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Final WIA Adult and Dislocated Worker Review Tool 2011-12

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Final WIA Adult and Dislocated Worker Review Tool 2011-12 Powered By Docstoc
					                    2011-2012 Workforce Investment Act
                                                                                                                                                                      On-site
                        Adult and Dislocated Worker                                                    References                       Location of Data
                                                                                                                                                                      Review
               RWB ____ On-Site Quality Assurance Review Tool


                                                                                                                                 DEO sample selection
    Review Period:                                                                                                                                                              1   2   3   4   5
                                                                                                                                 DEO sample selection
    Participant Last Name:                                                                                                                                                      0   0   0   0   0
                                                                                                                                 DEO sample selection
    Participant First Name:                                                                                                                                                     0   0   0   0   0
                                                                                                                                 State MIS Application or Hard copy
    SSN (last four digits):                                                                                                                                                                     0
                                                                                                                                                                                0   0   0   0
                                                                                                                                 State MIS Application or Hard copy
    Case Manager:                                                                                                                                                               0   0   0   0   0
    Special Project Contractor's Name:
    Special Project Name:
    Reviewer Name:
    Dates of On-Site Review:
                                PROGRAM ELIGIBILITY

                                                                                                                                 State MIS or Hard/Electronic Case
1   Indicate whether participant is an Adult (A) or Dislocated Worker (DW).                                                                                             X
                                                                                                                                  File Supporting Documentation.

    If an Adult, was priority of service in effect for the region at the time of              20 CFR 663.600, WIA Sec. 134          State MIS or Hard/Electronic
2   registration? (Y, X) (Note: X=priority of service was not in effect at time of            (d)(4)(A), and Local Workforce            Case File Supporting            X
    registration).                                                                                      Service Plan                      Documentation


    If yes to # 2, was the Adult determined low income under the priority of service
    rule as described in the local plan and was there documentation in the file to
                                                                                              20 CFR 663.600, WIA Sec. 134          State MIS or Hard/Electronic
    support the low income determination? (Y, N, X) (Note: X= Priority of service was
3                                                                                             (d)(4)(A), and Local Workforce            Case File Supporting            X
    not in effect at time of registration, low-income was not applicable to the                         Service Plan                      Documentation
    participant, or participant was a Dislocated Worker or Incumbent Worker) (Note:
    Only applicable if received Intensive or Training services).


    If a Dislocated Worker, did the case file contain documentation of lay-off,                                                     State MIS or Hard/Electronic
                                                                                              WIA Sec. 101(9) and (10), WIA             Case File Supporting
4   termination, plant closure, or other eligible Dislocated Worker criteria? (Y, N, X)                                                                                 X
                                                                                                    Resource Guide                   Documentation (Note: self-
    (Note: X=Participant was not determined eligible as a Dislocated Worker).                                                         attestation is acceptable)

    Was documentation in the case file that the participant was 18 years of age or          20 CFR 663.110, WIA Sec. 101(1),         Hard/Electronic Case File
5                                                                                                                                                                       X
    older at registration? (Y, N).                                                               WIA Resource Guide                  Supporting Documentation


    Was documentation in the case file of U.S. citizenship or authorization to work in       29 USC 2938(a)(5), WIA Sec.188          Hard/Electronic Case File
6                                                                                                                                                                       X
    the U.S.? (Y, N).                                                                          (a)(5), WIA Resource Guide,           Supporting Documentation


    If required, was documentation in the case file of Selective Service Registration or
                                                                                            29 USC 2939(h), WIA Sec.189(h),
    an allowable exemption? (Y, N, X) (Note: X= exempt from selective service                                                        Hard/Electronic Case File
7                                                                                              WIA Resource Guide, Local                                                X
    registration) (Note: federal requirement for males born on or after January 1,                                                   Supporting Documentation
                                                                                                Workforce Service Plan,
    1960).

                                          Veterans

                                                                                            20 CFR 1010; WIA Sec. 168, TEGL         State MIS or Hard/Electronic
    If the participant was a veteran, did the file contain documentation to verify
8                                                                                          14-08, and Local Workforce Service           Case File Supporting            X
    veteran status? (Y, N, X) (Note: X= Participant was not a veteran.).                                 Plan                             Documentation


    If the participant was an eligible spouse of a veteran, did the file contain           20 CFR 1010, JVA(38 U.S.C. 4215(a))      State MIS or Hard/Electronic
9   documentation to verify eligible spouse of a veteran status?(Y, N, X) (Note: X=            Sec. 2(a),TEGL 14-08, Local              Case File Supporting            X
    Participant was not an eligible spouse of a veteran.).                                       Workforce Service Plan                   Documentation




    Last Updated:
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     Participant Last Name:                                                                                                                                              0   0   0   0   0
                                                                                                                                DEO sample selection
     Participant First Name:                                                                                                                                             0   0   0   0   0
                                                                                                                                State MIS Application or Hard copy
     SSN (last four digits):                                                                                                                                                             0
                                                                                                                                                                         0   0   0   0
                                                                                                                                State MIS Application or Hard copy
     Case Manager:                                                                                                                                                       0   0   0   0   0
     Special Project Contractor's Name:
     Special Project Name:
     Reviewer Name:
     Dates of On-Site Review:
                        ASSESSMENT and PROGRAM ACTIVITIES
                                        Core Services

                                                                                                                                   State MIS or Hard/Electronic
     Was documentation in the case file of a Core service such as an initial                   20 CFR 663.160(a), WIA Sec.
10                                                                                                                                     Case File Supporting          X
     assessment or job search and placement assistance? (Y, N).                               134(d)(2), WIA Resource Guide,
                                                                                                                                         Documentation

                                     Intensive Services


                                                                                                                                   State MIS or Hard/Electronic
     Was an Intensive service entered in the State's MIS? (Y, X) (Note: X = Participant  20 CFR 663.200(a) and 220, WIA
11                                                                                                                                     Case File Supporting          X
     received Core services only) (If X, questions 12 and 13 will also be X).           Sec. 134(d)(3), WIA Resource Guide
                                                                                                                                         Documentation



     If yes to #11, was documentation in the case file of an Intensive service such as a                                    State MIS or Hard/Electronic Case
                                                                                         20 CFR 663.220, 240, and 245, WIA
12   jointly developed Individual Employment Plan (IEP) or Individual Counseling and                                         File Supporting Documentation,          X
                                                                                         Sec. 134(d)(3), WIA Resource Guide
     Career Plan? (Y, N, X) (Note: X = Participant received Core services only).                                                       Case Notes




     If yes to #12, was documentation in the case file of a determination of need for       20 CFR 663.160(b), 220, 240(b), WIA State MIS or Hard/Electronic Case
13   Intensive services to gain/obtain employment, or retain employment leading to            Sec. 134(d)(3)(ii), WIA Resource   File Supporting Documentation,      X
     "self-sufficiency"? (Y,N,X) (Note: X= Participant received Core services only).                       Guide                           Case Notes




                                      Work Experience
     Did the individual participate in Work Experience (WE)? (Y, X) (Note: X =
                                                                                                                                State MIS or Hard/Electronic Case
14   Participant did not receive a WE activity). (If X, questions 15 through 19 will also      Local Workforce Service Plan
                                                                                                                                 File Supporting Documentation
     be X).

