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uNGLASSIF|EDTTLAW ENFORCEMENT SENSITIVE (When Gompleted) <br />lf ,No,to the previous question, has a DoJ PREA audit been scheduled? <br />CYes CNo <br />Scheduled DOJ PREA Audit Date <br />ls a hard copy of the PREA audit available? <br />CYes CNo <br />lf 'Yes', Audit Date What was the name of the Auditor? <br />ls there a corrective action plan in place? <br />CYes CNo <br />Has corrective action taken Place? <br />CYes CNo <br />Was the facility re-inspected to ensure the violations were corrected properly? <br />CYes CNo <br />HEALTH CARE <br />lntake and Screening <br />Does the facilitY have PolicY or procedures for medical screening during intake? <br />CYes CNo <br />Do allprisoners undergo medicalscreening during the initial intake process? <br />CYes CNo <br />lf 'No', how long after intake does the screening occur? <br />months days <br />ls a comprehensive health appraisalfor each prisoner completed within 14-days after initial intake? <br />CYes CNo <br />lf 'No', how long after intake does the appraisal occur? <br />months days <br />Does the facili$ ensure TB testing during the initial intake process? <br />CYes CNo <br />lf 'No', how long after intake does the TB test occur? <br />months days <br />Are TB test results provided to the USMS within 14 days? <br />CYes CNo <br />NoTICE: This document is intended FoR oFFlctAL usE oNLY and may conlain tAW ENFoRCEMENT sENslrlvE oR CONFIDENTIAL informalion <br />which is for the sole use of lhe intended recipient(s). Any unauthodzeo revtew. use, disclosure, or distribution is prohibited' lf you are not the intended <br />,".ipi"nt, please contact the sender and deitroy iri copils of this document. Any Protecled Health lnformation contained in this document is to be used <br />o.l,ii" iiO i" p.viding heallhcare services to federal prisoners. Any other use is a violation of Federal HIPAA Law and/or the Privacy Ac{ and will be <br />reported as such. <br />UNCLASS|FIED//LAW ENFORCEMENT SENSITIVE (When Completed) <br />Form usM_218 <br />Page I of 22 Rev. o7121