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Chapter 1:
Administration
1.1
Legal Authority and Mission
DJJ Mission And Vision - Spanish Translation
1.2
Organization Chart
Attachment A: Organizational Chart
1.3
Legal Services
Attachment A: Request for Representation
1.4
Establishment and Maintenance of DJJ Policies
Attachment A: LOP Header
1.5
Planning, Reporting, and Review
1.8
Public Information
Attachment A: DJJ Media Agreement
Attachment B: Parental/Guardian Release Form
Attachment C: Letterhead Template
1.9
Research
Attachment A: Research Request
Attachment B: Research Agreement
1.10
Open Records Act
1.11
Sealing of Records
Chapter 2:
Financial Services
2.1
Employee Travel Regulations
Attachment A: Employee Travel Expense Statement
2.2
Per Diem and Fee Paid Services
Attachment A: Request for Fee Paid Professional Services
Attachment B: Per Diem and/or Bill for Services Rendered Request
Attachment C: Fee Paid Professional Services Tracking Form
Attachment D: Independent Contractor Certification
Attachment E: HIPAA Agreement
Attachment F: PREA Acknowledgement Statement
Attachment G: E-Verify Contractor Affidavit
Attachment H: E-Verify Subcontractor Affidavit
Attachment I: E-Verify Sub-Subcontractor Affidavit
Attachment J: Immigration and Security Contractor Affidavit
Attachment K: Vendor Management Form
2.3
Grants Administration
Attachment A: Transmittal / Approval Form
Attachment B: Federal Assistance Budget Information Form
2.4
Cash Bank Accounts
Attachment A: Request to Establish or Change a Bank Account
Attachment B: Cash Account Reconciliation Report
2.6
Organizational Memberships and Accreditations
Attachment A: Membership Approval and Request for Payment of Fees for Organizational Memberships, Accreditations or Surveys
2.7
Payment of Employee Relocation Expenses
Attachment A: Application for Intrastate Relocation Expense Reimbursement
Attachment B: Intrastate Relocation Expense Voucher
Attachment C: Employee Travel Expense Statement
Attachment D: High Cost Area Employee Travel Expense Statement
2.8
Collection of Funds
Attachment A: Sample Letter - First Notice, Continuing Relationship
Attachment B: Sample Letter - First Notice, Non-Continuing Relationship
Attachment C: Sample Letter - Second Notice
Attachment D: Sample Letter - Third Notice
Attachment E: Sample Memo to Office of the Attorney General
2.10
Youth Medical Expenses
Attachment A: Payment Responsibility Letter
Attachment B: Certification of Medical Necessity
Attachmnet C: Committed Youth Payment Responsibilty Letter
2.11
Assignment and Use of State Vehicles
Attachment A: Motor Vehicle Assignment and Use Authorization Form
Attachment B: Motor Vehicle Log
Attachment C: Monthly Assigned Vehicle Utilization Report
Attachment D: Motor Vehicle Weekly Safety/Inspection Checklist
2.13
Audits and Audit Standards
2.14
Personal Property Inventory
Attachment A: Property Coordinator for Facilities/Offices
Attachment B: Property Transfer Form
Attachment C: Missing or Stolen Property Report
Attachment D: Surplus Property Affidavit of Disposal
2.15
State Credit Card Programs
Attachment A: Bank of America Dispute Form
Attachment B: Lost Receipt/Invoice Affidavit Form
Attachment C: Authorization for Purchasing Card Background Checks Form
Attachment D: Cardholder Agreement
Attachment E: P-Card Profile
Attachment F: Special Approval Request
Attachment G: P-Card Data Sheet
2.16
Contracts Administration
Attachment A: Contract Procedure Manual
Attachment B: Ethics in Procurement and Contracting Procedures
2.17
Issuance Of Badges
Attachment A: Replacement Notice
Attachment B: Badge Tracking Log
Attachment C: Assignment of Badge Numbers
Chapter 3:
Personnel
3.1
Delegation of Authority
3.2
Third Party Involvement
3.3
Inclement Weather and Other Emergencies
3.4
Customer Services
Attachment A: Customer Service Communications Guide
Attachment B: Customer Service Brochure
3.5
Bulletin Boards
3.10
Standards of Conduct and Ethics
Attachment A: State of Georgia Executive Order
Attachment B: Standards of Conduct and Ethics Policy Acknowledgement Statement
3.11
Prohibition Against Sleeping on Duty / Failing to Remain Alert
3.12
Dress Code for Uniformed Officers
Attachment A: Uniform Action Form
Attachment B: Uniform Sizing Sheet
Attachment C: Made to Measure Sizing Form
Attachment D: Uniform Grid
3.13
Dress Code for Non-Uniformed Staff
3.14
Political Activity
Attachment A: Political Activity Request
3.15
Drug and Alcohol Free Workplace Program
Attachment A: Drug Free Work Force Notification
3.16
Other Employment
Attachment A: Standard Request for Approval of Other Employment
Attachment B: Special Request for Approval of Other Employment With Another State Agency
Attachment C: Request to Continue Other Employment While on Leave of Absence
3.17
Visitors and Children in the Workplace
3.18
Fitness for Duty
Attachment A: EAP Referral Letter
Attachment B: Attending Physicians Statement of Functional Capability
Attachment C: Termination Letter Template
Attachment D: Notification of Suspension
Attachment E: Disclosure of Criminal or Traffic Offense Information
Attachment F: Georgia Peace Officer Standards and Training Council Change of Status Form, Form C-11
3.20
Non-Discrimination in the Workplace
Attachment A: Equal Employment Opportunity Notice
3.21
Americans with Disabilities
Attachment A: Equal Employment Opportunity Notice
Attachment B: ADA Physician Statement
Attachment C: Authorization for Release of Protected Health Information
Attachment D: Model for Analysis and Resolution of ADA Issues
3.22
Harassment
3.23
Employee Complaint Process
Attachment A: Employee Complaint Form
Attachment B: Employee Group Complaint Form
Attachment C: Notice of Eligibility to File a Complaint
3.25
Whistleblowers
3.26
Employee Assistance Program
Attachment A: EAP Contractor's Flyer
Attachment B: Supervisory Referral Letter
Attachment C: EAP Evaluation Report
3.27
Workers Compensation
Attachment A: Workers Compensation Payment Selection/Leave Form
Attachment B: Report of Injury
Attachment C: Incident Notice Only
3.28
Injury in the Line of Duty
Attachment A: Workers Compensation Payment Selection/Leave Form
3.30
Work Hours
Attachment A: DJJ Time Record
Attachment B: Four 10-hour Days Work Schedule Agreement
Attachment C: Alternating Weekday Off Schedule Examples and Sample Calendars
Attachment D: Alternating Weekday Off Work Schedule Agreement
3.31
Fair Labor Standards Act
Attachment A: Time & Leave Keeping Guidelines
3.32
Teleworking
Attachment A: Teleworking Checklist and Agreement
3.33
State Compensatory Time
3.49
POST Applications and Notifications
Attachment A: POST Application Checklist
Attachment B: POST Application Fee Log
3.51
Recruitment And Selection
Recruitment and Selection Guidelines
- For reference use only. Do not print for policy manual.