     If yes to #14, was a WE training agreement executed between the employer and
                                                                                                                                State MIS or Hard/Electronic Case
15   the Region for the participant's training? (Y,N,X) (Note: X = Participant did not         Local Workforce Service Plan
                                                                                                                                 File Supporting Documentation
     receive a WE activity).


     Was documentation in the case file that the WE start date was on or after the
                                                                                             Local Workforce Service Plan and   State MIS or Hard/Electronic Case
16   employer's WE training agreement effective date? (Y, N) (Note: X = Participant                                                                                  X
                                                                                                 WE contract agreement           File Supporting Documentation
     did not receive a WE activity).

     Was the WE training provided as described in the WE Training Plan? (Y, N)               Local Workforce Service Plan and   State MIS or Hard/Electronic Case
17
     (Note: X = Participant did not receive a WE activity).                                       WE contract agreement          File Supporting Documentation


                                                                                                CFR 20 663.200, Fair Labor
                                                                                                                                State MIS or Hard/Electronic Case
18   Was this a paid WE? (Y,X) (Note: X=Participant did not receive paid WE)                  Standards Act, Local Workforce
                                                                                                                                 File Supporting Documentation
                                                                                                      Service Plan


     If yes to #18, was the participant paid the wage stated in the agreement and were         CFR 20 663.200, Fair Labor
                                                                                                                                State MIS or Hard/Electronic Case
19   FLSA requirements met? (Y, N) (Note: X = Participant did not receive a WE              Standards Act and Local Workforce
                                                                                                                                 File Supporting Documentation
     activity).                                                                                       Service Plan




     Last Updated:
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     Participant Last Name:                                                                                                                                                   0   0   0   0   0
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     Participant First Name:                                                                                                                                                  0   0   0   0   0
                                                                                                                                   State MIS Application or Hard copy
     SSN (last four digits):                                                                                                                                                                  0
                                                                                                                                                                              0   0   0   0
                                                                                                                                   State MIS Application or Hard copy
     Case Manager:                                                                                                                                                            0   0   0   0   0
     Special Project Contractor's Name:
     Special Project Name:
     Reviewer Name:
     Dates of On-Site Review:

                          Occupational/Skills Upgrade Training


     Was an Occupational/Skills Upgrade Training activity entered in the State's MIS?                                              State MIS or Hard/Electronic Case
                                                                                             WIA Resource Guide, Special Project
20   (Y, N, X) (Note: X = Participant did not receive Occupational/Skills Upgrade                                                   File Supporting Documentation,        X
                                                                                                         Contract
     Training services) (If X, questions 21 through 24 will also be X).                                                                       Case Notes



     Was documentation in the case file of a determination of need for training
                                                                                                20 CFR 663.240 and 310, WIA        State MIS or Hard/Electronic Case
     services as identified in the IEP, comprehensive assessment, or Individual
21                                                                                             Sec.134(d)(4)(A), WIA Resource       File Supporting Documentation,
     Counseling and Career Plan? (Y, N, X) (Note: X = Participant did not receive                          Guide                              Case Notes
     Occupational/Skills Upgrade Training services).


     If Occupational Skills or Skills Upgrade Training was provided, was the training in     20 CFR 663 subpart E, WIA Sec. 134
                                                                                                                                   State MIS or Hard/Electronic Case
                                                                                              (d)(4)(G)(iii), WIA Sec. 122 (e)(4),
22   a local/state demand occupation? (Y, N, X). (Note: X = Participant did not receive                                             File Supporting Documentation,        X
                                                                                                WIA Sec. 117(f)(1)(B)(III), WIA
     Occupational/Skills Upgrade Training services).                                                                                          Case Notes
                                                                                                       Resource Guide


     Was the training provider on the local/state approved eligible training provider list   20 CFR 663 Subpart E; WIA Sec.122,
                                                                                                                                      AWI website, Local Eligible
23   (ETPL)? (Y, N, X). (Note: X = Participant did not receive Occupational/Skills              WIA Sec. 134(d)(4), WIA Sec.                                              X
                                                                                                                                        Training Provider List
     Upgrade Training services).                                                             112(17)(A)(iii), WIA Resource Guide


                                                                                                                             State MIS, Program Page, or
     If an Individual Training Account (ITA) was utilized, were ITA costs recorded in the AWI FG 069, 20 CFR 663 Subpart D,
                                                                                                                               Hard/Electronic Case File
24   Training Enrollment Cost table in the State's MIS? (Y, N, X). (Note: X =                 WIA Sec.134(d)(4)(G), WIA
                                                                                                                            Supporting Documentation, Case
     Participant did not receive Occupational/Skills Upgrade Training services).          Sec.122(e)(5), WIA Resource Guide
                                                                                                                                        Notes

                                    Work-Based Training
                                                                                                                                   State MIS or Hard/Electronic Case
     Was the participant an employed worker at the time of registration? (Y, N). (If No,
25                                                                                                                                  File Supporting Documentation,        X
     questions 26 through 29 will also be X).                                                                                                 Case Notes

     If yes to #25, and the participant was not referred by an employer, is there
     documentation in the case file indicating that the participant was not earning a self-
                                                                                             20 CFR 663.310, 220 and 230, WIA Local self-sufficiency policy, State
     sufficient wage at the time of registration, was in need of training services to
26                                                                                          134(d)(3)(ii), Sec.134(d)(4)(A)(ii), WIA MIS, Program Page, Case Notes        X
     obtain or retain employment leading to "self-sufficiency", and was the participant                 Resource Guide                      and/or hard copy
     in agreement with the training selection? (Y, N, X) (Note: X = Referred by an
     employer).


