MONITORING CHECKLIST - DOC by keara

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MONITORING CHECKLIST Pre-Monitoring
    Announcement Letter Last Monitoring Report Most Recent Audit Print Screens – HP Financial Contract screen #1 Payments screen #9 Expenditures #10 Comment screen #13 Budget Comparison #30 Monitoring Checklist Make copies of financial forms for each contract: 1. Transactions 2. Cash Disbursements Review most current Head Start Federal review  Examine findings  Obtain general impression of management of Head Start program Review current work program summary as compared to Quarterly Reports Separate checklist for First Start [Separate Implementation Manual] Separate checklist for ESG (cities, towns, counties) [Separate Implementation Manual]

      

CONTRACT NO. CSBG/CFN ESG HP HS Collab. HS Coord. SAF/CAA SAF/HS SEEDS Youth Restitution
Weatherization DOE/DHS

PROGRAM REPORTS DUE

RECEIVED

EXPENDITURE REPORTS DUE RECEIVED

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OKLAHOMA DEPARTMENT OF COMMERCE OFFICE OF COMMUNITY DEVELOPMENT MONITORING CHECKLIST COMMUNITY ACTION AGENCY MONITORING

AGENCY_______________________________________________________________ DATE (S) _______________________________________________________________ MONITOR______________________________________________________________

Monitoring letter mailed _______________

Response due_________________

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SIGN IN SHEET – AGENCY______________________________________________ DATE_______________ ENTRANCE NAME TITLE BOARD MEMBER / DIRECTOR, STAFF _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

__________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________

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EXIT NAME TITLE
BOARD MEMBER / DIRECTOR, STAFF

______________________
_____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

_________________________
_________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________

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GENERAL PROGRAM ADMINISTRATION PERSONNEL POLICIES (ODOC Requirement #101) Review Personnel Policies for compliance with standards. 1. Effective date of Policies _____________ 2. Statement of travel & travel allowances (ODOC Requirement #105) 3. List of items to be included in personnel records (Policies should list items specific to Agency) 4. Statement regarding accessibility to personnel files (Are files located in secured areas with limited access) 5. Certification of time and attendance records 6. Describes employee categories (Permanent, full time, etc.) 7. Describes employee performance appraisal procedures (When, who, etc.) 8. Prohibits discrimination 8A. Are discrimination policies posted? 9. Prohibits conflicts of interest and nepotism 10. Statements regarding employment of persons with criminal records 11. Statement that salaries and benefits to be consistent with prevailing compensation practices. 11A. Has the agency conducted wage comparability studies? 12. Details Fringe Benefits including leave and holidays 13. Prohibits receipt of gifts and/or gratuities Yes Yes No No

Yes

No

Yes Yes Yes

No No No

Yes Yes Yes Yes Yes

No No No No No

Yes Yes Yes

No No No

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14. Includes employee Grievance Procedure

Yes

No

15. Prohibit certain political activity (ODOC Requirement #104)

Yes

No No

16. “NO SMOKING” posted in facilities entered during the review OR a Yes “NO SMOKING” policy. Includes all facilities, funded in whole or part, in which children could enter, even if accompanied by their parents while their parents are seeking services or assistance and not just a facility that offers services for children. (CSBG CONTRACT PROVISION to comply with the Pro-Children Act of 1994) COMMENTS

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Review Personnel Records for compliance with Personnel Policies Personnel Record Reviewed
1. Resume and/or application for employment 2. Internal Revenue Service W-4 Exemption form 3. Current job description

4. All personnel actions

5. Performance evaluations

COMMENTS ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________________

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Affirmative Action (ODOC Requirement #102) 1. Date of current plan ______________________ 2. Equal employment policy 3. Responsibility for implementation 4. Evaluation of previous goals 5. Establish goals and timetables 6. Procedures for dissemination of the Plan 7. Internal evaluation procedures 8. Grievance procedures 9. Identification of the Equal Employment Opportunity Officer Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No