Attachment A: Job Preview Form
Attachment B: Request to Advertise Vacancy
Attachment C: Employment Verification Form
Attachment D: Reference Check Form
Attachment E: Offer of Employment
Attachment F: Request for Personnel Action
Attachment G: DJJ Selection Report
Attachment H: Transfer Request
3.52
Background Investigations
CHU - Criminal History Unit Handbook
3.53
Appointments
Attachment A: Acknowledgement of Unclassified Position
3.54
Salary Administration
Attachment A: Position/Personnel Action Request
Attachment B: Criteria and Procedures for Special Salary Adjustments and Supplements
Attachment C: Advanced Salary Request Upon Hire/Promotion
Attachment D: Voluntary Demotion Acknowledgement
Attachment E: Demotion Without Loss of Salary
Attachment F: Authorization for Temporary Salary Supplement
Attachment G: Monthly Interpretive Services Salary Supplement
3.55
Professional Credentials
Attachment A: Acknowledgement of Required Professional Credential
Attachment B: Professional Credentials
3.56
Employee and Applicant Alcohol and Drug Testing
Attachment A: Alcohol and Drug Testing User Manual
3.57
Medical and Physical Examination Program
Attachment A: Job Analysis Worksheet
Attachment B: MAPEP Manual
Attachment C: Medical Findings
Attachment D: Letter to Reviewing Physician
Attachment E: Report to Employing Agency
3.58
Employment of Family Members
Attachment A: Employment of Relatives Acknowledgement and Disclosure Form
3.59
Employment Eligibility Verification
Attachment A: Form I-9
3.60
Annual, Sick and Personal Leave
Attachment A: Leave Request Form
Attachment B: Application for Restoration of Divested Sick Leave
3.62
State Holidays
Attachment A: Approved State Holidays
3.65
Family and Medical Leave
Attachment A: Request for Family Medical Leave
Attachment B: Family and Medical Leave Notice of Eligibility, Rights and Responsibilities
Attachment C: Certification of Healthcare Provider-Employee
Attachment D: Certification of Healthcare Provider-Family
Attachment E: Certification of Serious Injury or Illness of Service Member
Attachment F: Certification for Military Member Exigency Leave
Attachment G: Family and Medical Leave Designation Notice
Attachment H: Georgia Activity Analysis Form
Attachment I: Employee Rights and Responsibilities Under the Family and Medical Leave Act
Attachment J: Notice of Family and Medical Leave
3.66
Miscellaneous Paid Time Off
Attachment A: Leave Request Form
3.67
Leave Without Pay and Furlough
Attachment A: Leave Without Pay Request Form
Attachment B: Attending Physician's Statement of Functional Capacity
3.68
Leave Donation
Attachment A: Request for Leave Donation
Attachment B: Certification of Health Care Provider
Attachment C: Solicitation of Leave Donation Announcement
Attachment D: Leave Donation Authorization
3.80
Employee Progressive Discipline
3.81
Performance Management
Attachment A: Performance Plan Review
Attachment B: Performance Evaluation Review
3.83
Separation from Employment
Attachment A: Personnel Action Form
3.90
Salary Payments
Attachment A: Direct Deposit Notification Form
Attachment B: Direct Deposit Authorization Agreement
Attachment C: Direct Deposit Personal Exemption Request Form
3.92
Garnishments
Chapter 4:
Staff Development and Training
4.1
Training Program
Attachment A: DJJ Training Record
Attachment B: External Training Request Form
Attachment C: External Training Request Guide
Attachment D: Internal Training Request Guide
Attachment E: Professional Development Course Planning Guide
Attachment F: Event Reservation/Training Planning Form
4.2
New Employee on the Job Training
Attachment A: JCO OJT Checklist and Manual
Attachment B: JPPS OJT Checklist and Manual
Attachment C: Community Non-JPPS OJT Checklist and Manual
Attachment D: Behavioral Health OJT Checklist
Attachment E: Counseling Staff OJT Checklist
Attachment F: Education Staff OJT Checklist
Attachment G: Food Service Staff OJT Checklist
Attachment H: Health Care Staff OJT Checklist
Attachment I: Generic Non-Security OJT Checklist
Attachment J Generic Central Office Staff OJT Checklist
Attachment K: Facility OJT Handbook
Attachment L: New Employee OJT Curriculum
4.3
Field Training Officer Program
Attachment A: FTO Daily Progress Report
Attachment B: JPPS FTO Daily Progress Report
Attachment C: FTO Weekly Progress Report
Attachment D: JPPS FTO Weekly Progress Report
Attachment E: FTO POST Checklist
Attachment F: POST BJPOT-BCST Checklist
Attachment G: Remedial Training Form
4.4
POST Annual Training Requirements
4.5
Staff Training Requirements
Attachment A: Training Matrix
4.6
Leadership and Management Training
Chapter 5:
Records Management
5.1
Records Management
Attachment A: Approved Retention Schedules
Attachment B: Reviewers Guidelines for Records Management
Attachment C: Records Inventory Form
Attachment D: Authorization for Records Transfer and Receipt Form
Attachment E: Preparing Records for Transfer to the Records Center
Attachment F: Reference Request Form
Attachment G: Certificate of Record Destruction
Attachment H: Records Coordinator Approval Form
Attachment I: Confidential Records Access Form
5.2
Case Records
Attachment A: DJJ Secure Facility Case Records Format
Attachment B: DJJ Community Case Records Format
Attachment C: Case Management Transfer Form
Attachment D: Authorization for Release of Information
Attachment E: Memorandum of Understanding with GA Department of Human Resources
Attachment F: Notice of Release From Confinement/Custody
Attachment G: Case Management Monitoring Tool
5.4
Education Records
Attachment A: Education Records Retention Protocol
Attachment B: Format for Education Records
