The Wyoming Division of Victim Services SFY 2018 On Site Review Checklist Revised July 2017

Key: V= Volunteer; P= Paid Staff; NP= Non-Profit Program Name: Board Chair Name: or Governing Entity Name: Director/Coordinator Name: On-Site Date: INTRODUCTIONS Board Chair/Governing Entity Describe the purpose of the on-site. Provide an overview of DVS. Describe RPM’s role and responsibilities. PROGRAM MISSION & ORGANIZATION Government Only – Governing Entity Review Mission Statement. (Date of last review/revision) Provide an overview of the program. What role does the governing body play in program operation? How does the governing body ensure adequate funding? Describe the interaction between the Supervisor and other staff. What are the governing body’s goals for the program? Describe the activities to achieve the goals stated. How is the impact of the program in the community evaluated? Who reviews the annual performance report submitted to the Division? How is the governing body made aware of the day to day financial transactions? Describe how fiscal oversight is provided. Review signed assurances with Supervisor.

PROGRAM MISSION & ORGANIZATION Non-Profit Only – Board Chair Review Mission Statement. (date of last review/revision)

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Provide an overview of the program. Review Articles of Incorporation. Review By-laws to include:  date of last review/revision;  executive board member job duties;  consistency with Articles of Incorporation;  committees (finance committee required, policy committee recommended);  terms and replacement of board members;  conflict of interest clause;  annual meeting. Review annual meeting minutes. Review board minutes and supporting documents:  does the board follow Roberts Rules of Order;  agendas for meetings;  is financial information included in the minutes (beginning balance, revenues, expenses, ending balance);  executive director reports;  committee reports;  approval of meeting minutes. How many members does the board have? Are all board positions filled? Discuss board roster and how membership reflects and represents the communities served. (i.e., selfidentified survivors, mental health, law enforcement, prosecution, corrections, medical professionals, service agencies, financial expertise, and interested citizens.) How often does the board meet? What initial and ongoing training does the board receive? How does the board ensure adequate funding of the program? How is the performance of the board evaluated? Describe the supervision of the Director. Describe the interaction between the board and other staff. What are the board’s goals for the program? Describe the activities to achieve the goals.

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What is the expectation of community collaboration with other allied partners? How is the performance of the program evaluated? Who reviews the annual performance report submitted to the Division? What is the composition of the board’s finance committee? (Program staff may serve in advisory capacity only) How often does the finance committee meet? Describe how fiscal oversight is provided. How is the board made aware of the day to day financial transactions? Review signed assurances with board chair. PROGRAM POLICIES Director/Coordinator Equal Employment Opportunity Plan (EEOP) (For detailed information regarding EEOP requirements, refer to the Office of Justice Department website: http://www.ojp.usdoj.gov/about/ocr/eeop.htm) Is the program required to prepare an Equal Employment Opportunity Plan (EEOP) in accordance with 28 C.F.R. §§42.301-.308? If so, does the grantee have an EEOP on file for review and does it include: a) Adopted grievance procedures b) Designated person to coordinate compliance c) Notification that grantee does not discriminate based on disability On what date did the grantee prepare the EEOP? If required by 28 C.F.R. §§42.301-.308, has the program submitted an EEOP Short Form to the Office for Civil rights (OCR), Office of Justice Programs (OJP), U.S. Department of Justice (DOJ)? If the program is not required to submit an EEOP Short Form to the OCR, has it submitted a Certification Form to the OCR claiming a partial or complete exemption from the EEOP (within 60 days of the grant award date)? How does the program conduct training for its employees on the requirements under federal civil rights laws? Part 1: https://wcadvsa.ilinc.com/perl/ilinc/lms/vc_launch.pl?activity_id=vsjrkhk&user_id= Part 2: https://wcadvsa.ilinc.com/perl/ilinc/lms/vc_launch.pl?activity_id=zvwztty&user_id= If applicable, has the program complied with the requirement to submit to OCR any findings of discrimination against the program issued by a federal or state court on the grounds of race, color, religion, national origin, or sex?

If the program operates an educational program or activity, has the program taken the following actions:

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a. Adopted grievance procedures that provide for the prompt and equitable resolution of complaints alleging a violation of the DOJ regulations implementing Title IX of the Education Amendments of 1972, found at 28 C.F.R. pt. 54, which prohibit discrimination on the basis of sex? b. Designated a person to coordinate compliance with the prohibitions against sex discrimination contained in 28 C.F.R. pt. 54? c. Notified applicants for admission and employment, employees, students, parents, and others that the program does not discriminate on the basis of sex in its educational programs or activities? Does the program provide federally funded services to eligible beneficiaries regardless of religion, a religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice? If the program engages in explicitly religious activities, does it do the following: a. Separate the explicitly religious activities in either time or location from the federally funded activities? b. Ensure that participation in the explicitly religious activities is voluntary for participants in the federally funded program? If the program is a religious institution or a faith-based organization, does the program do the following: a. Provide appropriate notice to program beneficiaries or prospective beneficiaries that the program does not discriminate on the basis of religion in the delivery of services or benefits? b. Provide appropriate notice to program beneficiaries or prospective beneficiaries that if they object to the “religious character” of the program, the program will make a reasonable effort to find an acceptable alternative provider in close geographic proximity that offers comparable services? c. Keep a record of the requests for an alternative provider from beneficiaries or prospective beneficiaries who object to the program’s “religious character,” noting the program’s efforts to find an appropriate alternative provider and to follow up with the beneficiary or prospective beneficiary? If the program receives funding under VAWA or from OVW, does it serve male victims of domestic violence, dating violence, sexual assault, and stalking? If the program receives funding under VAWA or from OVW, does the program provide sex-segregated or sex-specific services? If yes, describe how the services are sex-segregated or sex-specific. If yes, has the program determined that providing services that are sex-segregated or sex-specific is necessary to the essential operation of the program? If yes, describe how the program determined that providing sex-segregated or sex-specific services is necessary to the essential operation of the program. How are rules, policies, and procedures made available to staff, volunteers, and other interested individuals? Review non-discrimination policy for employees.

