals served per day with at least 2 being hot meals, and no more than 14 hours between meals.

  • Serving Line Sanitation

  • Food Preparation Area Sanitation

  • Kitchen Utensils Cleaned and Properly Stored

  • Stove and Stove Hood Sanitation

  • Oven Sanitation

  • Deep Fryer Sanitation

  • Meat Slicer Sanitation

  • Microwave Sanitation

  • Can Opener Sanitation

  • Spice Bins and Scoop Sanitation / Storage

  • Ice Maker and Scoop Sanitation / Storage

  • Other Kitchen Equipment Sanitation (Mixers, Steamers, Warmers, etc...)

  • Three Compartment Sink Sanitation / Operation

  • Automated Dishwasher Sanitation / Operation

  • Freezer Correct Temperature (O degrees or less)

  • Freezer Sanitation

  • Freezer Products at Least 6 Inches off the Floor, Labeled Properly, and Not Out of Date

  • Freezer Lighting and Shield

  • Refrigerator Correct Temperature (between 34 and 40 degrees)

  • Refrigerator Sanitation

  • Refrigerator Products at Least 6 Inches off the Floor, Labeled Properly, and Not Out of Date

  • Refrigerator Lighting and Shield

  • Thawing Meat Stored on Bottom Shelf

  • Dry Storage Sanitation

  • Dry Storage Products at Least 6 Inches off the Floor, Labeled Properly, and Not Out of Date

  • Dry Storage Lighting

  • Hand Washing Station Installed and Maintained / Operational, with Soap and Drying Device Available

  • Thermometers Available on or near Severing Line

  • Food on Serving Line at 136 Degrees or Higher

  • Garbage Cans Cleaned and Covered

  • Kitchen Personnel have clean clothing and hair restraints

  • Kitchen Personnel are not eating or drinking in serving / prep areas

  • Kitchen Workers properly supervised

  • Kitchen Floors, Walls, and Celling are Clean and in Good Repair

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

  • Knife Organization and Accountability

  • Kitchen Tool Organization and Accountability

  • Kitchen Janitor Equipment and Toxic Items / Chemicals Organization and Accountability

  • Overall Maintenance and Security of Kitchen and Dining Hall Area

SAFETY, SECURITY, AND SANITATION

  • Fire Extinguishers are Functional and Inspected Monthly

  • Emergency Lighting in Place and Functional

  • Exit Signage in Place and Functional

  • Electrical Boxes and Light Switches Covers in Place, in Good Condition, and unobstructed.

  • Exits Free from Obstruction

  • Hallways Free From Clutter and Obstruction

  • Windows in Good Condition

  • Celling Sanitation and Condition

  • Tools, Supplies, and Other Hazardous Equipment Only Used by Residents Under Direct Supervision

  • All Tools, Corrosive, Flammable, and Other Potentially Dangerous Supplies and Equipment Stored in a Locked Area

  • Safety Data Sheets (SDS) are Available, Current, and Easily Accessible

  • Non Kitchen Janitorial Equipment and Toxic Items / Chemicals Organization and Accountability

  • First Aid Kits Available and Properly Stored

  • Overall Maintenance and Sanitation in Common Areas to include Classrooms, Visitation, and Conference Rooms

  • Overall Maintenance and Sanitation in Non-Living Area Bathrooms

  • Overall Maintenance and Sanitation of Facility Exterior

RESIDENT LIVING AREAS

  • Living Area Amenities Provided (bed, sheets, pillow, storage, and chair per DOC resident)

  • Living Area Square Footage (50 ft.) per DOC Resident

  • Room Lighting and Night Lights in Place are Functional

  • Living Area House Keeping and Clutter

  • Overall Maintenance, Plumbing, and Sanitation in Living Areas (to include bathrooms)

REQUIRED DOCUMENTATION (Due Within 2 Buisness Days After Inspection)

  • Fire or Emergency Drills

  • Certified Food Manager on Staff

  • Vermin and Pest Control

  • DOC Resident Orientation (signed by resident)

  • List of All Programing Available at Facility (include KYDOC approval letter, certificate, or memo)

  • Program Facilitator Certification for each Program

  • Daily Facility Log (48 consecutive hour period)

  • Hourly Rounds Conducted (48 consecutive hour period)

  • Documented Head Counts (at least 3 per day, and 1 per shift)

  • Resident Sign In and Out Log

  • Drug Screening Log (at least 10% of DOC Population)

  • Extraordinary Occurrence Report Log

  • Grievance Log

AREAS TO MONITOR/FOLLOW-UP (IF NEEDED)

  • Follow-Up #1

  • Follow-Up #2

  • Follow-Up #3

  • Follow-Up #4

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.