Attachment C: Persons Having Access to Confidential Student Information
Attachment D: Record Access Log
Attachment E: Contact Log
Attachment F: Notification of Rights Under FERPA
Attachment F: Notification of Rights Under FERPA (Spanish)
Attachment G: Statement of Parental Rights
Attachment G: Statement of Parental Rights (Spanish)
Attachment H: Notice of Release of Confidential Student Information
5.5
Health Records
Information Security:
ONLINE TRAINING
Attachment A: DJJ Secure Facility Health Record Format
Attachment B: DJJ Community Health Record Format
Attachment C: Request to Amend Health Record
Attachment D: Privacy Practices Denial Form
Attachment E: Privacy Practice Complaint Form
Attachment F: Authorized Psychological Testing Materials
Attachment G: Medical Permission Form
Attachment H: Notice of Privacy Practices
Attachment I: Health Records Fax Cover Sheet
Attachment J: Guidelines for the Release of Health Information
Attachment K: Authorization for Release of Health Information
5.8
Documentation Standards
DOCUMENTATION:
ONLINE TRAINING
5.9
Personnel Records
Attachment A: DJJ Personnel Records Format
Attachment B: Personnel Records Review
Chapter 6:
Information Technology
6.1
Functions of the Office of Technology and Information Services
6.2
Network Access
6.3
Wireless Communication Devices
6.4
Juvenile Tracking System
6.5
E-Mail
Attachment A: DJJ Logo Seal
Attachment B: DJJ Flag Logo
6.6
Social Media
6.7
Hardware and Software
6.8
IT Security
Attachment A: IT Publications and Standards
Chapter 7:
Physical Plant
7.1
Physical Plant Requirements
7.6
Video Monitoring Systems
7.10
Building & Equipment Maintenance
7.21
Tobacco Free Environment
7.30
Tool Control
Attachment A: Daily Tool and Equipment Accountability Log
Attachment B: Tool and Equipment Audit Form
Attachment C: Weekly Tool and Equipment Report
Attachment D: Tool and Equipment Receiving Log
Attachment E: Lost Tool or Equipment Report
Attachment F: Spork and Meal Tracking Form
Attachment G: Culinary Equipment Tracking Form
7.31
Control of Hazardous Materials
Attachment A: Hazardous Material Audit Form
Chapter 8:
Safety, Security, and Control
8.1
Security Management
Attachment A: Post Order
Attachment B: Post Order Signature Sheet
8.2
Administrative Duty Officer
8.3
Logbooks
8.4
Inspections
Attachment A: Secure Facility Housekeeping Plan
Attachment B: Secure Facility Inspection Matrix
Attachment C: Inspection Report
8.5
Special Incident Reporting
Attachment A: Special Incident Report
Attachment B: Staff Statement for the Record
Attachment C: Youth Statement for the Record
Attachment D: Report of Youth Injuries
Attachment E: Report of Youth Injuries Addendum
Attachment F: Shift Supervisor/JPM Review
Attachment G: Administrative Review
Attachment H: SIR Critical Incident Review
Attachment I: SIR Codes Guide
Attachment J: Chain of Command Notification
Attachment K: SIR Monitoring Tool for Secure Facilities
Attachment L: SIR Monitoring Tool for CSOs
8.6
Fatality Review in Secure Facilities
8.7
Protective Custody
Attachment A: Protective Custody Protocol
Attachment B: Confinement Checks Form
Attachment C: Protective Custody Acknowledgement Form
Attachment D: Protective Custody Plan
Attachment E: Protective Custody Conversation Guide
Attachment F: Protective Custody Agreement Signature Form
Attachment G: Protective Custody Report
Attachment H: Request For Extended Confinement
8.8
Use Of Isolation
Attachment A: Isolation Approval Continuum
Attachment B: Isolation Release Structure Interview
Attachment C: Authorization for Use of Isolation
Attachment D: Isolation Checks Form
8.9
Child Abuse Reporting
8.10
Control Room
8.11
Perimeter Security and Control
Attachment A: Vehicle Log
Attachment B: Gate Vehicle Inspection Procedures
8.12
Key Control
Attachment A: Request for Key/Lock Change, Addition or Maintenance
Attachment B: Key Control Audit
Attachment C: Highly Restricted Key Log
Attachment D: Request for Keys
Attachment E: Request for Replacement of Lost Chit
Attachment F: Administrative/White Chit Log
Attachment G: 24-Hour Key Authorization
Attachment H: Quarterly Emergency Key Inspection
8.14
Radio Communications
Attachment A: Approved 10-Codes
8.15
Video Cameras
8.20
Room Checks
Attachment A: Room Observation Form
8.21
Counts and Control of Youth Movement
Attachment A: Movement Report
Attachment B: Count Slip
8.22
Searches and Contraband Control
Attachment A: Vendor Acknowledgement Statement
Attachment B: Approved Cell Phone Entry/Exit Log
Attachment C: Visitor Log / Visitor Consent to Search Form
Attachment D: Employee Search Consent Form
Attachment E: Chain of Custody Form
Attachment F: Officer Transfer Form
8.23
Transportation of Youth
Attachment A: Officer Transfer Form
Attachment B: Notification of Infectious Disease
8.24
Facility Drug Screening
Attachment A: Approved Drug Kit Manufacturers
8.30
Use of Force
Attachment A: Pepperball Equipment Inventory Sheet
Attachment B: Post Chemical Intervention Care
Attachment C: OC Flow Sheet
8.31
Restraint of Youth
Attachment A: Employee Certification of Compliance with Physical Intervention Continuum and Restraint of Youth
Attachment B: Approved Mechanical Restraint Devices
Attachment C: Restraint Flow Sheet
Attachment D: Therapeutic Restraint Order
Attachment E: Therapeutic Restraint Annual Inventory
8.32
Security Emergency Response Teams
Attachment A: Physical Fitness Assessment
8.33
Body Cameras
8.34
Firearms
8.35
SMRT
Attachment A: Physical Fitness Assessment
8.40
Emergency Management
Attachment A: National Incident management System Training
Attachment B: Emergency Plans
Attachment C: Escape Prevention and Notification Procedures