(NOTE: This policy should be updated annually)

COMMENTS

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Client Appeals & Complaint/Grievance Procedures (ODOC Requirement #103) 1. Date of current procedures _________________ 2. Initiation within ten (10) days 3. Final appeal to ODOC 4. Right of applicant 5. Right to private and confidential interviews 6. No discrimination based on race, gender, etc. 7. Timely approval or disapproval of application 8. Written notification of appeal procedures 9. Reasonable opportunity for fair hearing 10. Access to relevant records 11. Timely determination and prompt notice of hearing decision. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No

COMMENTS

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Requirements for Board of Directors (ODOC Requirement #201) 1. Board Size A. How many board members are required by the Board By-laws? _________ B. How many board members are currently seated? C. Why and how long have the seats been vacant? ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 2. Composition A. Number of public representatives seated compared to the number required? ______ / _____ _________

B. Number of low-income representatives seated compared to the number required? _____ / _____ C. Number of private representatives compared to the number required? 3. Selection Procedure Board Member Selection Documents Reviewed _____ / ______

[Review at least two representatives from each sector]

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4. Meeting and Quorum Requirements A. How many board meetings were required by the agency by-laws during the last 12 months? ________________ B. How many board meetings were held during the last 12 months? _____________

5. Open Meeting Act A. Has the board meeting schedule been filed with the county clerk? __________ B. Are board meeting agendas posted at the site of the meeting 24 hours in advance? ________________ C. Who is responsible for posting and notification of board meetings? __________________________________

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CONFAX Implementation Manual Has the agency submitted revised copies of documents as required by ODOC Requirement # 202? 1. Articles of Incorporation 2. By-laws 3. Affirmative Action Plan 4. Personnel Policies 5. Board Membership Roster 6. Board Committee Membership List 7. Organizational Chart 8. Program/Project Chart 9. Approved Board Minutes 10. List of satellite offices 11. Equipment/Inventory Listing date: ______________________ 12. Client Appeals 13. Financial Policies COMMENTS Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No

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MONITORING REPORT
ODOC REQUIREMENT #108 FINANCIAL MANAGEMENT Agency Director please have the following available and ready for review: REVIEWED Yes Accounting Manual/Written Accounting Procedures Bonding/Employee Dishonesty Insurance Agency _____________________________ Amount $____________________________ General Liability Insurance Agency Workers Compensation Insurance Policy # ______________ Date of expiration ______________ Building/Property Leases Chart of Accounts Written Procurement Procedures No

Bank Accounts in which ODOC Contract Funds are deposited Number: Name:

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Questions for Fiscal staff Does the Accounting System have Fixed Assets Register (do we have copy of inventory?) General Ledger Cash Receipts Journal Cash Disbursements Journal Are Balance Sheet Accounts Reconciled monthly Are operating and savings accounts within FDIC limits Are Certificates of Deposit purchased with contract funds Are the following kept locked: Blank Checks Check Protector Signature Stamp Personnel Records Undelivered Checks Are any of the following types of expenses charged to ODOC Grant Programs: Bad Debts Entertainment Fines and/or penalties Interest or other financial costs AGENCY FISCAL STAFF _________________________________ _________________________________ _________________________________ _________________________________ TITLE

Yes

No

___________________________________ ___________________________________ ___________________________________ ___________________________________

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Financial Monitor will review and answer the following during the course monitoring visit. Payroll/Time Sheets/Leave Yes Is there adequate documentation for distribution of hours worked Are leave sheets completed by employees Are time sheets completed by employees Are time sheets approved by the supervisor Cash Receipts/Expenditures/Cash Disbursements Yes Are the books posted up-to-date Are all funds tracked separately by contract Do the expenditure reports submitted to ODOC agree with the Cash Disbursements Journal and Expense ledgers Are all general ledger entries traceable to source documentation Is there appropriate supporting documentation for all checks written Are invoices paid within the discount period Are invoices marked “PAID” with the check number on the check Does there appear to be excessive cash on hand? Are all checks pre-numbered Travel Yes Are Travel Advances allowed by Policy Are they charged to the receivable account Are they reconciled after travel has been completed Procurement Yes Are Contracts awarded to other than the Lowest Bidder without justification Are procurement transactions conducted to provide maximum open and free competition Is a purchase order system in place Are purchase orders dated prior to purchase Are purchase orders approved by the correct authority Are purchase orders attached to vendor’s invoice Are purchase orders pre-numbered