     If yes to #25, and the participant was referred by an employer, is there
     documentation in the case file from the employer indicating the participant was in         20 CFR 663.720 and 310, WIA        Local self-sufficiency policy, State
27   need of WIA training services in order to obtain or retain employment that leads to      Sec.134(d)(4)(A)(ii), WIA Resource    MIS, Program Page, Case Notes         X
     self-sufficiency as described in local policy? (Y, N, X) (Note: X = Not referred by                    Guide                           and/or hard copy
     an employer).



     If an IWT waiver was used, was documentation in the case file that the participant     AWI Memorandum dated May 31,
                                                                                                                             State MIS or Hard/Electronic Case
                                                                                            2011-Layoff Aversion Incumbent
28   met the waiver requirements in effect at the time of registration? (Y, N, X) (Note: X                                    File Supporting Documentation,              X
                                                                                           Worker Training, TEGL 26-09, TEGL
     = Waiver was not used).                                                                                                            Case Notes
                                                                                                          30-09

     If yes to #28, was the correct activity code(s) entered in the State MIS indicating
                                                                                              AWI Memorandum dated May 31,         State MIS or Hard/Electronic Case
     the use of the IWT waiver? (Y, N, X) (X = Waiver was not used). (Note: IWT
29                                                                                            2011-Layoff Aversion Incumbent        File Supporting Documentation,
     waiver codes - 190, 290 and 390 prior to October 10, 2011; IWT waiver codes                     Worker Training                          Case Notes
     191, 291 and 391 after October 11, 2011).




     Last Updated:
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     Participant Last Name:                                                                                                                                               0   0   0   0   0
                                                                                                                                 DEO sample selection
     Participant First Name:                                                                                                                                              0   0   0   0   0
                                                                                                                                 State MIS Application or Hard copy
     SSN (last four digits):                                                                                                                                                              0
                                                                                                                                                                          0   0   0   0
                                                                                                                                 State MIS Application or Hard copy
     Case Manager:                                                                                                                                                        0   0   0   0   0
     Special Project Contractor's Name:
     Special Project Name:
     Reviewer Name:
     Dates of On-Site Review:
                            On-The-Job/Customized Training

     Was On-The-Job (OJT) or Customized Training (CT) provided to the participant?             20 CFR 663.700-710, WIA Sec.
                                                                                                                                 State MIS or Hard/Electronic Case
30   (Y, X) (Note: X = Participant did not receive OJT or CT) (If X, questions 31             101(8), WIA Resource Guide, and
                                                                                                                                  File Supporting Documentation
     through 37 will also be X).                                                                Local Workforce Service Plan


                                                                                               20 CFR 663.700-710, WIA Sec.
                                                                                                                                 State MIS or Hard/Electronic Case
31   If yes to #30, indicate the type of training provided (OJT or CT).                       101(8), WIA Resource Guide, and
                                                                                                                                  File Supporting Documentation
                                                                                                Local Workforce Service Plan


     Was an OJT/CT agreement executed between the employer and the Region for                  20 CFR 663.700-710, WIA Sec.
                                                                                                                                 State MIS or Hard/Electronic Case
32   the participant's training position? (Y, N, X) (Note: X = Participant did not receive    101(8), WIA Resource Guide, and                                         X
                                                                                                                                  File Supporting Documentation
     OJT or CT).                                                                                Local Workforce Service Plan


                                                                                              AWI FG 00-009, 20 CFR 663.700-
     Is documentation in the case file of the referral to the OJT employer? (Y, N, X)   710, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
33                                                                                                                                                                    X
     (Note: X = Participant did not receive OJT) (Note: Question not applicable to CT). Guide, and Local Workforce Service File Supporting Documentation
                                                                                                            Plan


                                                                                               AWI FG 00-009, 20 CFR 663.700-
     If the participant was provided OJT, does the job title on the referral match the
                                                                                             710, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
34   occupation listed in the participant's IEP or case notes? (Y, N, X) (Note: X =                                                                                   X
                                                                                             Guide, and Local Workforce Service  File Supporting Documentation
     Participant did not receive OJT) (Note: Question not applicable to CT).                                Plan


     Is documentation in the case file that the participant's OJT/CT start date was on         20 CFR 663.700-710, WIA Sec.
                                                                                                                                 State MIS or Hard/Electronic Case
35   or after the employer's OJT/CT contract effective date? (Y, N, X) (Note: X =             101(8), WIA Resource Guide, and                                         X
                                                                                                                                  File Supporting Documentation
     Participant did not receive OJT or CT).                                                    Local Workforce Service Plan


     Was a copy of the OJT/CT outline in the participant's case file detailing the skills   AWI FG 00-009, 20 CFR 663.700-
                                                                                          720, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
36   to be attained, the duration of the training and the wage rate? (Y, N, X) (Note: X =                                                                             X
                                                                                          Guide, and Local Workforce Service  File Supporting Documentation
     Participant did not receive OJT or CT).                                                             Plan

     Was the training provided as described in the OJT/CT agreement? (Y,N,X)                   AWI FG 00-009, 20 CFR 663.700-
                                                                                             720, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
37   (Note: X = Participant did not receive OJT or CT). Comment: The use of                                                                                           X
                                                                                             Guide, and Local Workforce Service  File Supporting Documentation
     waivers is covered in the OJT and Customized Training Agreement Checklist                              Plan




     Last Updated:
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     Participant Last Name:                                                                                                                                              0   0   0   0   0
                                                                                                                                DEO sample selection
     Participant First Name:                                                                                                                                             0   0   0   0   0
                                                                                                                                State MIS Application or Hard copy
     SSN (last four digits):                                                                                                                                                             0
                                                                                                                                                                         0   0   0   0
                                                                                                                                State MIS Application or Hard copy
     Case Manager:                                                                                                                                                       0   0   0   0   0
     Special Project Contractor's Name:
     Special Project Name:
     Reviewer Name:
     Dates of On-Site Review:
                                CREDENTIAL ATTAINMENT

     If a credential attainment was entered in the MIS, was documentation in the
                                                                                            TEGL17-05, TEGL 14-08, TEGL15- State MIS or Hard/Electronic Case
38   participant's case file to support the credential? (Y, N, X) (Note: X = no credential                                                                           X
                                                                                           10, TEGL17-09, WIA Resource Guide, File Supporting Documentation
     entered in MIS).
     If yes to #38, was the credential attainment date and type match the credential         TEGL17-05, TEGL 14-08, TEGL15- State MIS or Hard/Electronic Case
39                                                                                                                                                                   X
     attainment information entered in the MIS? (Y, N, X).                                  10, TEGL17-09, WIA Resource Guide, File Supporting Documentation

                               GRIEVANCE/COMPLAINT FORM

     Was a signed and dated Grievance/Complaint and EEO/Discrimination Form in                AWI FG 00-004 rev. 06/08/07, 20    Signed and Dated Hard/electronic
40                                                                                                                                                                   X
     the participant's case file? (Y, N).                                                      CFR 667.600, WIA Sec.181(c)       copy (supporting documentation)

     If yes to #40, did the Grievance/Complaint and EEO/Discrimination Form include
                                                                                              AWI FG 00-004 rev. 06/08/07, 20    Signed and Dated Hard/electronic
41   correct names and addresses for filing a grievance, appeal or EEO complaint? (Y,                                                                                X
                                                                                               CFR 667.600, WIA Sec.181(c)       copy (supporting documentation)
     N).