Attachment D: Notification Sheets (Staff Recall)
Attachment E: First Aid Kit Contents
Attachment F: Razor Wire Extraction Kit Contents
Attachment G: Drill Report
8.41
Fire Safety Program
Attachment A: Weekly Fire Life Safety Assessment
Attachment B: Monthly Fire Life Safety Assessment
Attachment C: Drill Report
Attachment D: Fire Watch Notification
8.42
Crime Scene Preservation
Attachment A: Chain of Custody Form
Chapter 9:
Food Services
9.1
Food Service Management
Attachment A: Daily Meal Count Record
Attachment B: USDA Inventory Form
Attachment C: Daily Meal Ticket Reconciliation Report
Attachment D: Food Facts: Food Allergies In-Service
Attachment E: Food Service Document Retention Schedule
9.2
Menu Planning and Meal Serving
Attachment A: Approved Substitutions List
Attachment B: Temporary Special Diet Request Form
Attachment C: School Breakfast Prgram Site Assessment
Attachment D: Afterschool Care Program Site Assessment
Attachment E: Food Service Assessment Tool Criteria
9.3
Safety and Sanitation of Food Service
Attachment A: Daily Temperature Log
Attachment B: Kitchen Checklist
Attachment C: Youth Food Service Health and Safety Clearance
Attachment D: Body Fluid Cleanup Kit Checklist
Attachment E: Employee Illness Quick Decision Guide
Attachment F: K-30 Food Employee Reporting Agreement
Attachment G: K-25 Conditional Food Employee Interview
Attachment H: ServSafe Cooking Requirements
Attachment I: Serving Temperature Log
Attachment J: Thermometer Calibration Guide
Attachment K: Cooling Temperature Log
9.4
Wellness Program
Attachment A: Wellness Program Evaluation
Attachment B: Afterschool Snack In-Service
Chapter 10:
Transportation Unit
10.3
Transportation Requests for Releases and Transfers
Attachment A: Officer Transfer Form
10.5
Office of Classification
Attachment A: Superior Court Personal History Sheet
10.6
Transportation Unit Operations
Chapter 11:
Health and Medical Services
11.1
Medical Intake Screening
Attachment A: Medical Intake Screening
Attachment B: Youth Medical Orientation Form
11.2
Nurse Health Appraisal and Physical Examination
Attachment A: Nurse Health Appraisal
Attachment B: Physical Examination
Attachment C: Female Growth Chart
Attachment D: Male Growth Chart
Attachment E: Letter to Parent/Guardian Regarding Contact Lenses
Attachment F: Medical Screening Form for Education
11.3
Medical Classification
Attachment A: JTS Medical Alerts
11.10
Medical Treatment Planning
Attachment A: Health Services Release
11.11
Health Education Services
11.12
Dental Services
Attachment A: Oral Hygiene Instruction Sheet
Attachment B: Dental Examination Record
Attachment C: Guidelines for Parents/Guardians of Youth with Braces
Attachment D: Informed Consent for Orthodontics
11.13
Consent Process
Attachment A: Medical Permission Form
Attachment B: Consent For Medications
Attachment C: Consent to Medical, Dental, Surgical Invasive Diagnostic Procedure
Attachment D: Medication Notification Letter
Attachment E: Guidelines for Psychotropic Medication Consent
Attachment F: Refusal of Treatment Against Medical Advice
11.14
Diagnostic Services and Specialized Services
Attachment A: Off-Site Referral Log
Attachment B: Consultation Request Form
11.15
Emergency Medical Services
Attachment A: Off-Site Healthcare Log
Attachment B: Contents for Emergency Response Bags
Attachment C: Contents for First Aid Kits
11.17
Hunger Strikes
11.25
Medication Storage
Attachment A: Medication Receipt Log
Attachment B: Inventory Destruction Form
Attachment C: Approved Over-the-Counter Medications
11.26
Medication Administration
Attachment A: Medication Administration Training (Medical Staff)
Attachment A: Medication Administration Training (Non-Medical Staff)
Attachment B: Medication Administration Record (MAR)
Attachment C: Refusal of Treatment Against Medical Advice
Attachment D: Non-Medical Staff Medication Administration Record
Attachment E: Approved Over-the-Counter Medications
Attachment F: Medication Administration Test
Attachment G: Medication Adverse Event Report
Attachment H: Release of Responsibility
11.27
Pharmaceutical Services
Attachment A: Formulary
11.28
Emergency and Urgent Medication Administration
Attachment A: Guidelines for Youth Medication Consent
Attachment B: Parent Notification of Involuntary Medication Letter
Attachment C: Psychotropic IM Medication Information Sheet
Attachment D: Psychotropic Involuntary Medication Standards of Care
Attachment E: Youth Notification of Due Process Hearing
Attachment F: Parent/Guardian Notification of Due Process Hearing
Attachment G: Due Process Hearing Form for Continued Involuntary Treatment
11.30
Infection Control
Attachment A: Exposure Protocol
Attachment B: Tuberculin Skin Testing Procedure
Attachment C: Tuberculosis Screening and Skin Test
Attachment D: Notification of an Infectious Disease
Attachment E: Medical Equipment Cleaning Schedule
Attachment F: Woods Lamp Protocol
Attachment G: HIV Test Consent Form
Attachment H: MRSA Medical Protocol
Attachment I: Health Education Flow Sheet
Attachment J: Disease Reporting
Attachment K: Monthly Infection Control Report
Attachment L: Health Services Release Letter
Attachment M: Pandemic Preparedness Plan
Attachment N: Staff Handwashing Video Acknowledgment
Attachment O: Youth Handwashing Video Acknowledgment
Attachment P: Return to Work Clearance Worksheet
11.40
Medical Autonomy
11.41
Clinic Space, Equipment, and Supplies
Attachment A: Standard Supplies/Equipment List
11.42
Health Services Quality Assurance
Attachment A: Annual Comprehensive Review
Attachment B: RHSA Monthly Facility Evaluation Report