of the No

No

No

No

COMMENTS _________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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ACCOUNTING PROCEDURES AND INTERNAL CONTROLS REVIEW Please Complete Prior to Monitoring Visit

Administrative Staff
Who performs the following Approves: Journal Entries Purchase Orders Travel Request Vendor Invoices for Payment Employee Time-Sheets Requisitions Who: Deposits Cash and/or Cash Receipts Signs Checks Opens Mail Reconciles the Bank Statements Records receipts in books of account Records disbursements Is responsible for Equipment Inventory Is responsible for Materials Inventory Is responsible for Insurance Maintenance Is responsible for Bldg./Property Leases Payroll Processing Accounts Payable

COMMENTS: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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ACCOUNTING PROCEDURES AND INTERNAL CONTROLS REVIEW Please Complete Prior to Monitoring Visit

Administrative Staff Who is Custodian of: Blank Checks Signature Stamp Undelivered Checks Inventory Records Personnel Records Check Protector Payroll Tax Reports Who Prepares: Accounts Payable and Vendor Payment Checks Payroll Process and Payroll Checks Bank Reconciliation Request for Funds Payroll Tax Reports Payroll Tax Deposits Monthly Expenditure Reports Monthly Trial Balance Deposit Slips General Ledger Processing and Ledger Reconciliation Leave Records Year-end Closing Entries

COMMENTS: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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RANDOM EQUIPMENT CHECK

Program

Item Purchased

Program Year Purchased

Is item still utilized in program? Yes No

If no, explain what happened to equipment

* Check at least two items in each program ** Equipment with life expectancy of more than 1 year

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TRANSACTION TEST
Contract Number: ________________________ Contract Period From _____________________ Contract Amount ________________________ Program: ______________________ To ___________________________ Amount Expended: ______________

Use the Cash Disbursements journal or Monthly Trial Balance or Income Statement. On each of these look for expenses by month and program. (The monthly Income Statement will give you a total dollar amount. This may not be available in each agency.) Monthly Expenditure Reports reviewed:
Total Amount is Traceable to Ledger

Month/Year

Yes

No

Comments

Problems or Discrepancies:
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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CASH DISBURSEMENTS & SUPPORTING DOCUMENTATION Agency: _______________________________________________________________

Contract Number: ___________________ Program ___________________________ DOCUMENTATION Date Check # Payee Amount Req. or PO Inv. CC

LEGEND:

Req. - Requisition PO - Purchase Order

Use Check Register (by contract) or ask to review checks for each

Inv. - Invoice CC - Check Copy Problems or Discrepancies:

contract.

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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EMERGENCY SHELTER GRANT
MONITORING CHECKLIST

CONTRACTOR ________________________ CONTRACT NUMBER ___________________ AMOUNT $___________________________ REVIEWER ____________________________ CONTACT PERSON ___________________________________________________________ TELEPHONE NUMBER ________________________________________________________ NAME OF SHELTER ___________________________________________________________ ADDRESS ____________________________________________________________________ SHELTER CAPACITY ____________________ AVERAGE # CLIENTS SERVED _________

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SERVICES
[If using ESG funds] Yes Did the essential service fund create a new service? OR Did the essential service files document a quantifiable increase in services? Was the 30% cap observed? ______ ______ _____ ______ No ______ N/A _____

______

______

_____

Yes Were funds obligated or expended before release of funds?