                                  SUPPORTIVE SERVICES

     Was a supportive service activity entered in EFM? (Y, N, X) (Note: X =                    20 CFR 663 Subpart H, 20 CFR
                                                                                                                                State MIS or Hard/Electronic Case
42   Participant did not receive a support service). (If X, questions 43 and 44 will also   663.245, 815, 820,840, WIA Resource
                                                                                                                                 File Supporting Documentation
     be X).                                                                                                Guide

                                                                                               20 CFR 663 Subpart H, 20 CFR
     Did the supportive services in the case file match supportive service activities                                           State MIS or Hard/Electronic Case
43                                                                                          663.245, 815, 820,840, WIA Resource                                      X
     entered in EFM? (Y, N, X) (Note: X = no supportive service was provided).                                                   File Supporting Documentation
                                                                                                           Guide


     Was documentation in the case file to show that the support services were issued    20 CFR 663 Subpart H, 20 CFR
                                                                                                                          State MIS or Hard/Electronic Case
44   in accordance with local policy? (Y, N, X) (X = No supportive service was        663.245, 815, 820,840, WIA Resource                                            X
                                                                                                                           File Supporting Documentation
     provided).                                                                                      Guide




     Last Updated:
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     Participant Last Name:                                                                                                                                            0   0   0   0   0
                                                                                                                              DEO sample selection
     Participant First Name:                                                                                                                                           0   0   0   0   0
                                                                                                                              State MIS Application or Hard copy
     SSN (last four digits):                                                                                                                                                           0
                                                                                                                                                                       0   0   0   0
                                                                                                                              State MIS Application or Hard copy
     Case Manager:                                                                                                                                                     0   0   0   0   0
     Special Project Contractor's Name:
     Special Project Name:
     Reviewer Name:
     Dates of On-Site Review:

                                  EXIT and FOLLOW-UP

     Was the participant exited in EFM? (Y, N) (N = Case is open or there is a WIA                                            State MIS or Hard/Electronic Case
45                                                                                                WIA Resource Guide                                               X
     case closure but no exit) (If No, questions 46 and 49 will also be X).                                                    File Supporting Documentation

     If yes to #45, and the participant exited with employment, was documentation in                                          State MIS or Hard/Electronic Case
     the case file that the employment start date and wage information were verified       WIA Resource Guide, Federal Data     File Supporting Documentation,
46
     and accurately entered in the State's MIS? (Y, N, X). (X = Participant did not exit        Validation Requirement         Job Placement Verification, case
     with employment).                                                                                                                       notes


     Were required follow-ups made for each of the 1st, 2nd, 3rd, and 4th quarter after WIA Resource Guide, TEGL 17-05,
                                                                                                                          State MIS or Hard/Electronic Case
47   exit intervals, as applicable? (Y,N,X) (Note: X = Participant's case is currently  and Follow-up Memorandum 3/23/07,                                          X
                                                                                                                           File Supporting Documentation
     open or follow-up is not due).                                                       Master Cooperative Agreement

                                                                                            WIA Resource Guide, TEGL 17-05,
                                                                                                                             State MIS or Hard/Electronic Case
48   Were the follow-up contacts timely? (Y, N, X)                                         and Follow-up Memorandum 3/23/07,                                       X
                                                                                                                              File Supporting Documentation
                                                                                             Master Cooperative Agreement

                                                                                            WIA Resource Guide, TEGL 17-05,
     Was employment information correctly entered in the follow-up fields in EFM for                                         State MIS or Hard/Electronic Case
49                                                                                         and Follow-up Memorandum 3/23/07,                                       X
     each applicable quarter and properly verified? (Y, N, X)                                                                 File Supporting Documentation
                                                                                             Master Cooperative Agreement




     Legend:

     Finding - Requires Corrective Action

     Systemic Deficiency - Error Rate Greater Than 20%




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0               0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
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0               0    0    0    0    0    0    0    0    0    0
0               0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0




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0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0

0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0
                                                        0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0




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0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0
                                                        0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0




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0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0
                                                        0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0
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0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0
                                                        0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0




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0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0
                                                        0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0
0               0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0




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41              42   43   44   45   46   47   48   49

0               0    0    0    0    0    0    0    0

0               0    0    0    0    0    0    0    0
0               0    0    0    0    0    0    0    0

0               0    0    0    0    0    0    0    0




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0               0   0   0   0   0   0   0   0

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                                                        RWB XX          2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                                        Review
                                                                   Period: ________________________



                                                                                                     Adult       Dislocated Worker   N/A     Total
  1     Indicate whether participant is an Adult (A) or Dislocated Worker (DW).                        0                  0           0       0
                                               Percent                                               0.0%              0.0%

                                                                                                      Yes              N/A           Total

        If an Adult, was priority of service in effect for the region at the time of registration?
  2                                                                                                    0                0             0
        (Y, X) (Note: X=priority of service was not in effect at time of registration).

                                                 Percent                                             0.0%



                                                                                                      Yes               No           N/A     Total

        If yes to # 2, was the Adult determined low income under the priority of service rule
        as described in the local plan and was there documentation in the file to support
        the low income determination? (Y, N, X) (Note: X= Priority of service was not in
  3                                                                                                    0                0             0       0
        effect at time of registration, low-income was not applicable to the participant, or
        participant was a Dislocated Worker or Incumbent Worker) (Note: Only applicable
        if received Intensive or Training services).

                                                 Percent                                             0.0%              0.0%



                                                                                                      Yes               No           N/A     Total


        If a Dislocated Worker, did the case file contain documentation of lay-off,
  4     termination, plant closure, or other eligible Dislocated Worker criteria? (Y, N, X)            0                0             0       0
        (Note: X=Participant was not determined eligible as a Dislocated Worker).