Attachment C: DHA Monthly Facility Evaluation Report
Attachment D: Health Records Review Form
Attachment E: Corrective Action Plan
11.43
Health Care Staffing
Attachment A: Medical On Call Log
11.44
Automated External Defibrillators
Chapter 12:
Behavioral Health Services
12.1
Behavioral Health Services Delivery System
Attachment A: Credentialing Process
Attachment B: Psychiatrist Credentialing Documents
Attachment C: Psychologist Credentialing Documents
12.2
Scope of Behavioral Health Services
Attachment A: Program Plan Outline
Attachment B: Therapeutic Group Plan
Attachment C: Unapproved Therapeutic Group Form
12.3
Behavioral Health Autonomy
12.4
Staffing and On-Call Mental Health Services
Attachment A: Behavioral Health Staff Coverage Protocol
12.5
Behavioral Health Quality Assurance
Attachment A: Corrective Action Plan
12.6
Behavioral Health Placement Review Panel
Attachment A: Severe, Persistent Emotional Disturbances
12.7
Clinical Field Placements
Attachment A: Clinical Practicum MOU
Attachment B: Authorization for Release of Records and Information
Attachment C: Educational Training Program Agreement
Attachment D: Field Placement Supervision Log
12.8
Clinical Supervision
Attachment A: Clinical Supervision Log
12.9
Major Incident and Disaster Mental Health Response
12.10
Mental Health Screening
Attachment A: Mental Health Screening
Attachment A: Mental Health Screening Spanish
12.11
Mental Health Assessment
Attachment A: Informed Treatment Statement
12.12
Psychodiagnostic Evaluation
12.14
Specialized Treatment Units
Attachment A: STU Program Plan
Attachment B: STU Student Handbook
12.20
Treatment Planning
Attachment A: Release of Information
Attachment B: Discharge From Caseload Letter
12.21
Suicide Prevention
Attachment A: Safety Protocol
Attachment B: Behavior Record
Attachment C: Special Management Plan
Attachment D: Suicide Protective Garments Inventory
Attachment E: Approved Suicide Protective Garments
Attachment F: Notification of Precautions Letter
12.22
Special Management Planning
Attachment A: Special Incidents Requiring an SMP
Attachment B: Behavior Record
Attachment C: Request for Extended Removal from Programming
12.23
Emergency Psychiatric Hospitalization
Attachment A: Emergency Admission Certificate (Form 1013)
Attachment B: Protocol for Referral to Crisis Stabilization Programs
12.24
Psychotropic Medications
Attachment A: Medication Monitoring Protocols
Attachment B: Psychotropic IM Medication Information Sheet
Attachment C: Vanderbilt Assessment Scale
12.25
Behavioral Health Substance Abuse Services
Attachment A: Approved Substance Abuse Programs and Curricula
Chapter 13:
Education
13.1
School District
13.2
School Board
13.3
School Calendar
13.4
Educational Staffing and Professional Learning
Attachment A: Parent Notification Request for Information-English
Attachment A: Parent Notification Request for Information-Spanish
13.7
School Safety Zone
13.10
Curriculum and Instruction
Attachment A: Adult Education Parental Consent Form
Attachment B: Adult Education Program Admission Form
13.12
Student Grades, Transfers and Withdrawals
Attachment A: Release Letter
Attachment B: YDC Student Portfolio
13.13
Youth Internet Use and Safety
13.14
Standardized Testing
Attachment A: Student Assessment Handbook
Attachment B: Principal's Certification Form
13.20
Student Attendance
Attachment A: Youth Excluded From School Form
13.21
Behavior Management and Discipline
Attachment A: Core Classroom Rules
Attachment B: BREAC Program Description
13.22
Student Advisement
Attachment A: Workflow
Attachment B: Manual Transcript Entry
Attachment C: Education Transition Plan
13.30
Media Center
13.31
Response to Intervention
Attachment A: Response to Interventions Manual
13.32
Special Education Services
13.33
CTAE
13.35
Educational Services Quality Assurance
Attachment A: Staff School Visitation Form
Chapter 14:
Victim, Volunteer and Chaplaincy Services
14.2
Commercial Sexual Exploitation Referrals
Attachment A: CSEC Risk Factors
Attachment B: Georgia Cares Referral Form
Attachment C: Georgia Cares Release of Information Form
Attachment D: Interview Notice Form
14.3
Citizen and Volunteer Involvement
Attachment A: Volunteer Coordinator Manual
Attachment B: Calendar
Attachment C: Volunteer/Guest Consent and PREA Acknowledgement
Attachment D: Volunteer Application Form
Attachment E: Criminal/Driver History Consent
Attachment F: Volunteer Handbook
Attachment G: Volunteer Consent for Youth Under 18
Attachment H: Denial Letter
Attachment I: Government Agency Volunteer Verification Form
14.4
Advisory Council
14.5
Contributors
Attachment A: Contribution Solicitation Letter (Facility)
Attachment B: Contribution Solicitation Letter (Other DJJ site)
Attachment C: Contribution Received Letter
14.6
Interns
Attachment A: DJJ Employee Volunteer/Intern Request
14.7
Religious Programming and Chaplaincy Services
Attachment A: Informed Consent
Attachment B: Religious Service Attendance Record
Attachment C: Religious Special Request
Attachment D: Volunteer Religious Services Accountablility Log
Attachment E: Regional Chaplain Visitation Log
14.8
Rescue To Restore
14.10
Victims Rights, Services and Notification
Attachment A: Victim Notification Letter
Attachment B: Employee Victim Notification Letter
Attachment C: Violent Delinquent Acts
Attachment D: Georgia Victims Bill of Rights
Chapter 15:
Rights of Youth
15.1
Basic Rights and Responsibilities of Youth
Attachment A: Basic Treatment Standards
Attachment B: Basic Responsibilities of Youth
15.2
Grievance Process
Attachment A: Grievance Form
Attachment B: Grievance Process Quality Assurance Review
15.3
Youth Access to Court and Counsel
