DAVIESS COUNTY COMMUNITY CORRECTIONS WORK RELEASE PROGRAM HANDBOOK

Transcription

1 DAVIESS COUNTY COMMUNITY CORRECTIONS WORK RELEASE PROGRAM HANDBOOK VISION We will become leaders in the field of offender rehabilitation and re-entry through the application and use of evidence based practices. MISSION We facilitate behavioral change in the lives of at-risk populations that results in a safer community. Work Release Facility Community Corrections Office 101 NE 4 th Street 415 W. Walnut Street Washington, Indiana Washington, Indiana Office (812) Fax (812)

2 Dear Program Participant: As a result of a court order, you have been placed in our work release program. We both share the same goal... for you to satisfactorily complete your sentence and return to the community as a responsible and productive citizen. Our agency operates on the premise that every program participant has the potential to achieve that goal. It will not be easy and your time in the work release program will be filled with challenges, but we believe that you can accomplish this or the court would not have placed you in this program. During your placement in our work release program, you can expect staff to assist you in this effort by prioritizing your participation in services that address treatment and education needs identified during the development of your case plan. These services will support you and increase the likelihood of you successfully completing your sentence. The program has a great many rules and guidelines, all of which are designed to guarantee accountability and encourage a change in negative behavior. Our expectation is that you attend all required treatment and education programs, that you abide by the rules and guidelines, and that you demonstrate the desire and put forth the effort required to change your behavior. The following material outlines the rules, guidelines, and behavior that are expected of our program participants. Our staff will explain the following information to you during the intake process, and you are encouraged to ask questions. It is recommended that you keep this material and review it carefully. If you have any questions, do not hesitate to contact a member of our staff. Respectfully, Diana L. Snyder Executive Director Page 2 of 31

3 Contents COMMUNITY CORRECTIONS STAFF... 4 WORK RELEASE PROGRAM CONTRACT... 5 DAVIESS COUNTY WORK RELEASE REWARDS AND PRIVILEGES DAVIESS COUNTY WORK RELEASE VIOLATIONS AND SANCTIONS WORK RELEASE PROGRAM FORMS EMPLOYER S WORK AGREEMENT WORK RELEASE JOB SEARCH VERIFICATION WORK RELEASE REQUEST FORM WORK RELEASE INFORMATION FORM MEETING/SUPPORT GROUP VERIFICATION WORK RELEASE ARRIVAL AND DEPARTURE FORM MEDICAL APPOINTMENT/INFORMATION RELEASE FORM CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION WORK RECORD MISCELLANEOUS INFORMATION Page 3 of 31

4 COMMUNITY CORRECTIONS STAFF Daviess County Community Corrections Executive Director: Diana L. Snyder Administrative Assistant: Sheila Petty Work Release Case Manager: Evett Arney Work Release Program Assistant: Laura L. Petty Community Service/HD Case Manager: Joe Hamdan Home Detention Case Manager: Brandy Chapman Home Detention Case Manager: Terence Wright Field Officer: Mike Healy Field Officer: Steve Sturgis Page 4 of 31

5 Daviess County Community Corrections 415 W. Walnut Street Washington, Indiana (812) FAX (812) WORK RELEASE PROGRAM CONTRACT Name: Beginning Date: Cause Number: Projected Release Date: Date of Birth: Length of Sentence: Charge: Felony Misdemeanor Class Circle One: DC Ex. Sent. S.S. Prob. VOP MOS PT CTP Trans. Other SPECIFIC CONDITIONS OF THE WORK RELEASE PROGRAM 1. I,, agree to comply with the special conditions stated in this contract, in addition to the Standard Rules of Probation. I am signing this contract with the understanding that failure to comply with any of these conditions may result in a violation being filed with the Court and/or Probation Department I understand that in addition to the Judicial review, I will also be subject to administrative disciplinary action for failure to follow the Work Release Program Disciplinary Code and Sanctions. I am subject to loss of privileges. I understand that while on the Work Release Program, I will be under the supervision of Daviess County Community Corrections and subject to all rules and regulations of that program. I understand that Work Release is a privilege and not a right. I will cooperate with and truthfully answer all reasonable inquiries of Community Corrections Staff. I understand that failure to return to the Work Release Facility as scheduled or being in an unauthorized location may subject me to prosecution for the crime of escape under I.C I understand that I am not to commit any law violations resulting in a new arrest or summons to Court while on the Work Release Program. Failure to obey all Municipal, County, State and Federal laws may result in termination from the Work Release Program and the immediate filing of a violation. I understand that I am not to violate any term of a license suspension and/or any restriction of a license. Page 5 of 31