                                                 Percent                                             0.0%              0.0%



                                                                                                      Yes               No           Total



        Was documentation in the case file that the participant was 18 years of age or
  5                                                                                                    0                0             0
        older at registration? (Y, N).



                                                 Percent                                             0.0%              0.0%



                                                                                                      Yes               No           Total
        Was documentation in the case file of U.S. citizenship or authorization to work in
  6                                                                                                    0                0
        the U.S.? (Y, N).
                                             Percent                                                 0.0%              0.0%

                                                                                                      Yes               No           N/A     Total
        If required, was documentation in the case file of Selective Service Registration or
  7     an allowable exemption? (Y, N, X) (Note: X= exempt from selective service                      0                0             0       0
        registration) (Note: federal requirement for males born on or after January 1,
        1960).
                                               Percent                                               0.0%              0.0%

                                                                                                      Yes               No           N/A     Total

        If the participant was a veteran, did the file contain documentation to verify veteran
  8                                                                                                    0                0             0       0
        status? (Y, N, X) (Note: X= Participant was not a veteran.).

                                                 Percent                                             0.0%              0.0%

                                                                                                      Yes               No           N/A     Total
        If the participant was an eligible spouse of a veteran, did the file contain
  9     documentation to verify eligible spouse of a veteran status?(Y, N, X) (Note: X=                0                0             0       0
        Participant was not an eligible spouse of a veteran.).
                                                 Percent                                             0.0%              0.0%

                                                                                                      Yes               No           Total

        Was documentation in the case file of a Core service such as an initial assessment
  10                                                                                                   0                0             0
        or job search and placement assistance? (Y, N).


                                                                                  Page 73
                                                      RWB XX         2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                      Review
                                                                Period: ________________________



                                               Percent                                            0.0%        0.0%

                                                                                                   Yes        No     N/A   Total
        Was an Intensive service entered in the State's MIS? (Y, X) (Note: X = Participant
  11                                                                                                0          0     0      0
        received Core services only) (If X, questions 12 and 13 will also be X).
                                               Percent                                            0.0%        0.0%

                                                                                                   Yes        No     N/A   Total

        If yes to #11, was documentation in the case file of an Intensive service such as a
  12    jointly developed Individual Employment Plan (IEP) or Individual Counseling and             0          0     0      0
        Career Plan? (Y, N, X) (Note: X = Participant received Core services only).

                                               Percent                                            0.0%        0.0%

                                                                                                   Yes        No     N/A   Total

        If yes to #12, was documentation in the case file of a determination of need for
  13    Intensive services to gain/obtain employment, or retain employment leading to "self-        0          0     0      0
        sufficiency"? (Y,N,X) (Note: X= Participant received Core services only).

                                               Percent                                            0.0%        0.0%


                                                                                                   Yes        No     N/A   Total
        Did the individual participate in Work Experience (WE)? (Y, X) (Note: X =
  14    Participant did not receive a WE activity). (If X, questions 15 through 19 will also be     0          0     0      0
        X).
                                               Percent                                            0.0%        0.0%




                                                                               Page 74
                                                      RWB XX          2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                         Review
                                                                 Period: ________________________



                                                                                                    Yes        No     N/A     Total
        If yes to #14, was a WE training agreement executed between the employer and
  15    the Region for the participant's training? (Y,N,X) (Note: X = Participant did not            0          0      0       0
        receive a WE activity).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was documentation in the case file that the WE start date was on or after the
  16    employer's WE training agreement effective date? (Y, N) (Note: X = Participant               0          0      0       0
        did not receive a WE activity).
                                             Percent                                              0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was the WE training provided as described in the WE Training Plan? (Y, N) (Note:
  17                                                                                                 0          0      0       0
        X = Participant did not receive a WE activity).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        N/A    Total
  18    Was this a paid WE? (Y,X) (Note: X=Participant did not receive paid WE)                      0          0      0
                                               Percent                                            0.0%

                                                                                                    Yes        No     N/A     Total
        If yes to #18, was the participant paid the wage stated in the agreement and were
  19    FLSA requirements met? (Y, N) (Note: X = Participant did not receive a WE                    0          0      0       0
        activity).
                                                Percent                                           0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was an Occupational/Skills Upgrade Training activity entered in the State's MIS?
  20    (Y, N, X) (Note: X = Participant did not receive Occupational/Skills Upgrade                 0          0      0       0
        Training services) (If X, questions 21 through 24 will also be X).
                                                Percent                                           0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was documentation in the case file of a determination of need for training services
        as identified in the IEP, comprehensive assessment, or Individual Counseling and
  21                                                                                                 0          0      0       0
        Career Plan? (Y, N, X) (Note: X = Participant did not receive Occupational/Skills
        Upgrade Training services).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total

        If Occupational Skills or Skills Upgrade Training was provided, was the training in a
  22    local/state demand occupation? (Y, N, X). (Note: X = Participant did not receive             0          0      0       0
        Occupational/Skills Upgrade Training services).

                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total


        Was the training provider on the local/state approved eligible training provider list
  23    (ETPL)? (Y, N, X). (Note: X = Participant did not receive Occupational/Skills                0          0      0       0
        Upgrade Training services).


                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        If an Individual Training Account (ITA) was utilized, were ITA costs recorded in the
  24    Training Enrollment Cost table in the State's MIS? (Y, N, X). (Note: X = Participant         0          0      0       0
        did not receive Occupational/Skills Upgrade Training services).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was the participant an employed worker at the time of registration? (Y, N). (If No,
  25                                                                                                 0          0      0       0
        questions 26 through 29 will also be X).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total

                                                                                Page 75
                                                      RWB XX          2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                         Review
                                                                 Period: ________________________




        If yes to #25, and the participant was not referred by an employer, is there
        documentation in the case file indicating that the participant was not earning a self-
        sufficient wage at the time of registration, was in need of training services to obtain
  26                                                                                                 0          0      0       0
        or retain employment leading to "self-sufficiency", and was the participant in
        agreement with the training selection? (Y, N, X) (Note: X = Referred by an
        employer).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     Total
        If yes to #25, and the participant was referred by an employer, is there
        documentation in the case file from the employer indicating the participant was in
  27    need of WIA training services in order to obtain or retain employment that leads to          0          0      0
        self-sufficiency as described in local policy? (Y, N, X) (Note: X = Not referred by
        an employer).
                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total


        If an IWT waiver was used, was documentation in the case file that the participant
  28    met the waiver requirements in effect at the time of registration? (Y, N, X) (Note: X        0          0      0       0
        = Waiver was not used).