Attachment A: Notice of Right to Bail (for RYDCs)
15.4
Viewing, Listening and Reading Materials
15.5
Youth Visitation
Attachment A: Visitor Log/Visitor Consent to Search
15.6
Access to Mail
Attachment A: Postage Accountability Log
Attachment B: Mail Items Rejection Form
Attachment C: Acknowledgement of Victim’s Request for No Communication
15.7
Access to Telephone
15.8
Youth Property , State Issued Items and Personal Hygiene
Attachment A: State Issued Items Accountability Form
Attachment B: Personal Property Inventory
Attachment C: Disposal of Personal Property Form
15.9
Ombudsman
Attachment A: Action Form
Attachment B: Notification Letter
Attachment C: Resolution Letter
15.10
Language Assistance Services
Attachment A: Language Assistance Services Providers
Attachment B: I Speak Form
15.11
Request For Services
Attachment A: Help Request Form
Chapter 16:
Rules and Discipline
16.3
Cooling Off
Attachment A: Cooling Off Form
16.4
Pre-Hearing Confinement
Attachment A: Confinement Checks Form
16.5
Disciplinary Reports and Hearings
Attachment A: Disciplinary Reports and Hearings Guidelines
Attachment B: Behavior Infractions Grid
Attachment C: Disciplinary Report
Attachment D: Investigation Summary Report
Attachment E: Statement for the Record
Attachment F: Conducting a Disciplinary Hearing
Attachment G: Due Process Hearing
Attachment H: Due Process Hearing Appeal
Chapter 17:
Admission and Release
17.1
Admission to a Secure Facility
Attachment A: Notification of Foreign National in Detention
17.2
Youth and Parent Orientation
Attachment A: Orientation Acknowledgement Statement
Attachment B: RYDC Parent Letter
Attachment C: YDC Parent Letter
Attachment D: RYDC Student Handbook
Attachment D: RYDC Student Handbook (Spanish)
Attachment E: YDC Student Handbook
Attachment E: YDC Student Handbook (Spanish)
17.3
Custody and Housing Assessment
Attachment A: Custody and Housing Assessment Room Assignment Matrix
17.10
Transfers Between Secure Facilities
17.20
Facility Passes and Appointments
Attachment A: Off-Site Request and Supervision Plan
Attachment B: Off-Site Activity Supervision Plan
17.22
Designated Felon Order Modifications and Terminations
Attachment A: Good Behavior Brochure
Attachment B: Good Behavior Flow Chart
Attachment C: Request for Modification/Termination of Designated Felon Order
Attachment D: Good Behavior Secure Facility Checklist
Attachment E: Education Progress Form
Attachment F: Letter of Eligibility
Attachment G: Status Report
17.23
Release from Secure Facilities
Attachment A: Authorization for Release
Attachment B: Youth Status Report
Chapter 18:
Programs and Services
18.1
Facility Programs Case Management Services
Attachment A: Programs Coverage Plan
Attachment B: Approved Selection of Programs Protocol
Attachment C: Group Plan Form
Attachment D: Alternate Group Plan Form
18.2
Recreation Programming
Attachment A: Recreation Supply and Inventory Form
Attachment B: Leisure Supply and Inventory Form
18.3
Programs Quality Assurance
Attachment A: Program Corrective Action Plan
18.4
Work Activities for Youth
Attachment A: Work Assignment Detail Form
18.5
Program Provision in Secure Facilities
Attachment A: Superior Court Review of Order
Attachment B: Youth Sentenced by Superior Court Approaching Age 17
Attachment C: Youth Status Form
18.6
Positive Behavior Intervention and Support
18.8
Transition of Class B Designated Felons From Secure Placement
Attachment A: Step-Down Brochure
Attachment B: Class B Step-Down Criteria
Attachment C: Request for Step-Down of DF Class B Youth
18.10
Program Activity Schedule
Attachment A: Master Schedule Template
18.12
Personal Grooming
Attachment A: Barber/Cosmetology Sanitation Standards
Attachment B: Barber/Cosmetology Sanitation Inspection Report
Attachment C: Weekly Youth Haircut and Shaving List
Attachment D: Razor Checkout Log
Attachment E: Razor-Sharps Container Return Log
18.21
Extension of Youth Time in Secure Facilities
Attachment A: Youth Status Report
18.22
Superior Court Youth
Attachment A: Superior Court Review of Order
Attachment B: Youth Sentenced by Superior Court Approaching Age 17
Attachment C: Superior Court Personal History Sheet
18.23
Sexually Harmful Behaviors Treatment Program
Attachment A: Sexually Harmful Behavior Treatment Parent Letter
Attachment B: Youth Status Report
Attachment C: Sexually Harmful Review Panel Referral Form
Attachment D: Sexually Harmful Review Panel Criteria for Referral
18.30
Treatment Planning
Attachment A: Initial Programs Protocol
Attachment B: JDC Initial Parent Letter
Attachment C: Approved Selection of Programs Protocol
Chapter 20:
Case Management
20.1
Community Quality Assurance Monitoring
Attachment A: Operational Audit Form
Attachment B: Operational Audit Corrective Action Plan
Attachment C: Case Record Audit Form
Attachment D: Case Record Corrective Action Plan
20.2
Detention Monitoring
Attachment A: Request for Extension of Secure or Non-Secure Detention
20.3
Searches in Community Services Offices
Attachment A Visitor Notification - Spanish
Attachment A: Visitor Notification - English
Attachment B: Visitor Search Form
Attachment C: Lobby/Waiting Area Search Log
20.4
Interstate Compact and Out-of State Supervision
Attachment A: ICJ Form VII - Out-Of-State Travel Permit and Agreement to Return
Attachment B: Interstate Compact Home Evaluation Report – Form VIII
Attachment C: ICJ Victim Notification Supplement
Attachment D: Application for Services and Waiver Form IA/VI
Attachment E: Parole or Probation Investigation Request Form IV
Attachment F: Report of Sending State Upon Parole or Probationer Being Sent to the Receiving State Form V