No

N/A

_____ _____ _____

What kinds of services did the contractor provide with Operations funds? (Maintenance, operation, security, fuels, equipment, insurance, utilities and furnishings) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What kind of services was achieved by Essential Services funds? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Yes No N/A

Were these the same number of services as stated _____ _____ _____ in the application? If no, recommend: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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CAA’s Community Involvement: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Yes Do the Prevention files contain evidence of eviction or utility termination? Was the 30% cap observed? Was the Confidentiality of Victims of Family Violence observed? If Yes, how? No N/A

_____ _____ _____

_____ _____ _____ _____ _____ _____

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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REPORTING (ODOC Requirement #111 & #706) A. Do client files, intake logs, and other management information documents reconcile with progress reports? 1. Has unit of General Local Government and shelter staff jointly discussed the ESG program and reporting process? 2. Does shelter staff/unit of General Local Government discuss program progress? B. Were progress reports submitted on time? Yes No

Yes

No

Yes

No

Yes

No

COMMENTS

Make copies as needed.

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REHABILITATION ONLY What kind of Rehabilitation was achieved with REHAB funds? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Were funds used for any ineligible expenses? Ineligible acquisition or construction of shelter; preparation of work specs, loan processing, inspections; cost to renovate, rehab or convert buildings owned by religious organizations; any activities that would result in the displacement of a place of business. Yes No N/A

_____ _____ _____

COMMENTS: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Were funds used for major rehabilitation or conversion? (Must be maintained as shelter for 10 years, if Yes) COMMENTS:
_____________________________________________________________________________________ _____________________________________________________________________________________

_____ _____ _____

Were funds used for rehab? (three-year restriction) If the funds were spent for rehab, was an on-site inspection performed by the contractor?

_____ _____ _____ _____ _____ _____

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Was the rehab completed? If no, when is rehab expected? __________________________

Yes No N/A _____ _____ _____

COMMENTS: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Number of structures undergoing rehab ____________________ Yes Was there a work write up and cost estimate prepared? Date_________________ Were there specifications written? Date_________________ Was there a bid package? Including: a bid advertisement with scope of work list of responders criteria for selecting bid acceptance or rejection letters Were bids in line with cost estimates and write up? Did the advertisement for bid call attention of the bidders to: Section 3 Segregated Facility Section 109 Were there minutes of the bid opening? Was there a written Section 3 Plan? No N/A

_____ _____ _____

_____ _____ _____

_____ _____ ____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

_____ _____ _____

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

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Rehabilitation (continued) Yes Does the contract with the subcontractor include reference to the following? EO 11246 Equal Opportunity clause Title VI clause Section 3 clause Section 109-clause Lead Based Paint clause Conflict of Interest Hold Harmless clause Is there a written inspection? Date ___________________ Did the contractor contact ODOC regarding the debarred list? Did the contractor issue a Notice to Proceed to subcontractor? (If not, what process was used to make the determination?) Did the contractor issue a Notice of Acceptance of Work? Date ___________________ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ No N/A

_____ _____ _____ _____ _____ _____

_____ _____ _____

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RATING CRITERIA
If the project was awarded points for:  Sub-population - Did the project serve at least 20% in the application populations? Yes ___ No ___ N/A ___  Total number of shelter beneficiaries (excluding those served by traditional housing) ____________________

Prevention - Was usage of budget commensurate with points awarded? Yes ___ No ___ N/A ___ Points Awarded ______ Bed capacity - Did bed capacity increase?