                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total

        If yes to #28, was the correct activity code(s) entered in the State MIS indicating
        the use of the IWT waiver? (Y, N, X) (X = Waiver was not used). (Note: IWT
  29                                                                                                 0          0      0       0
        waiver codes - 190, 290 and 390 prior to October 10, 2011; IWT waiver codes
        191, 291 and 391 after October 11, 2011).

                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total

        Was On-The-Job (OJT) or Customized Training (CT) provided to the participant?
  30    (Y, X) (Note: X = Participant did not receive OJT or CT) (If X, questions 31 through         0          0      0       0
        37 will also be X).

                                               Percent                                            0.0%         0.0%



                                                                                                   OJT         CT     Total


  31    If yes to #30, indicate the type of training provided (OJT or CT).                           0          0      0


                                               Percent                                            0.0%         0.0%

                                                                                                    Yes        No     N/A     Total
        Was an OJT/CT agreement executed between the employer and the Region for
  32    the participant's training position? (Y, N, X) (Note: X = Participant did not receive        0          0      0       0
        OJT or CT).
                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     N/A     Total
        Is documentation in the case file of the referral to the OJT employer? (Y, N, X)
  33                                                                                                 0          0      0       0
        (Note: X = Participant did not receive OJT) (Note: Question not applicable to CT).
                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     N/A     Total
        If the participant was provided OJT, does the job title on the referral match the
  34    occupation listed in the participant's IEP or case notes? (Y, N, X) (Note: X =               0          0      0       0
        Participant did not receive OJT) (Note: Question not applicable to CT).
                                               Percent                                            0.0%         0.0%


                                                                                Page 76
                                                      RWB XX          2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                         Review
                                                                 Period: ________________________




                                                                                                    Yes        No     N/A     Total
        Is documentation in the case file that the participant's OJT/CT start date was on or
  35    after the employer's OJT/CT contract effective date? (Y, N, X) (Note: X =                    0          0      0       0
        Participant did not receive OJT or CT).
                                                Percent                                           0.0%         0.0%

                                                                                                    Yes        No     N/A     Total

        Was a copy of the OJT/CT outline in the participant's case file detailing the skills to
  36    be attained, the duration of the training and the wage rate? (Y, N, X) (Note: X =            0          0      0       0
        Participant did not receive OJT or CT).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     N/A     Total

        Was the training provided as described in the OJT/CT agreement? (Y,N,X) (Note:
  37                                                                                                 0          0      0       0
        X = Participant did not receive OJT or CT). Comment: The use of waivers is
        covered in the OJT and Customized Training Agreement Checklist
                                              Percent                                             0.0%         0.0%



                                                                                                    Yes        No     N/A     Total
        If a credential attainment was entered in the MIS, was documentation in the
  38    participant's case file to support the credential? (Y, N, X) (Note: X = no credential        0          0      0       0
        entered in MIS).
                                                 Percent                                          0.0%         0.0%


                                                                                                    Yes        No     N/A     Total

        If yes to #38, was the credential attainment date and type match the credential
  39                                                                                                 0          0      0       0
        attainment information entered in the MIS? (Y, N, X).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     Total

        Was a signed and dated Grievance/Complaint and EEO/Discrimination Form in the
  40                                                                                                 0          0      0
        participant's case file? (Y, N).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     Total

        If yes to #40, did the Grievance/Complaint and EEO/Discrimination Form include
  41    correct names and addresses for filing a grievance, appeal or EEO complaint? (Y,             0          0      0
        N).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     Total

        Was a supportive service activity entered in EFM? (Y, N, X) (Note: X = Participant
  42                                                                                                 0          0      0
        did not receive a support service). (If X, questions 43 and 44 will also be X).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     N/A     Total

        Did the supportive services in the case file match supportive service activities
  43                                                                                                 0          0      0       0
        entered in EFM? (Y, N, X) (Note: X = no supportive service was provided).

                                               Percent                                            0.0%         0.0%



                                                                                                    Yes        No     N/A     Total



                                                                                Page 77
                                                     RWB XX          2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool                                                                                      Review
                                                                Period: ________________________




        Was documentation in the case file to show that the support services were issued
  44    in accordance with local policy? (Y, N, X) (X = No supportive service was                   0          0     0      0
        provided).
                                               Percent                                           0.0%         0.0%

                                                                                                   Yes        No     N/A   Total
        Was the participant exited in EFM? (Y, N) (N = Case is open or there is a WIA
  45                                                                                                0          0     0      0
        case closure but no exit) (If No, questions 46 and 49 will also be X).
                                               Percent                                           0.0%         0.0%



                                                                                                   Yes        No     N/A   Total
        If yes to #45, and the participant exited with employment, was documentation in the
        case file that the employment start date and wage information were verified and
  46                                                                                                0          0     0      0
        accurately entered in the State's MIS? (Y, N, X). (X = Participant did not exit with
        employment).
                                               Percent                                           0.0%         0.0%



                                                                                                   Yes        No     N/A   Total
        Were required follow-ups made for each of the 1st, 2nd, 3rd, and 4th quarter after
  47    exit intervals, as applicable? (Y,N,X) (Note: X = Participant's case is currently open      0          0     0      0
        or follow-up is not due).
                                               Percent                                           0.0%         0.0%



                                                                                                   Yes        No     N/A   Total

  48    Were the follow-up contacts timely? (Y, N, X)                                               0          0     0      0

                                               Percent                                           0.0%         0.0%



                                                                                                   Yes        No     N/A   Total
        Was employment information correctly entered in the follow-up fields in EFM for
  49                                                                                                0          0     0      0
        each applicable quarter and properly verified? (Y, N, X)
                                               Percent                                           0.0%         0.0%




                                                                               Page 78
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                                                                                                   AGENCY FOR WORKFORCE INNOVATION
                                                                                       2007-2007 ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL




             Region XX Summary                 0   0   0   0   0   0       0   0       0   0       0   0   0   0   0       0   0   0   0   0   0

ID   LAST NAME, FIRST                SSN   1   2   3   4   5   6   7   8   9   10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26                  27   28   29   30   31   32   33   34   35   36   37   38   39   40   41   42   43   44   45   46   47   48   49
 1                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 2                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 3                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 4                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 5                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 6                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 7                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 8                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
 9                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
10                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
11                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
12                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
13                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
14                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
15                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
16                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
17                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
18                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
19                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
20                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
21                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
22                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
23                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
24                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
25                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
26                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
27                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
28                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
29                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
30                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
31                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
32                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
33                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
34                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
35                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
36                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
37                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
38                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
39                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
40                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
41                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
42                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
43                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
44                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
45                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
46                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
47                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
48                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
49                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
50                      0        0    0    0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0   0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0    0
                                                     AGENCY FOR WORKFORCE INNOVATION
                                    2006-2007 UNIVERSAL ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL