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Review non-discrimination policy for beneficiaries. Review drug-free workplace policy. Review violence-free workplace policy. Review ADA policy. Review service eligibility policy. Review lobbying policy. Review sexual harassment policy. Review confidentiality policy. Review maintenance and storage of files policy. Review mandatory reporting policy (child abuse/neglect, vulnerable adults [age 18 and up]). Review crisis intervention services policy. Review shelter policies (domestic violence service providers only). Review service documentation policy. Review safety policy. (Includes maintenance of premises, external and interior security, safety and security of phone, mail, and electronic communication). Review transportation policy. (Includes seat belt use, car safety seats for children, use of cell phones while driving). Does the program utilize gift cards? If yes, review policy on the use of gift cards and gift card logs. Review policy on how deposits for housing costs and storage units are handled.  Verify deposits are returned to grantee, not the client Review the language-access policy regarding providing services to LEP persons. Review Personnel and Volunteer policies. a) Orientation b) Staff development (P only) c) Ethical behavior d) Problem solving e) Evaluation (P only) (non-exempt employees only) f) Grievance (non-exempt employees only) g) Dismissal (non-exempt employees only) h) Background checks (including Child Abuse Central Registry) i) Travel policy

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j) Recruitment (V only) k) Selection (V only) l) Training (V only) What are the hours of operation and on-call services? Have there been any changes in services since the funding application was submitted? How does the program serve people with special needs? Identify underserved population(s). How was the population identified? How does the program provide outreach and services to the identified underserved population(s)? How does the program inform and assist victims with compensation claim applications? Date staff members last attended compensation training? How does the program evaluate services (quality, accessibility, impact, community collaboration, exit interviews, survey monkey, etc.)? How does the program evaluate community partnerships (quality, accessibility, impact, community collaboration, survey monkey, etc.)? Review victim outcome survey(s) to include (2) mandatory questions required by DVS (excludes CASA’s and CAC’s) What issues are there in securing victim rights in the community? How does the program promote victim issues and the availability of services? Review program’s publications/brochures/website for: list of services; If any of the materials are paid with federal funds, is the grant number reflected on the publication/brochure?; Is the Wyoming Division of Victim Services listed as a sponsoring agency on ALL materials as related to services and work to be performed under the contract agreement as per contract section 7, provision J. Where are the publications and brochures located throughout the community and how are they maintained? Describe collaboration to deliver direct victim services in the community. PROGRAM STAFF & VOLUNTEERS Director/Coordinator How many grant-funded personnel does the program have? How many volunteers does the program have?

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How does the program identify burn-out, compassion fatigue, and vicarious trauma in staff and volunteers, and how is this handled? Review grant-funded personnel job descriptions, to include qualifications. Review volunteer job descriptions/responsibilities, to include qualifications for direct service volunteers. Does program anticipate any changes in grant-funded personnel? Grant-funded personnel & volunteer employment information – Review the following: Name, Date of Hire, and Title Hours per Week Confidentiality Statement Central Registry for Child Abuse & Vulnerable Adults Training Status Confirm the following: Application/Resumѐ Employment and Academic Experience (Qualifications) Background Checks Interview grant-funded personnel –    

Describe professional and educational background. Describe day to day job duties. Describe the leadership provided from program supervisors. Describe challenges in performing the duties of your position.

PROGRAM VICTIM PROCEDURES Director/Coordinator Describe the program’s practices on crime victims’ files. Review release of information document. Are they written, informed, reasonably time limited, and signed by both the victim and staff? How long are victim files kept? How are victim files disposed of? Briefly describe the content of a victim file. Who has access to a victim’s file? Describe how the program tracks services provided to victims. Describe any restrictions on timing and duration of services.

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PROGRAM ADMINISTRATIVE RESPONSIBILITIES Director/Coordinator Discussion of contract and attachments. Discussion of current funding application. Discussion of reimbursement process. FISCAL MANAGEMENT Fiscal Agent Fiscal Agent Name/Title: Interview Fiscal Agent: Describe day to day job duties. Describe challenges in performing your duties.

Review fiscal accounting policies and procedures for internal/external controls, segregation of duties, and cash management procedures (NP only). Does the program utilize a computerized double entry accounting system in accounting for funds? Review chart of accounts and documentation on revenue and expenditures. Indirect cost rate. 

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A recipient that is eligible under the Part 200 Uniform Requirements to use the "de minimis" indirect cost rate described in 2 C.F.R. 200.414(f), and that elects to use the "de minimis" indirect cost rate, must advise OJP in writing of both its eligibility and its election, and must comply with all associated requirements in the Part 200 Uniform Requirements. The "de minimis" rate may be applied only to modified total direct costs (MTDC). Provide documentation showing compliance with this requirement, if indirect cost rates are being used.

Do the program‘s accounting records identify receipt and expenditure of program funds separately for each grant/funding source? What is the program’s pay period? Who are authorized check signers for the program? Number of signatures required. Verify revenues are properly accounted for. Obtain a copy of the most current audit or financial review and provide documentation on corrective action required, if applicable. Describe program’s plan for response and recovery from:  Misappropriation of funds  Overpayment from DVS

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Unapproved expenditures

Verify certification of compliance with Unemployment Insurance. Verify certification of compliance with Worker’s Compensation. Review and verify Secretary of State Annual Report (NP only).

CLOSING ON-SITE/DESK REVIEW Director/Coordinator What technical assistance would be most useful to the program? Overall comments:

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