 

Yes ___ No ___ N/A ___

Review case management plan and compare to actual case management. Are activities consistent with points awarded? Yes ___ No ___ N/A ___ Points Awarded ______ Review individual and families’ involvement in work at shelter. How is this documented?_______________________________________________ ___________________________________________________________________ ___________________________________________________________________ Review plan to provide homeless individuals the opportunity to participate on shelters’ policy-making entity. How is this documented? ______________________ ____________________________________________________________________ ____________________________________________________________________ Is it consistent with points awarded? Yes ___ No ___ N/A ___ Points Awarded ______

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

Case Manager and Duties - Review personnel file for job description(s) of the case manager(s). Do the duties include: - Intake - Assistance in obtaining services - Evaluation of services - Tracking and evaluating client attendance and progress Yes ___ No ___ N/A ___ Review time sheets, do the hours of the case manager(s) equal a full time position? Yes ___ No ___ N/A ___

Intake Process How is intake documented? _________________________________________ ________________________________________________________________ How were individuals given assistance in obtaining appropriate essential services? _________________________________________________________________ _________________________________________________________________ Essential Service Chart Compare chart to actual services provided. Is the number and types of services provided in line with points awarded? Yes ___ No ___ N/A ___ Benefit of Service Does client file contain evidence of the benefit of service to client? Yes ___ No ___ N/A ___ Partnerships Review documentation provided to clients that outlines service providers that are available. Does this list correspond to the application listing? Yes ___ No ___ N/A ___ Tracking How is attendance and progress of clients evaluated? How is it documented? ______________________________________________________________ ______________________________________________________________

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Communication Review documentation indicating ongoing communication between case manager and provider(s). Is it consistent with application listing? Yes ___ No ___ N/A ___ Will the percentage of clients to receive case management reach 50% as documented in the application? Yes ___ No ___ N/A ___ How many have received case management services to date?____________________

Transitional Housing Checklist Are the number and location of transitional houses consistent with points awarded? Yes ___ No ___ N/A ___ Were the units occupied or vacant? Yes ___ No ___ N/A ___ If occupied, what is the date of occupancy and the length of the agreement? ______________________________________________________________ Types of essential services offered through transitional housing. ___________ ______________________________________________________________ ______________________________________________________________ Is there evidence of the qualifications and guidelines for the client(s) to meet for obtaining and maintaining transitional housing? Yes ___ No ___ N/A ___

How is it documented? _________________________________________________ ____________________________________________________________________ ____________________________________________________________________ What is the total number of clients served through transitional housing as of monitoring date? ________________ Compare the process for moving clients into transitional housing and permanent housing to actual plan. Is it consistent with points awarded? Yes ___ No ___ N/A ___ ________________________________________________________________________ ________________________________________________________________________ Is there documentation as to what service is provided to individuals and families who will be unsuccessful in obtaining transitional housing? Yes ___ No ___ N/A ___ ________________________________________________________________________ ________________________________________________________________________

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HEAD START MONITORING CHECKLIST Contract Number: ___________________ Contract Amount: ___________________

Number of Head Start sites: ______________________ Site Locations: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Total number of children (unduplicated): Total number of families (unduplicated): SAF ___________ SAF ___________ HS ______________ HS ______________ Yes ____ No ____

Does total number of children and families reconcile to the number projected in the work summary?

If not, explain. ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Were equipment purchases made according to required procurement Yes ____ No ___ procedures? If no, explain. ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

If there were findings/recommendations in the federal review, have corrective actions been taken? What actions? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Yes ____ No ____

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If corrective actions have not been taken, why not? ______________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Is contractor complying with the Work Program Summary? Yes ____ No ____

If yes, explain. ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If no, explain. ____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Verify that funds were expended to meet Work Program Summary objectives as indicated in Quarterly reports. (Attach Quarterly Report. Check off items verified.)

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SEEDS
MONITORING CHECKLIST

DATE: ___________________________ MONITOR DATE _____________________ MONITORING TEAM: ___________________________________________________ CONTRACTOR: ________________________________________________________
CONTRACT NUMBER ____________________________ SEEDS CONTACT PERSON: ____________________________________________________ QUARTERLY REPORTS: _______________________ through _________________________ CONTRACT AMOUNT: $_________________________ LEVERAGE: $__________________ TOTAL PROJECT: $_____________________________

Portfolio Information (verify to quarterly reports)
A. B. C. D. E. F. G. H. I. J. K. L.