     SSN   Last Name   First Name    Region    County      One Stop   Unit       R/C/O/U    Case Manager   SP CODE   Case ID
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                 AGENCY FOR WORKFORCE INNOVATION
2006-2007 UNIVERSAL ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL
                 AGENCY FOR WORKFORCE INNOVATION
2006-2007 UNIVERSAL ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL
ITEM #          ELEMENT                                   INSTRUCTIONS

         Review Period:             The WIA Adult and Dislocated Worker Program quality
                                    assurance review period begin date is ________ the
                                    end date is determined by the Quality Assurance Review
                                    schedule
         Participant last name:
                                    This information is populated from the Sample Table.
         Participant first name:    This information is populated from the Sample Table.
         SSN (last four digits):    This information is populated from the Sample Table.
         Case manager name:         This information is populated from the Sample Table.
         Special Project
         Contractor's Name          This information is populated from the Sample Table.
         Special Project Name       This information is populated from the Sample Table.
         Reviewer Name:             Enter your name once at the COLON (:)
                                    Enter the date range for the on-site review at the COLON
         Dates of on site-review:   (:)

  1      Program Category


                                    This information is populated from the Sample Table.
  2      Priority of service        Check with the region to determine if they have the
                                    priority of service rule in effect. If so, determine if the
                                    participant is determined low income under this rule.
  3      Priority of service

                                    If priority of service is in effect, determine if the adult
                                    meets the low income criteria.
  4      Dislocated Worker
                                    Review participant's hard copy case file for
                                    documentation of lay-off, termination letter, plant closure
                                    or other eligible criteria (i.e., UC documents, letter from
                                    employer etc.)
  5      Age                        Adults/Dislocated workers must have documentation in
                                    the participant's hard copy case file that shows that they
                                    are 18 years of age or older at the time of first service.

  6      U. S. Citizen/Right to     All participants must document that they are a U.S.
         Work in the U.S.           Citizen or have the right to work in the U.S.
                          According to USDOL’s issuance entitled “Q’s and A’s”
                         – Transition/Closeout- April 1999, citizenship must be
                         verified for all individuals before WIA services are
                         provided.




                          Participation in programs and activities financially
                         assisted in whole or in part under this Act is open to
                         citizens and nationals of the United States, lawfully
                         admitted permanent resident aliens, lawfully admitted
                         refugees and parolees, and other individuals
                         authorized by the Attorney General to work in the
                         United States. In order to ensure that funds are not
                         improperly spent on of citizenship/authorization to work
                         Any documentation individuals, it is recommended that
                         in the United States that is accepted by the
                         Immigration and Naturalization Service can be
                         accepted by the one-stop operator




7   Selective Service   Proof of compliance with the Military Selective Service
    Registration        Act must be verified prior to enrollment or during
                        enrollment should the individual turn 18 during
                        participation. [Section 3(a) of the Military Selective
                        Service Act [50 U.S.C. App. § 453(a)]. Male individuals
                        may also register on-line at http://www.sss.gov/



                        Unless specifically stated otherwise, all male U.S
                        Citizens born after December 31, 1959, must register
                        while they are between the ages of 18 and 26 years.
                        More information on who must register is available at
                        http://www.sss.gov/PDFs/WhoMustRegisterChart.pdf
8   Veteran             Veteran status claimed on the WIA application must be
                        supported with documentation. Self-attestation is not
                        acceptable.
                            Additionally, the veteran must be given priority for
                            services (See 20 CFR 1010.230, published at 73 Fed.
                            Reg. 78132 on December 19, 2008)




                             (a) with respect to any qualified job training program,
                             that a covered person shall be given priority over a non-
                             covered person for the receipt of employment, training,
                             and placement services provided under that program,
                             notwithstanding any other provision of the law.




                             (b) Priority in the context of providing priority of service
                             to veterans and other covered persons in qualified job
                             training programs covered by this regulation means the
                             right to take precedence over non-covered persons in
                             obtaining services. Depending on the type of service or
                                (1) The covered person receives access to the
                                service or resource earlier in time than the non-
                                covered person; or



                               (2) If the service or resource is limited, the covered
                               person receives access to the service or resource
                               instead of or before the non-covered person.

9   Eligible spouse of an   A veteran or eligible spouse - Eligible spouse means the
    veteran                 spouse of any of the following:

                             (1) Any veteran who died of a service connected
                             disability;




                             (2) Any member of the Armed Forces serving on active
                             duty, who at the time of application for the priority, is
                             listed in one or more of the following categories and
                                (i) Missing listed for
                             has been so in action; a total of more than 90 days:


                               (ii) Captured in the line of duty by a hostile force; or
                               (iii) Forcibly detained or interned in line of duty by a
                               foreign government power; or




                              (3) Any veteran who has a total disability resulting from
                              a service connected disability, as evaluated by the
                              Department of Veterans Affairs;

                              (4) Any veteran who died while a total disability, as
                              indicated in Paragraph (3) of this definition, was in
                              existence.
10   Core Activity            Review participant's hard copy case file for
                              documentation of an assisted core-activity. For
                              example: WIA application.
11   Intensive Service        Review EFM to determine if an intensive service was
                              entered.
12   Intensive Service        Review participant's hard copy case file for
                              documentation of an intensive service. For example,
                              an individual employment plan (IEP), career plan, job
                              search etc.
13   Determination of need    Review participant's case file for determination of
     for intensive services   need. For example, case notes, IEP etc.
14   Work Experience (WE)     Review EFM to determine if a WE activity was entered
                              in EFM.
15   Work Experience (WE)-    Review the training agreement to ensure that the
     executed agreement       agreement was executed between the region and the
                              employer and that the agreement contained the
                              participant's training position.
16   Work Experience (WE)-    Review the participant's case file to ensure that the
     training date            participant's start date was on or after the training
                              agreement effective date.
17   Work Experience (WE)-    Review the participant's case file to ensure that the
     training                 training was provided as described in the agreement.
18   Work Experience (WE)-    Review the participant's agreement to determine if the
     pay or unpaid            WE was paid or unpaid.
19   Work Experience (WE)-    Review the participant's case file to ensure that the
     wage rate                participant was paid the wage stated in the agreement.