6 8. I understand that my primary residence while on the Work Release Program shall be the Daviess County Security Center, unless otherwise ordered by the sentencing Court. 9. I understand that while on the Work Release Program, I will have no contact with anyone on probation/parole, unless granted permission by Daviess County Community Corrections. 10. I understand that while on the Work Release Program, I will immediately remove myself from the presence of anyone performing an illegal act. I shall immediately notify Daviess County Community Corrections of the incident. 11. I understand that I am not to possess or use any firearm, destructive device, or other dangerous weapon unless granted written permission by Daviess County Community Corrections. 12. I agree to allow the Daviess County Community Corrections Staff to make reasonable inquiry into my activities. I agree to waive my right against search and seizure, and permit Daviess County Community Corrections or any law enforcement officer acting on behalf of Daviess County Community Corrections, to search my person, motor vehicle, or any location where my personal property may be found, to insure compliance with my conditions of the Work Release Program. 13. A. I will not consume, or possess on my person, or in my vehicle, any alcohol or drugs unless prescribed by a physician. I will submit to drug and alcohol tests immediately upon request. Failure to submit to a test or tests will be considered an admission of guilt. I understand I have two hours from the time notified to produce a urine specimen for drug testing. I will be responsible for the cost of said tests. B. I will not use or consume any illegal drugs, controlled substances, hemp, hemp products or extracts. C. I will not consume anything containing alcohol, including but not limited to an alcoholic beverage. I will not take medication containing alcohol in it, (i.e., liquid cold medicine, cough syrup, or medicated mouthwash). D. I will not be in the company of anyone that is using or possessing alcohol or illegal drugs. E. By signing this contract I waive any objection to the admissibility of the results of the test as they are received by the Court into evidence at any Revocation Hearing. If urine screen results return diluted, it will be deemed a violation of the contract. I will be responsible for the payment of the cost of said test. 14. I agree to sign a release of information for Daviess County Community Corrections. 15. I agree to permit Community Corrections and/or law enforcement, acting on behalf of Community Corrections, to visit my place of employment at any given time. 16. All Work Release Program participants are required to provide verification of work hours and treatment attendance on a weekly basis or upon request. Failure to do so may result in termination from the program. Weekly schedules once approved by Daviess County Community Corrections staff may only be changed for the following reasons: Page 6 of 31

7 A. Medical Emergency: The Participant must contact Daviess County Community Corrections as soon as possible to inform staff as to the nature and extent of the medical emergency. Failure to notify Community Corrections may result in a violation being filed with the Court and/or Probation Department. B. Change in work/treatment hours: At times the participant s employer may request that the participant works over or shorten the participant s hours due to more or lack of work. Your employer is required to inform the Daviess County Community Corrections Staff immediately of these schedule changes to receive necessary approval. Failure to do so may result in the participant s removal from the Work Release Program and the filing of a violation with the Court and/or Probation Department.. I understand that Daviess County Community Corrections is the only agency that may approve any work schedule and/or changes in my work schedule. I understand that any schedule change requires 24 hour notice, excluding weekends and holidays. 17. I understand that I must find verifiable employment within 30 days of entering the Work Release Program. If I am not successful, I will be removed from the program. I will be let out of the facility on Tuesdays and Thursdays from 8:00am-1:00pm to go on an intensive job search. 18. I understand that I cannot be self-employed or work for family members. 19. I understand that I will not work more than one (1) job. I will also be limited to working no more than six (6) days a week, and twelve (12) hours a day. Scheduled hours are to be provided to Daviess County Community Corrections at a time arranged by them 20. I agree to allow Daviess County Community Corrections Staff to monitor my employment by examining my time cards, contacting my supervisor, and conducting work-site visits. I shall authorize my employer to release all records and information requested concerning my hours of employment, attendance on the job, duties of employment, reporting and dismissal times, and such other information as may be requested by Daviess County Community Corrections. 21. I understand that I will not be permitted to work on certain holidays unless granted permission by Daviess County Community Corrections. I also understand that if I am permitted to work these holidays, I must be able to be contacted by landline telephone at my place of business. 22. I understand that I am responsible for all my transportation needs while on the Work Release Program. All transportation arrangements must be approved by Daviess County Community Corrections. 23. I agree to travel in a direct route to and from my place of employment, or any other permitted destination without making any stops or side trips, and to have no unauthorized passengers in my vehicle. Side trips are defined as any deviation in the normal route of travel to and from the facility. 24. I understand that if I am released from work early at any time, I will immediately notify Daviess County Community Corrections, and return directly to the facility or home with no side trips and/or stops. I also understand that if work is canceled at any time, I will immediately notify Daviess County Community Corrections, and return directly to the facility with no side trips and/or stops. Stops are defined as any stop that a Participant makes at any location or business that has not been approved by Daviess County Community Corrections. Page 7 of 31