How many active loans in portfolio? What is the dollar amount of loans in portfolio? How many new loans made? What is the total dollar amount of the new loans made? How many new jobs created from the loans? What is the total amount of loan payments received? How many loans paid off? How many loans settled? How many loans were written off? How many loans restructured? How many loans had collection activity initiated? How many loans had collection activity from the previous quarters?

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II.

Beneficiary Information Verified Technical Assistance given for quarterly report:        Low Income ____ Black ____ Hispanic ____ Asian or Pacific Islander ____ American Indian or Alaskan Native ____ Handicapped ____ Female Head of Household ____

Verified assistance given to loan recipients:  Low Income ______  Black ______  Hispanic ______  Asian or Pacific Islander ______  American Indian or Alaskan Native ______  Handicapped ______  Female Head of Household ______ III. SEEDS Activity Summary (verified from quarterly reports) How many recruitment/selection activities? How many training activities? How many business plan development activities? How many lending policies/activities? How many portfolio management activities? How many follow-up activities? Notes * Summary ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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WEATHERIZATION ASSISTANCE PROGRAM

Weatherization Eligibility and Application Review Procedures (ODOC Requirement #301 and #303) A. Has the contractor established procedures to ensure that eligible applicants are assisted? _____________________________________________________________ _____________________________________________________________________ Does the contractor have an active waiting list for each co? If Yes, estimate of how many on each list ____________________________________ B. Do they need to market the program? ______________________________________ If they are already marketing, are the marketing documents current and correct? _____________________________________________________________________ How are the marketing materials distributed? ________________________________ _____________________________________________________________________ How are they marketed? ________________________________________________ Is the marketing updated regularly? _____ Yes No _____

C. Has the Contractor weatherized any shelters? If Yes, were the procedures below followed? 1. Was the shelter counted as one (1) unit per 800 square feet? __________________ 2. Were expenditures limited to twenty (20) percent of the Weatherization contract? __________________________________________________________________ 3. Did the Contractor obtain written permission to weatherize the shelter? ________ D. Has the Contractor established procedures to obtain certification by DHS for units served under the LIHEAP Program? ____________. If not, what are the procedures for establishing eligibility? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ E. Have weatherization services to units weatherized during the period of September 30, 1975 through September 30, 1993 received a new audit. _____________

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F. Application Processing 1. Are ineligible clients informed in writing with the Weatherization Denial Form? __________________________________________________________________ 2. Who conducts the on-site needs assessment? _____________________________________________________________________ _____________________________________________________________________ 3. Who orders the Weatherization materials? _______________________________ 4. Who performs the final inspection of the weatherized unit? __________________ __________________________________________________________________ COMMENTS

Maximum Allowable Costs and Waivers (ODOC Requirement #302) 1. What procedures have been established to ensure that Contractor expenditures do not exceed maximum allowable limits? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Has the Contractor exceeded the maximum allowable cost on any dwelling this contract year? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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3. Were waivers requested and received prior to the Weatherization of units with expenditures above the maximum limits? ________________________________________________________________________ _______________________________________________________________________ 4. What is the current average cost per dwelling unit? ___________________________ 5. Has the agency exceeded $500.00 repair? ___________________________________

REVIEW of WEATHERIZATION FILES (ODOC Requirement #304) 1. Review 10% Weatherization Client Files. Attach Client File Checklist. 2. Weatherization Dwelling Inspection and Health & Safety Checklist. 3. Perform “on-site” visit to a minimum of three (3) WX houses per contractor/crews using Final Inspection checklist from client file. TRAINING AND TECHNICAL ASSISTANCE: (Indicate below all recommendations and requests for T/TA) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Yes  No 

Request success stories, articles and photos.