Attachment G: ICJ Form IX: Quarterly Progress/Violation, or Absconder Report
Attachment H: ICJ Form III: Consent for Voluntary Return by Runaway, Escapee or Absconder
Attachment I: Rights for Voluntary Return of Runaway, Absconder, Escapee, or Juvenile Being Charged as Delinquent
Attachment J: ICJ Form I: Requisition for Runaway Juvenile
Attachment K: ICJ Form II: Requisition for Escapee or Absconder, or Juvenile Alleged to be Delinquent
Attachment L: ICJ Form X: Case Closure Notification
20.6
Status Offender / CHINS and Jail Monitoring
Attachment A: Annual Jail Monitoring Report
Attachment A: Annual Jail Monitoring Report - Markups
Attachment B: Annual Court Holding Report
20.7
Community Services Key Control
Attachment A: Request for Key/Lock Change, Addition or Maintenance
Attachment B: Key Control Audit
Attachment C: Key Log
Attachment D: Request for Keys
Attachment E: 24-Hour Key Authorization
20.8
High Profile Incident Review
Attachment A: Summary Template
Attachment B: Audit Template
Attachment C: Response to Division Audit
Attachment D: Response to Audit
20.9
Use of Security Equipment by Community Services Staff
Attachment A: Restraint Flow Sheet
Attachment B: Security Equipment Inventory and Verification Log
20.10
Intake
20.11
Detention Decision
Attachment A: Detention Assessment Instrument
Attachment B: Notice of Detention
Attachment C: Notice of Right to Bail
Attachment D: Application for Bond
20.12
Alternatives to Detention
20.13
Informal Adjustment
Attachment A: Informal Adjustment Agreement
20.14
PDRA / SDM
Attachment A: Pre-Disposition Risk Assessment Intrument
Attachment B: Structured Dispositional Matrix (SMD)
20.15
Referral for Apprehension of Youth
20.16
Short Term Programs
20.17
Incompetent Youth
Attachment A: Placement Checklist
20.20
Screening of Youth
Attachment A: Home Study Report
Attachment B: Screening Committee Recommendation Addendum
Attachment C: Screening Notification Letter
Attachment D: Notification of Screening Committee Recommendation
Attachment E: Screening Committee Recommendations
20.21
Community Mental Health Screening
Attachment A: MAYSI Notice to Parents
20.22
Placement of Youth
Attachment A: RBWO Assessment Checklist
Attachment B: Residential Emergency Phone List
Attachment C: Request For YDC
Attachment D: Parents/Legal Guardian Consent for Non-Parental Home Placement
Attachment E: Home Study Report for Non-Parental Home Placement
Attachment F: RPS CE Funding Letter
20.23
Trial Period
20.24
Community Residential Programs
Attachment A: RBWO Program Deficiencies Template
Attachment B: Community Medical Permission Form
Attachment C: RBWO Task Force Audit Tool CCI
Attachment D: RBWO Task Force Audit Tool CPA
Attachment E: Youth Residential File Audit Form
Attachment F: Pass Request for Youth in Residential Programs
Attachment G: Working Transition Plan (Guide)
Attachment H: Working Transition Plan (Template)
Attachment I: Administrative Appeal Procedures
Attachment J: DJJ Scorecard and Appeal Process
20.25
Termination and Extension of Commitments
Attachment A: Two-Year Termination Request Form
Attachment B: Notification of Administrative Termination to Court
Attachment C: Two-Year Extension Request Form
20.26
Administrative Revocation
Attachment A: Violation Report
Attachment B: Notice of Preliminary Hearing
Attachment C: Conducting a Preliminary Hearing
Attachment D: Admission of Violation / Waiver
Attachment E: Findings of Preliminary Hearing
Attachment F: Final Revocation Hearing
20.27
Administrative Supervision
Attachment A: Request for Administrative Supervision
20.31
Needs Assessment and Service Planning
20.32
Standards of Contact
Attachment A: Standards of Contact Grid
20.33
Graduated Sanctions
Attachment A: Secure Probation Sanctions Affidavit
Attachment B: Supervision Violations
Attachment C: High Level of Service Grid
Attachment D: Medium Level of Service Grid
Attachment E: Low Level of Service Grid
20.35
Supervision of Designated Felons in the Community
Attachment A: Youth Status Report
Attachment B: Request for Modification/Termination of Designated Felon Order
Attachment C: Community Checklist
Attachment D: Good Behavior Community Flow Chart for DF
Attachment E: Letter of Recommendation
20.36
Supervision of Sexually Abusive Youth in the Community
Attachment A: Agreement to Complete Certification Program
Attachment B: DJJ Sexually Harmful Behaviors Intervention Program Manual
Attachment C: Supervision Specialist Scope of Service
Attachment D: Sexually Harmful ReviewPanel Criteria
Attachment E: Sexually Harmful Youth Quarterly Review Checklist
Attachment F: JSOAP II
Attachment G: Parent Letter
Attachment H: Sexually Harmful Behavior Review Panel Referral Form
Attachment I: Offsite Request and Supevision Plan For Sexually Abusive Youth
20.37
High Intensity Team Supervision
Attachment A: Housebound Detention Referral Process & Standards of Contact
Attachment B: Housebound Detention Discharge Summary
Attachment C: HIT Referral Form
Attachment D: HIT Handbook
Attachment E: HIT Tri-Level System and Standards of Contact
Attachment F: Surveillance Report
Attachment G: Six Month Report
20.38
Electronic Monitoring Services
20.39
Community Drug Screening
Attachment A: Drug Screening Log
Attachment B: Request for Drug Screening
20.40
Supervision of Probated Youth
Attachment A: Authorization for Release of Information
Attachment B: Termination Summary
Attachment C: Sealing Your Court Record
20.41
Probation Management Program and Secure Probation Sanctions
Attachment A: Secure Probation Sanctions Hearing Officers
Attachment B: Secure Probation Sanctions Affidavit
