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UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />How many suicidal prisoners were placed in restrictive housing during the rating period? <br />Prisoner Death <br />Does the facility have procedures to respond to a prisoner's death? <br />C Yes C No <br />Does the facility immediately notify the USMS in the event of a USMS prisoner death? <br />C Yes C No <br />Does the facility review each prisoner death? <br />C Yes C No <br />Infectious Disease <br />Does the facility have policy or procedures to address the management and reporting <br />diseases? <br />C Yes C No <br />Does the plan include: <br />HIV? <br />C Yes <br />C <br />No <br />Tuberculosis? <br />(' Yes <br />C <br />No <br />Hepatitis? <br />{` Yes <br />C <br />No <br />Influenza? <br />Yes <br />C <br />No <br />Chlamydia? <br />C Yes <br />(' <br />No <br />COVID? <br />C Yes <br />C <br />No <br />Ebola? <br />C" Yes <br />C <br />No <br />HPV? <br />C Yes <br />C <br />No <br />Salmonella? <br />C Yes <br />C <br />No <br />Scabies? <br />( Yes <br />C <br />No <br />Zika? <br />C Yes <br />(' <br />No <br />E. coli? <br />C Yes <br />C <br />No <br />Chicken Pox? <br />C Yes <br />C <br />No <br />Does the facility have an infectious and communicable disease policy or procedures to: <br />Include identify prisoners with infectious and communicable diseases? C Yes (' No <br />Treat prisoners with infectious and communicable diseases? C Yes C No <br />Quarantine prisoners with infectious and communicable diseases? C Yes ( No <br />Does the facility report all cases of infectious and communicable diseases to the USMS? <br />C Yes C No <br />Does the facility maintain adequate PPE for all staff in the event of a pandemic? <br />C Yes C No <br />and communicable <br />NOTICE: This document is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL information <br />which is for the sole use of the intended recipient(s) Any unauthorized review. use, disclosure. or distribution is prohibited. If you are not the intended <br />recipient. please contact the sender and destroy all copies of this document. Any Protected Health Information contained in this document Is to be used <br />only to aid in providing healthcare services to federal prisoners Any other use is a violation of Federal HiPAA Law and/or the Privacy Act and will be <br />reported as such. <br />UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />Page 11 of 22 <br />Form USM -218 <br />Rev. 07/21 <br />