8 25. I understand that I am not to leave my place of employment or any other approved location without prior approval of Daviess County Community Corrections. 26. I understand that I will be given 1 hour at my home base after work. This hour will be used for eating, showering, laundry, and visiting with family. I must wear clean clothes back to the facility that I will wear out to work the following day. 27. I understand that my home base needs to be approved by Daviess County Community Corrections. If I need to change my home base to a different location, I shall not change my home base until Community Corrections has approved a different location. 28. A. If I become unemployed during the term of my Work Release Program sentence, I shall immediately notify Daviess County Community Corrections. Community Corrections shall commence an investigation into the reasons for my unemployment. During the time that this investigation is ongoing, I understand that I shall be permitted to continue to be released for the purpose of conducting an intensive job search. B. If it is determined from the above investigation that my unemployment is for reason other than my own misconduct or poor work performance, then I shall be allowed to continue on the Work Release Program under the following conditions: 1. I must conduct an intensive job search on Tuesdays and Thursdays from 8:00am-1:00pm. 2. I shall continue with Court and/or Community Corrections mandated treatment. 3. I understand that my program fees must remain current, regardless of employment. C. If, however, it is determined from the above investigation that my unemployment was due to my own misconduct or poor work performance, then I understand that my release privileges shall be immediately suspended and a violation will be filed with the Court and/or Probation Department. Such suspension, however, may be stayed at the discretion of the Daviess County Community Corrections if I have commenced acceptable employment before the completion the above investigation. 29. I understand that I am required to pay for any medical services and/or care needed during my Work Release Program sentence. 30. I understand that I must be making a good-faith effort in paying all Court Cost, fines, restitutions, and child support. A receipt of payment must be provided to Community Corrections for verification. 31. I understand that I will be charged an initial fee, a weekly fee, and other fees as approved by the Daviess County Community Corrections Advisory Board. Payments will be made by money order or exact cash. Payments are due every Monday. I understand that failure to make payments as scheduled, or departure from the program with a balance of payments in arrears may result in any or all of the following: A. A violation may be filed against me with the Court and/or Probation Department. B. The Court may enter a civil judgment against me in the criminal case for the amount of the arrearage. Page 8 of 31

9 C. I may be sued in civil court or subject to collection proceedings for the amount of the arrearage, plus costs of the proceedings and attorney fees. 32. I understand that Daviess County Community Corrections has the authority to direct me to substance abuse treatment, school (if I do not have a high school diploma or GED), counseling, or any other program that Daviess County Community Corrections has determined to be appropriate for me to attend. Failure on my part to follow through on such directives may result in a violation being filed with the Court and/or Probation Department. 33. I understand that Daviess County Community Corrections can terminate my participation in this program without notice, if I have any violations of the above conditions. 34. I understand that I may be required to remain in the facility on the last day of my sentence in order to complete an exit interview or any other paperwork that needs to be finished. 35. Waiver of Extradition: If I leave the State of Indiana, with or without permission of the Daviess County Community Corrections or the sentencing Court, I understand that I waive (give up) my extradition rights and will voluntarily return to the State of Indiana. 36. Special Orders: During my term in the Work Release Program, if a determination is made that there is probable cause to believe that I have violated any of these conditions; I may be removed from participation in this program and may be incarcerated pending further Court determination. I further acknowledge that if the Court finds that I have violated any one of these conditions, the Court may, after a hearing, revoke the suspended sentence and impose any sentence it may have originally imposed, modify my conditions, or continue my placement. This contract has been read and explained to me and my signature below acknowledges that I have fully read and fully understand all terms and conditions of this contract. I further acknowledge that I have initialed each and every term of this Work Release Contract as I have read and understood each term. I further acknowledge that I have received the Daviess County Community Corrections Work Release Program Handbook and agree to comply with all the rules and procedures set forth in it. Work Release Participant Date Community Corrections Staff Date Judge Date Sheriff Date Revised: 8/23/2013: Approved by AB: 9/4/2013: Effective Date: 9/5/2013 Page 9 of 31