Attachment C: Notice of Secure Probation Sanctions Hearing
Attachment D: Conducting a Secure Probation Sanctions Hearing
Attachment E: Admission of Violation/Waiver
Attachment F: Findings of Secure Probation Sanctions Hearing
Attachment G: Secure Probation Sanctions Referral Worksheet
20.42
Emergency Management for Community Offices
Attachment A: Emergency Plans
Attachment B: Acknowledgment of Review of Annual Emergency Plan
Attachment C: Notification Sheet (Staff Recall)
Attachment D: First Aid Kit Content
Attachment E: Drill Report
Attachment F: CSO Monthly Fire Assessment
Attachment G: National Incident Management System (NIMS) Primary Classes
20.43
School Resource Officer
Attachment A: Transportation Log
20.50
Restitution
Attachment A: Victims Right to Restitution Brochure
Attachment B: Restitution Court Notification Letter
20.51
Community Transportation Of Youth
20.52
Transfer of Certain Class A DFs to the Department of Community Supervision
Attachment A: Department of Community Supervision (DCS) Transfer Form
Attachment B: Notification of Transfer to the Department of Community Supervision
Attachment C: DCS Transfer Packet List
Attachment D: DCS Conditions of Supervision
Attachment E: DCS Conditions of Supervision for Sex Offenders
Attachment F: Notification of Expiration of Designated Felony Commitment
Chapter 21:
Quality Assurance
21.1
Program Evaluations
Chapter 22:
Investigations
22.1
Sworn Law Enforcement Retired ID
22.2
Security Risk Groups
Attachment A: Security Risk Group Questionnaire
Attachment B: Intelligence Submission Form
Attachment C: SRG Contact Form
22.3
Internal Investigations
Attachment A: Investigation Confidentiality and Privacy Acknowledgement
22.5
Polygraph Examinations
Attachment A: Direction to Submit to Polygraph Examination
Attachment B: Voluntary Stipulation
Attachment C: Understanding of Rights and Options (Contractors)
Attachment D: Understanding of Rights and Options (Employees)
Attachment E: Refusal to Submit to Polygraph Examination (Employees)
Attachment F: Refusal to Submit to Polygraph Examination (Contractors)
Attachment G: Juvenile-Parental Waiver of Consent
Chapter 23:
Prison Rape Elimination
23.1
Prison Rape Elimination Act
Attachment A: Facility Annual Staffing Report
Attachment B: PREA Unannounced Rounds
Attachment C: Cross Gender Searches Documentation
Attachment D: PREA Employment Questionnaire
Attachment E: Staff PREA Acknowledgement Statement
Attachment F: Consent to Disclose Protected & Confidential PREA Related Inf.
Attachment G: PREA Training Series
Attachment H: Youth PREA Acknowledgement Statement
Attachment H: Youth PREA Acknowledgement Statement (Spanish)
Attachment I: Resident Notification of Investigative Outcome
Attachment J: Sexual Abuse Incident Review Team Meeting Minutes
Attachment K: Requirements of A PREA Case
Attachment L: PREA Retaliation Monitoring Sheet
Attachment M: Written Plan for Coordinated Response for Allegations of Sexual Abuse
23.2
Sexual Assault
Attachment A: Facility Coordinated Response to a Sexual Assault Incident
23.3
LGBTI
Attachment A: Transgender/Intersex Declaration of Preference Statement
Attachment B: Sexual Orientation, Gender Identity, and Expression (SOGIE) Assessment
Chapter 24:
Federal Programs
24.1
Medicaid Application/ IV-E for Youth in Non-Secure Residential Programs
Attachment A: Georgia Department of Human Services Medicaid and IV-E Application Form 223
Attachment B: Form 223 Instructions
Attachment C: Georgia Department of Human Services Removal Home Income and Asset Checklist Form 224
Attachment D: Form 224 Instructions
Attachment E: Georgia Department of Human Services Medicaid and IV-E Redetermination Form 226
Attachment F: Form 226 Instructions
24.2
GA Gateway Administration and Benefit Applications for YDC Youth
Attachment A: COMPASS Individual User Agreement Form
Attachment B: COMPASS Transaction Authorization Form - English
Attachment B: COMPASS Transaction Authorization Form - Spanish
Attachment C: COMPASS Community Partner Handbook
24.3
Social Security Administration Pre-Release Program
Attachment A: Authorization to Disclose Information to Form SSA-827
Attachment B: Consent for Release of Information Form SSA-3288
Attachment C: Appointment of Representative Form SSA-1696-U4
Attachment D: Pre-Release Cover Sheet
Attachment E: Pre-Interview Report of Contact
Attachment F: Application for Supplemental Security Incoe Form SSA-8000-BK
Attachment G: Disability Report-Adult (>18), Form SSA-3820-BK
Attachment H: Disability Report-Adult (>18), Form SSA-3368-BK
Attachment I: Application for Disability Insurance Benefits Form SSA-16-BK
24.4
Georgia Health Information Network (GaHIN)
Attachment A: Member Subscription Agreement
Attachment B: Georgia Health Information Network, Inc. Georgia Direct Policies and Procedures
Attachment C: Georgia Health Information Network User Guide
24.5
Social Security and Supplement Security Income Benefits for Committed Youth
24.6
Benefit Applications for PreAdjudicated Youth
Attachment A: Application for Benefits (DHS Form 297)
Attachment B: Change Form
Attachment C: COMPASS Community Resources Handbook
Attachment D: COMPASS Transaction Authorization
24.7
Federal Benefit Eligibility and Health Insurance Coverage
Chapter 25:
Youth Centered Re-entry Team
25.1
YCRT
Attachment A: YCRT Meeting Letter
Attachment B: Consent for YCRT Participation
Attachment C: YCRT Staff Roles and Responsibilities
Attachment D: YCRT Agenda
Attachment E: Sign-In Sheet
25.2
ReEntry Framework
Attachment A: Reentry Strategic Plan
Attachment B: Task Force Governance Committee Bylaws
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