20   Occupational/Skills      Review EFM to determine if a training activity (300
     Upgrade Training         code) was entered.
21   Determination of Need    Review participant's case file/EFM case notes for
                              documentation that the participant was in need of
                              training services. Information should be found in the
                              IEP, comprehensive assessment, Individual
                              Counseling and Career Plan or case notes
22   Occupational/Skills      Review EFM to determine the type of training provided.
     Upgrade Training         After review, check the Regional Targeted
                              Occupational List to ensure that the training is in a
                              demand occupation.
23   Eligible Training Provider   Review EFM activities for the training provider
     List (ETPL)                  providing the Occupational/Skills Upgrade Training to
                                  the participant. Next, review the Local and/or State
                                  ETPL to ensure the training provider is an approved
24   ITA cost recorded in         provider. participant's hard copy case for an ITA
                                  Review the
     EFM                          voucher. Click the training activity in EFM to determine
                                  if the Occupational /Skills Upgrade Training costs were
                                  recorded in the Training Enrollment Cost Table.

25   Employed Participant at      Review participant's application to determine if the
     registration                 participant was employed at the time of registration.
26   Employed Participant not     Review participant's case file (hard copy or EFM case
     referred by an employer      notes) and the region's local self-sufficiency policy to
                                  ensure the participant's wages did not meet the local
                                  self-sufficiency definition at time of registration.


27   Employed Participant         Review participant's case file for documentation (i.e.,
     referred by an employer      letter from employer) that indicated participant was in
                                  need of services to obtain or retain employment.
28   IWT waiver                   Review participant's case file to determine if an IWT
                                  waiver was used. If a waiver was used ensure that the
                                  waiver requirements were met based on the
                                  requirements for the applicable time period.
29   IWT waiver-activity          IWT waiver codes should be entered in EFM if an IWT
     codes                        waiver is used. IWT waiver codes-190, 290, 390.


30   On-The- Job (OJT) or         Review EFM to determine if an OJT or CT activity was
     Customized Training          entered in EFM.
     (CT)
31   On-The- Job (OJT) or         Review EFM to determine the type of training
     Customized Training          provided.
     (CT)
32   On-The- Job (OJT) or         Review the training agreement to ensure that the
     Customized Training          agreement was executed between the region and the
     (CT) executed                employer and that the agreement contained the
     agreement                    participant's training position.
33   On-The- Job (OJT)            Review the participant's case file to ensure that a
     referral to the OJT          referral was given to the OJT employer.
     employer
34   On-the-Job Training          Review the participant's case file to ensure that the job
     (OJT) job title match        title on the referral match the occupation listed in the
                                  participant's IEP.
35   On-The- Job (OJT) or         Review the participant's case file to ensure that the
     Customized Training          participant's start date was on or after the contract
     (CT) start date              effective date.
36   On-the-Job Training          Review the participant's case file to ensure that the
     (OJT) skills, duration of    OJT training outline provided the skills to be attained,
     training and wage rate.      duration of training and the wage rate.



37   On-The- Job (OJT) or         Review the participant's case file to ensure that the
     Customized Training          training was provided as described in the agreement.
     (CT) training provided
38   Credentials entered in       Review EFM to determine if a credential was entered in
     EFM                          EFM and documentation obtained
39   Credential Attainment        If a credential was obtained and entered in the MIS,
     Date and Type                review the participant's hard copy case file for
                                  documentation of the credential and ensure that the
                                  type of credential and the credential attainment date
                                  matches the information recorded in the MIS.
40   Signed and dated WIA         RWBs are required to inform all WIA participants of the
     Grievance/Complaint          WIA grievance/complaint procedures. The individuals
     and EEO/Discrimination       are to complete the local grievance form attesting that
     Form                         they were informed of the procedure and that they
                                  received the completed form.
41   Signed and dated WIA         Review the form to ensure that it include the following:
     Grievance/Complaint          Complaints shall be sent to Agency for Workforce
     and EEO/Discrimination       Innovation, Office of General Counsel, 107 East
     Form                         Madison Street, MSC 110, Tallahassee, Florida, 32399-
                                  4128, or to the appropriate federal agency with a copy
                                  of the complaint sent to AWI Office of General
                                  Counsel.
42   Supportive service           Review EFM to determine if a support service was
                                  entered in EFM .
43   Supportive service           Review the participant case file to ensure that the
     documentation                supportive service matches the support service
                                  entered in EFM. Examples of supportive services are:
                                  transportation, uniforms etc. Refer to the region's local
                                  policy on if and what type of supportive services will be
                                  given. If Needs Related Payments are given, ensure
                                  that the Adult participant is unemployed, does not
                                  qualify or have ceased qualifying for unemployment
                                  compensation, and enrolled in a program of training
                                  services under WIA section 134(d)(4). For a dislocated
                                  worker, ensure that the participant is unemployed, has
                                  ceased to qualify for unemployment compensation or
                                  trade readjustment allowance under TAA or NAFTA-
                                  TAA, and is enrolled in a program of training services
                                  under WIA section 134(d)(4).

44   Support service-            Review the participant case file for documentation of a
     determination of need.      needs assessment. Refer to the region's local policy on if
                                 and what type of needs assessments will be given.

45   Employment and               Review EFM to determine if the participant was exited
     Termination                  in EFM.
46   Employment and            If the participant exited the WIA program, check the case
     Termination               file for employment at exit. If the participant exited with
                               employment, compare the Placement information in the
                               State MIS to the hard copy file to determine if the start
                               date and wage per hour match. Note: The case is open
                               or the participant is still receiving services when at least
                               one activity does not have a PROGRAM OUTCOME
                               (Activity End date) in EFM.

47   Follow-ups performed      Look at the EFM Follow-up Table for required follow-ups
     Quarters 1-4 After Exit
48   Timely Follow-ups          Review the participant's case file to ensure that the
                                follow-ups are conducted timely.
49   Follow-ups- Employment     Review EFM to determine if employment information
     information                was correctly entered in the follow-up fields in EFM for
                                each applicable quarter and properly verified.
                2011-2012 Workforce Investment Act

    Last Name       First Name        Last 4 SSN       Case Manager
0               0                 0                  0
0               0                 0                  0
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0               0                 0                  ///
            A

    Issue
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Adult and Dislocated Worker   RWB ____ On-S
RWB ____ On-Site Quality Assurance Review Tool

				
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posted:8/10/2012
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