OMB 0970-#### [valid through MM/DD/YYYY]
Monitoring Checklist – Facility Walkthrough
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
Controlled entry/exit of premises |
|
|
|
Knives/sharp objects inaccessible to UAC |
|
|
|
Prohibited from allowing entry of any individual (except UAC in the process of admission) who meet any COVID-19 criteria |
|
|
|
Cleaning chemicals maintained in a locked area |
|
|
|
Alarms system for all areas of the residential structure |
|
|
|
Medical supplies/prescriptions inaccessible to UAC |
|
|
|
Video monitoring in common and living areas and classrooms |
|
|
|
Other unsafe areas inaccessible to UAC |
|
|
|
Video monitoring for exterior of building & surrounding premises |
|
|
|
Vehicle(s) inspection stickers up-to-date |
|
|
|
Ability to download video footage permanently |
|
|
|
Vehicle(s) appear to be in good repair (including fire extinguisher and first aid kit) |
|
|
|
System for tracking and regulating UAC movement |
|
|
|
Vehicle (s) contain working seat belts |
|
|
|
Meeting UAC to floor staff ratios/appropriate supervision |
|
|
|
Evacuation procedures posted prominently on each floor and at eye level for children and youth |
|
|
|
“Mirrored windows”/window in offices where staff meet with child 1:1 |
|
|
|
Fire extinguishers and smoke detectors in good working order and inspected (as required) |
|
|
|
Infants/Toddlers – age appropriate furniture (e.g. cribs/bedding, high chairs, toys, outlet covers) |
|
|
|
|
|
|
|
Play equipment safe and in good repair |
|
|
|
|
|
|
|
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
Case files in secure location (open and closed) |
|
|
|
Case files being maintained indefinitely by program |
|
|
|
Only individuals with a need to know basis have access to the case files |
|
|
|
Case files safe from physical damage |
|
|
|
Private place for UAC to make phone calls (including pre-programmed phones) |
|
|
|
Pre-programmed telephones (Required: UAC SA Hotline, CPS, Local Community Service Provider; Highly recommended: Top 3 consulates and LSP) |
|
|
|
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
Clean |
|
|
|
Desk and chair in room |
|
|
|
Child-friendly (e.g. no safety/trip hazards) |
|
|
|
Identified UAC Medical Quarantine/Isolation Space |
|
|
|
Furniture and building are properly maintained |
|
|
|
Kitchen |
|
|
|
Well-ventilated |
|
|
|
UAC dietary restrictions posted/accessible |
|
|
|
Adequately heated/cooled |
|
|
|
Food stored in a sanitary manner |
|
|
|
Bedrooms |
|
|
|
Bathrooms |
|
|
|
Natural light/Dark at night |
|
|
|
Soap |
|
|
|
Private place to store personal items/clothing |
|
|
|
Toilet paper |
|
|
|
Provision of appropriate linens |
|
|
|
Working toilets |
|
|
|
Adequately accommodate all UAC (per State Licensing) |
|
|
|
Hot/cold water |
|
|
|
Separated by gender (per licensing) |
|
|
|
Separated by gender |
|
|
|
Adequately accommodate all youth (e.g. individual bed with mattress for each youth) |
|
|
|
Appropriate privacy |
|
|
|
Provision of appropriate bed linens |
|
|
|
Hygiene/grooming items |
|
|
|
|
|
|
|
Towels |
|
|
|
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
Window/Door Screens are intact or Air Conditioning |
|
|
|
Drainage sites are clear |
|
|
|
Garbage storage areas properly maintained |
|
|
|
Irrigation/sprinkler systems free of leaks |
|
|
|
Lawn and landscaping are properly maintained |
|
|
|
Stagnant water sites drained |
|
|
|
Recreational areas properly maintained |
|
|
|
Parking areas/driveways are properly maintained |
|
|
|
Outdoor containers properly maintained |
|
|
|
|
|
|
|
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
Posters with phone numbers for UAC to report sexual abuse/harassment |
|
|
|
Care Provider AND ORR Pamphlets on sexual abuse/harassment |
|
|
|
Notice to Pregnant Females (Garza vs. Azar) next to posters |
|
|
|
Booklets on “A Woman’s Right to Know” in areas where reading materials and pamphlets are available |
|
|
|
Notice to Pregnant Females (support for pregnancy) next to posters |
|
|
|
Extra copies of UAC grievance forms |
|
|
|
Grievance Procedures (in common areas) |
|
|
|
Program Rules |
|
|
|
Saravia Notice (English and Spanish posted next to Garza and Sexual Abuse/Harassment notices) – posting currently applicable to Secure, Staff Secure and RTC – effective 10/22/2020 |
|
|
|
|
|
|
|
|
Compliant? |
|
Compliant? |
||||
|
Y |
N |
n/a |
|
Y |
N |
n/a |
UAC provided appropriate clothing/footwear |
|
|
|
Sufficient supply of Mosquito Repellant |
|
|
|
UAC/Staff provided/wearing face masks and/or offered face masks, as applicable |
|
|
|
UAC personal property/valuables kept by program maintained in a secure location |
|
|
|
Sufficient supply of Mosquito Repellant |
|
|
|
Emergency Evacuations Notification List (must be posted in office area and includes: ORR contacts, DHS contact, and local law enforcement) |
|
|
|
Car Seats (if transporting young children) |
|
|
|
Special needs vehicle (if applicable) |
|
|
|
Sufficient supply of Face Mask / Hand Sanitizers / Gloves |
|
|
|
|
|
|
|
No Touch Thermometers available |
|
|
|
|
|
|
|
Walkthrough NOTES
|
|
|
|
|
|
|
|
|
|
On-Site Monitoring Checklist - Other
|
Observed? |
|
Observed? |
||||
Services to Potentially Observe |
Y |
N |
n/a |
|
Y |
N |
n/a |
Education |
|
|
|
Group counseling/community meeting |
|
|
|
Recreation – large muscle, outdoors |
|
|
|
Chores |
|
|
|
Meals |
|
|
|
Vocational (if applicable) |
|
|
|
|
Reviewed? |
|
Reviewed? |
||||
Logs/Schedules to Potentially Review |
Y |
N |
n/a |
|
Y |
N |
n/a |
Fire Drills Logs |
|
|
|
Group Counseling Curriculum |
|
|
|
Daily (Shift) logs |
|
|
|
Chore assignments |
|
|
|
System for inspecting vehicles |
|
|
|
Visitor Logs |
|
|
|
Prescription/Non-prescription medication logs |
|
|
|
Vocational curriculum (if applicable) |
|
|
|
Spot Inspections and Quarterly Safety Assessments |
|
|
|
Case File Review (Quarterly) |
|
|
|
Facility inspection checklist (safety check) |
|
|
|
Care Provider Policies for UAC to Request Emergency and Non-Emergency Health Care Services |
|
|
|
Grievance binder |
|
|
|
UAC Temperature Tracker |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other NOTES
Services to Observe |
|
Logs to Review |
|
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF
PUBLIC BURDEN: The purpose of this information collection is to
allow ORR Monitoring Team staff to document their findings during
the walkthrough portion of biennial site visits. Public reporting
burden for this collection of information is estimated to average 4
hours per response (if the site visit is performed by a contractor
monitor), including the time for reviewing instructions, gathering
and maintaining the data needed, and reviewing the collection of
information. This is a mandatory collection of information
(Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection
of information subject to the requirements of the Paperwork
Reduction Act of 1995, unless it displays a currently valid OMB
control number. If you have any comments on this collection of
information please contact UACPolicy@acf.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2021-02-15 |