Weekly Walkthrough Report

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

• Select date

  Date

• Temperature at Officer's Desk.

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Location of inspection

  Select 4B 4C 3B 3C 2B 2C D2 D3 Medical Kitchen Transportation Common Areas Control Education Administration Maintenance

  • 4B
  • 4C
  • 3B
  • 3C
  • 2B
  • 2C
  • D2
  • D3
  • Medical
  • Kitchen
  • Transportation
  • Common Areas
  • Control
  • Education
  • Administration
  • Maintenance

Sanitation

• Have measures been taken to prevent cross-contamination?

  Yes

  No

  N/A

• Is area properly stocked, I.e. paper towels, soap, sanitizer?

  Yes

  No

  N/A

• Are cell bars, windows, window sills, etc. clean/dust free?

  Yes

  No

  N/A

• Are vents free of dust/grime? Are surrounding areas dust free?

  Yes

  No

  N/A

• Has trash been taken out? Are trash cans clean inside/out?

  Yes

  No

  N/A

• Are the floors clean? Have spills been cleaned up?

  Yes

  No

  N/A

• Have appliances been wiped down?

  Yes

  No

  N/A

• Are the showers clean?

• Is anything growing on the walls/floors?

  Yes

  No

  N/A

• Are the fixtures clean?

  Yes

  No

  N/A

• Have the shower vents been dusted?

  Yes

  No

  N/A

Safety/Fire Safety

• Is safety equipment easily accessible? Fire extinguishers, pull stations, etc.

  Yes

  No

  N/A

• Are wet floor sings and other safety measures being utilized? (Mats, spills immediately cleaned, etc.)

  Yes

  No

  N/A

• Is the 18" rule being followed?

  Yes

  No

  N/A

• Are cells free of clutter?

  Yes

  No

  N/A

• Are means of egress clear to exit?

  Yes

  No

  N/A

• Is the area clear of slips, trips, and fall hazards?

  Safe

  At Risk

  N/A

Maintenance

• Are there any obvious maintenance issues?

  Yes

  No

  N/A

• Are all lights burning appropriately?

  Yes

  No

  N/A

• Does plumbing work correctly?

  Yes

  No

  N/A

• Has a Maintenance Request Form been submitted? If so, by whom?

  Yes

  No

  N/A

Security

• Are containers (cleaning supplies) properly labeled?

  Yes

  No

  N/A

• Are inmates in cells visible? (Nothing should be hanging over the bottom bunk or over toilet area obstructing the view).

  Yes

  No

  N/A

• Have cleaning supplies been properly secured?

  Yes

  No

  N/A

• Is anything hanging from the bars, I.e., clothes lines, trash bags, clothing, etc.?

  Yes

  No

  N/A

• Is the main Pod door secure?

  Yes

  No

  N/A

• Have unnecessary security threats been removed from the area?

  Yes

  No

  N/A

• Printed name

  Sign