10 DAVIESS COUNTY WORK RELEASE REWARDS AND PRIVILEGES PURPOSE - To establish a facility disciplinary code and sanctions, and a schedule of rewards for positive behavior for participants. - To develop reasonable rules and regulations designed to encourage participants to respect the rights of others and practice the self-discipline and self-control that will enable them to return to society and live within acceptable standards. LEVEL ONE STATUS & REWARDS STATUS: One month with no violations of any kind. PARTICIPANT RESPONSIBILITIES: - Seek, obtain, and maintain verifiable employment - Provide work hours verification, i.e. time card, time sheet, etc. (if employed) - Abide by all conditions of probation/sentencing order - Abide by all facility rules and regulations - Be current in program fees, including drug screen fees REWARDS: - One hour per month for family visitation - Permission to attend one GED class weekly, if needed - Permission to attend one weekly Lighthouse, NA/AA, or approved support group meeting (Monday-Saturday only) - if IRAS indicates need. LEVEL TWO STATUS & REWARDS STATUS: Two months with no Class A, B, or C violations and no more than one Class D violation. PARTICIPANT RESPONSIBILITIES: - Maintain verifiable employment - Provide work hours verification, i.e. time card, time sheet, etc. - Abide by all conditions of probation/sentencing order - Abide by all facility rules and regulations - Be current in program fees, including drug screen fees REWARDS: - One hour per month for family visitation - Attend church, main service only, with an approved person over the age of 21, once monthly. A specific time frame will be given and must be followed. Must be in Daviess County. No special services or meals allowed - Permission to attend two GED classes weekly Page 10 of 31

11 - Permission to attend two weekly Lighthouse meetings or NA/AA, or approved support group meetings (Monday-Saturday only) - One hour personal time once monthly (i.e. haircut, shopping-at approved places only) LEVEL THREE STATUS & REWARDS STATUS: Three months with no Class A, B, or C violations and no more than two Class D violations. PARTICIPANT RESPONSIBILTIES: - Continue to maintain verifiable employment and provide work hours verification - Abide by all conditions of probation/sentencing order - Abide by all facility rules and regulations - Be current or working towards being current on child support and/or restitution payments - Be current in program fees, including drug screen fees - Demonstrate a desire to advance to the next status level REWARDS: - An extra one hour of family visitation per month for a total of two hours - Attend church, main service only, with an approved person over the age of 21, twice monthly. A specific time frame will be given and must be followed. Must be in Daviess County. No special services or meals allowed. - Permission to attend two weekly Lighthouse meetings or NA/AA, or approved support group meetings (Monday-Saturday only) - One hour personal time once monthly (i.e. haircut, shopping-at approved places only) LEVEL FOUR STATUS & REWARDS STATUS: Four months with no Class A, B, or C violations and no more than two Class D violations. PARTICIPANT RESPONSIBILITIES: - Continue to maintain verifiable employment and provide work hours verification - Abide by all conditions of probation/sentencing order - Abide by all facility rules and regulations - Be current or working towards being current on child support and/or restitution payments - Be current in program fees, including drug screen fees - Demonstrate a desire to remain at this status level REWARDS: - Family time activity (two hour limit), a request form must be completed with the name and location of the activity at least 72 hours in advance, case manger approval required. Must be specific- Who, What, When, and Where. - Attendance at an event for your child(ren), same requirements as above. Page 11 of 31

12 - Attend church, main service only, with an approved person over the age of 21, twice monthly. A specific time frame will be given and must be followed. Must be in Daviess County. No special services or meals allowed. - Permission to attend two weekly Lighthouse meetings or NA/AA, or approved support group meetings (Monday-Saturday only) - One hour personal time once monthly (i.e. haircut, shopping-at approved places only) Once a participant reaches a level, the reward may continue weekly until the status level changes. Page 12 of 31