What type, if any, Health and Safety issues were addressed. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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Health and Safety Checklist Grantee Name _______________________________________________________________ Date __________________________ Reviewer ______________________________________________ Center/Areas Observed _______________________________________________ _________________________________________________ _________________________________________________

This observation form will help you, as a reviewer, to record your observations regarding several health and safety items. The items are based on the performance standards (1301 through 1308). Items are not intended to be an exhaustive list of performance standards related to health and safety, but rather items that can be rated according to a “checklist” format. This tool is intended to provide only one piece of the picture. In order to obtain a complete picture of the agency’s compliance with health and safety standards, it is necessary to combine information from this instrument with information obtained from other observations and interviews. Please indicate whether the standard is supported by observations. Rate each item by circling “Yes” or “No”. You may also, and are encouraged to, explain your ratings under “Observations/Comments.” In addition, if you are unclear about some items (e.g., where to find a first-aid kit or medication), you may need to ask a teacher or a person in charge of health services.

____________________________________________________________________________________________________________ Head Start Interim Monitoring Instrument – Health and Safety Checklist

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Health and Safety Checklist Area #1 – Classrooms (Infant/Toddler)  Nonporus gloves are available for use when dealing with bloody bodily fluids. [1304.22(e)(3)]  The diaper-changing area is clean and proper hygiene procedures are followed. [1304.22(c)(5)]  The Diaper-changing area is located away from areas used for cooking, eating, or children’s activities. [1304.53(a)(10)(xiv)]  Infant sleeping arrangements such as firm mattresses and they avoid soft bedding materials such as comforters, pillows, fluffy blankets, or soft toys. [1304.53(b)(3)]  Cribs are at least 3 ft. apart from each other. [1304.22(e)(7)]  Infant toys are made of non-toxic materials and are sanitized regularly [1304.53(b)(2)]  Toilet training equipment is available. [1304.53(a)(10)(xv)]  Diapers are disposed of in a safe and sanitary manner. [1304.53(a)(10)(xvi)] Area #2 – Classrooms (General)  Staff promote effective dental hygiene procedures. [1304.23(b)(3)]  Toys are stored in a “safe and orderly fashion” (e.g., in their assigned places, not out where people can trip over them). [1304.53(b)(1)(vii)]  The indoor and outdoor space for infants and toddlers is separated from general walkways and areas used by preschoolers. [1304.53(a)(4)]  Toys, materials, and furniture are safe, durable, and kept in good condition (e.g., materials free of sharp edges and loose pieces, balloons and/or plastic bags not used, no choking hazards). [1304.53(b)(1)(vi)]  Center space is organized into functional areas that are recognized by children and that allow for individual activities and social interactions. [1304.53(a)(3)]  Staffing patterns support regulations regarding class size and number of adults per class. [1306.20]  Staff, volunteers and children wash their hands with soap and running water at appropriate times. [1304.22(e)(1)]

Yes Yes Yes Yes Yes

No No No No No

Observations/Comments

Yes Yes Yes Yes

No No No No

Yes Yes Yes

No No No

Yes

No

Yes

No

Yes Yes

No No

___________________________________________________________________________________________________________________________________________ Health and Safety Checklist

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Area #3: Kitchen or Classroom  All medications are properly labeled (i.e., name of child/staff, name of medication, dosage, name/number of pharmacy/physician). [1304.22(c)(1)]  Medications are under lock and key and out of reach of children. [1304.53(a)(10)(iii), 1304.22(c)(1)]  Medications in need of refrigeration are refrigerated. [1304.22(c)(1)]  A well-supplied first-aid kit is available, accessible to staff, and out of reach of children. [1304.22(f)(1)] Area #4: Kitchen  Refrigerator(s) and/or freezer(s) are cold enough (e.g., meet state licensing requirements) and things that belong in the refrigerator or freezer (e.g., milk) are appropriately stored there [1304.23(e)(1); 1304.23(e)(2)] Area #5: Bathrooms  Bathroom facilities are clean, in good repair, and easily reached by children. [1304.53(a)(10)(xiv)]  Bathroom facilities are separated from areas used for cooking, eating or children’s activities. [1304.53(a)(10)(xiv)]  A utility sink is specifically used to clean potties. [1304.22(e)(6)]