13 DAVIESS COUNTY WORK RELEASE VIOLATIONS AND SANCTIONS CLASS A VIOLATIONS The following offenses constitute Class A violations: - Commission of any criminal offense as defined by Indiana or Federal Law - Escaping or absconding - Fighting or assaulting another person - Sexual assault - Holding a person hostage - Inciting others to riot or participating in a riot or violent disturbance - Possession, introduction, or use of a dangerous or deadly weapon - Possession, introduction or use of an explosive or any ammunition - Setting a fire or any type of reckless burning - Stealing (theft) or knowingly possessing stolen property - Extortion, blackmail, or demanding or receiving money or anything of value in return for protection from others, or under threat of informing - Involvement in any activity in such a manner as to likely result in danger to the health and safety of others, or to create a security risk to the orderly operation of the work release facility - Refusal to submit to any chemical test when legally requested by a staff member - Being the subject of an ongoing criminal investigation - A combination of any two Class B violations - Attempting to commit any of the above offense, or aiding, commanding, inducing, or procuring another to commit any of the above offenses shall be considered the same as commission of the offense itself. DISCIPLINARY ACTIONS: Class A violations shall receive the following disciplinary actions: - A violation filed with the Court and/or Probation Department - Termination of participation in the Work Release Program - CAB board hearing, with possible loss of earned credit time CLASS B VIOLATIONS The following offenses constitute Class B violations: - Possession, introduction, or use of any intoxicating substance, including, but not limited to, alcohol, narcotics, hallucinogens, depressants, unauthorized prescription medication, or any other illegal substance or drug paraphernalia - Engaging in consensual sexual acts with another within the facility - Making sexual proposals or advances to another - Indecent exposure - Possession or introduction of literature or plans regarding a dangerous or deadly weapon - Making a replica of a weapon or a potential weapon - Unauthorized possession or introduction of any device capable of being used as a weapon - Possession of escape paraphernalia - Encouraging others to refuse to work or participate in a work stoppage Page 13 of 31

14 - Unexcused absence from work or any assignment or program - Refusal to work or accept work or a program assignment - Representing oneself as another person - Engaging in or encouraging others to engage in unlawful group demonstration - Giving money or anything of value or accepting same from any person without proper authority - Giving or offering a money bribe or anything of value to a staff member - Physically resisting or fleeing a staff member in the performance of his/her duty - Destroying, altering, or damaging property belonging to another - Disorderly conduct: making unreasonable noise, disturbing any lawful assembly of person, or otherwise disturbing the peace and quiet, security, and orderly running of the facility or other area in which the participant is located - Tampering with, altering, or blocking any locking device - Unauthorized alteration of any food or drink - Gambling, preparing, or conducting a gambling pool, or possession of unauthorized gambling paraphernalia - Violating any facility rule, regulation, or condition associated with employment passes, treatment passes, or other temporary leaves - Counterfeiting, forging, or unauthorized reproduction of any document, article, identification, pass, money, security, or other legal paper - Unauthorized operation of a motor vehicle - Failure to pay program fees - A combination of any Class C violations - Attempting to commit any of the above offenses, or aiding, commanding, inducing, or procuring another person to commit any of the above offenses, or conspiring with another to commit any of the above offenses shall be considered the same as commission of the offense itself DISCIPLINARY ACTIONS: Class B violations may receive all or a combination of the following disciplinary actions: - A violation filed with the Court and/or Probation Department - Suspension of all privileges up to one year - Return to level zero status and rewards after privilege suspension - Lockdown for up to two weeks - Fined up to $200 - CAB hearing with possible loss of earned credit time, up to 30 days CLASS C VIOLATIONS The following offenses shall constitute Class C violations: - Unauthorized contact with the public - Vulgar, abusive, or profane language directed at another - Possession of property belonging to another person - Unauthorized use of medication (both prescription and over-the-counter) - Refusing to obey an order from any staff member - Lying or providing false statements to a staff member, employer, or prospective employer, or other responsible members of the community - Participating in any unauthorized meetings or gatherings - Any unauthorized removal, transfer, or relocation of property or the property of another - Selling or converting property for profit Page 14 of 31