Yes

No Observations/Comments

Yes Yes Yes

No No No

Yes

No

Yes Yes Yes

No No No

Area #6: General/Throughout Facility  Facilities are maintained at an adequate temperature. (Note: Take Yes No into account the difference between the inside and outside temperatures.) [1304.53(a)(10)(i)]  The facility has approved, working fire extinguishers, and an Yes No appropriate number of smoke detectors that are tested regularly. [1304.53(a)(10)(vi)]  Electrical plugs are covered. [1304.53(a)(10)(xi)]  Rooms are well lit. [1304.53(a)(10)(iv)]  Exits and/or evacuation routes are clearly marked. [1304.22(a)(3); Yes No 1304.53(a)(10)(vii)]  Emergency lighting is available. [1304.53(a)(10)(iv)] Yes No  Windows and glass doors are sufficiently marked or they have Yes No sufficient barriers to prevent injury to children. [1304.53(a)(10)(xii)  Facilities enable the safe and effective participation of persons with Yes No disabilities. [1304.4(o)(4)] Yes No ______________________________________________________________________________________________________________________________________________ Health and Safety Checklist

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CAA Monitoring

Area #6: General/Throughout Facility (cont.)  Emergency telephone numbers (e.g., EMS, Fire, Police, Poison Control) are posted at each telephone. [1304.22(a)(2)]  Policies on handling medical and health emergencies are posted clearly and visibly. [1304.22(a)(1)]  There is at least 35 sq. ft. of usable (i.e., not including bathrooms, halls, kitchen, staff rooms, and storage places) indoor space per child. [1304.53(a)(5)]  The heating/cooling system is adequately insulated. (Note: Look at pipes and/or radiators.) [1304.53(a)(10)(i)]  There is an absence of highly flammable furnishings, decorations, or materials that emit toxic fumes. [1304.53(a)(10)(ii)]  Flammable and other dangerous materials/poisons are stored in locked cabinets or facilities separate from medications and food and accessible only to authorized persons. [1304.53(a)(10)(iii)]  Appropriate cleaning supplies are available to staff but out of reach of children. [1304.22(e)(6), 1304.53(a)(10)(iii)]  Garbage and trash are stored and disposed of in a safe, sanitary manner. [1304.53(a)(10)(xvi)]  The indoor and outdoor premises are cleaned daily and kept free of undesirable and hazardous materials and conditions. [1304.53(a)(10)(viii)]  Appropriate licenses (water/sewage food/sanitation; fire codes; applicable transportation licenses; Indian Environmental Health, if applicable; and vendor/contractor licenses) are seen. [1304.53(a)(6) and (10)(xiii), 1304.23(e)(1), 1306.30(c)] Area #7: Outdoors  There is at least 75-sq. ft. of usable outdoor space per child. [1304.53(a)(5)]  The playground equipment is in good repair and safe condition (e.g., adequately secured to the ground, free of sharp edges and/or splinters soft falling surface). [1304.53(a)(7)(viii); 1304,53(a)(10)(viii); [1304.53(a)(10)(x)]  The outdoor area is arranged such that no child can leave premises or get into unsafe or unsupervised areas. [1304.53(a)(9)]

Yes Yes Yes

No Observations/Comments No No

Yes Yes Yes

No No No

Yes Yes Yes Yes

No No No No

Yes Yes

No No

Yes

No

___________________________________________________________________________________________________________________________________________ Health and Safety Checklist

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OKLAHOMA DEPARTMENT OF COMMERCE
WEATHERIZATION ASSISTANCE PROGRAM CLIENT FILE REVIEW SHEET
Audit

Name

Address

City

Contract Number

Application

LBP Notice

BWR

42

Material Receipts

Job Number

Rental Agreement

Occupant Agreement

Priority List

Inspection Checklist

Work Write -up

CAA Monitoring

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