15 - Unauthorized use of mail, telephone, or visiting privileges - Adhering by means material to walls, floors, ceilings, lights, etc. No pornographic material is to be displayed. Non-pornographic material may be displayed but not adhered to anything - A combination of any three Class D violations - Attempting to commit any of the above offenses, or aiding, commanding, inducing, or procuring another person to commit any of the above offenses, or conspiring with another to commit any of the above offenses shall be considered the same as commission of the offense itself DISCIPLINARY ACTIONS: Class C violations may receive all or a combination of the following disciplinary actions: - A violation filed with the Court and/or Probation Department - Suspension of all privileges for up to six months - Return to level zero status and rewards after six month suspension - Lockdown for up to one week - Fined up to $100 - CAB hearing with possible loss of good time credit, up to 15 days CLASS D VIOLATIONS The following offenses shall constitute Class D violations: - Possession of anything not authorized for retention by participants, and not issued to the individual participant through regular facility channels - Possession of unauthorized clothing - Violating any facility rule, regulation or standing order that has been communicated to the participant - Being in an unauthorized area - Returning to facility with cigarettes and/or lighter in your person - Tattooing or self-mutilation - Failure to follow safety or sanitation regulations - Being unsanitary or untidy; failing to keep one s person or one s dorm in accordance with published standards - Communicating with an inmate of Daviess County Security Center (jail or work release) orally, in writing, or in any other manner - Attempting to commit any of the above offenses, or aiding, commanding, inducing, or procuring another person to commit any of the above offenses shall be considered the same as commission of the offense itself DISCIPLINARY ACTIONS: Class D violations may receive all or a combination of the following disciplinary actions: - A violation filed with the Court and/or Probation Department - Suspension of all privileges for up to one month - Return to level zero status and rewards - Lockdown up to four days - Fined up to $50 Page 15 of 31

16 WORK RELEASE PROGRAM FORMS In order to assist the participant, Daviess County Community Corrections has several forms to be used to facilitate requests. It is important that the participant use the forms correctly and in the proper manner so that the appropriate person may review the requests. Program participants are to only use blue or black ink when completing forms. Whiteout or pencils are not to be used. Forms will be returned if the guidelines are not followed. If the participant uses the wrong form, the request may be returned and the participant will have to resubmit using the correct form. Once reviewed by personnel, the forms are to be placed in the correct folder in the search room. Program participants are not to remove forms from the handbook. Employment Work/Verification Form: This form is used to indicate the participant s place of employment. It must be completed and submitted to Community Corrections before the participant will be permitted to leave for a job. This form needs to be completed for any changes in the participant s employment. Daviess County Community Corrections has the discretion to approve or deny a place of employment. Job Search Form: This form is used to verify employment searches. This form must have the company name, location, phone number, arrival and departure times, and the printed name and signature of the person spoken to. This form must be submitted upon return to the facility. Failure to complete the form entirely or to submit the form in a timely manner may result in the delay of future employment searches. Request Form: This is used to give and request information to/from any agency personnel, requesting to make an appointment with agency personnel, or any problems the participant may have within the facility. Staff will review the forms every morning, Monday through Friday, except holidays, and either respond to these requests or direct them to the appropriate individuals. Maintenance issues or telephone problems should be directed to the jail staff. Information Form: This form is used to update personal information. After receiving the form, it must be fully completed and turned in within 24 hours. Support Group/Meetings Verification Form: Verification forms are used for documentation of participation in support/meeting groups. The program participant must have the group leader sign and date the verification form. If the form is not signed, the program participant could have release time reduced as well as receive a non-compliance violation. Arrival/Departure Form: This form is used to verify where a participant has been (excluding work) while outside of the facility. This form should be used at any appointment or place that the participant requested to visit to verify time spent outside the facility. Page 16 of 31

17 Medical Appointment/Release of Information Form: This form allows Community Corrections to obtain information regarding the participant s health. This form must be taken to any medical appointment, psychiatric appointment, hospital visit (if participant is the patient), or any other appointment concerning participant s health. It must be filled out completely and accurately. Failure to have this form filled out could result in a non-compliance violation. Consent for Release of Confidential Information: This form allows Community Corrections to obtain information regarding the participant s legal records, any information regarding past/present treatment, and/or education history. Other records may be requested that do not fall under the above categories. Work Record Form: This form is used to verify work hours at a participant s place of employment. This form should be filled out completely and accurately by the participant s supervisor. This form should only be used for those participants that work at a place without electronic timesheets or punch cards. These forms must be turned in weekly. Page 17 of 31

18 EMPLOYER S WORK AGREEMENT Daviess County Community Corrections I,, understand that is currently supervised by the Daviess County Work Release Program and that he/she must comply with the rules and regulations of the program. I have received a copy of the Employer s Work Agreement that outlines policies and expectations of Participants and employers. Signature: (Position/Title) Company Name: If working through an employment agency note actual work site company name Actual Work Site Address: City: State: Zip: Phone: Direct Supervisor: Start Date: Part-Time: Full-Time: Scheduled Work Hours: - Please be specific Number of Hours/Week: Hourly Wage: Frequency & day of pay: Example: Bi-weekly Friday; Weekly - Monday First Pay Date: If employment is through an employment agency please note agency name and contact number: Temp Agency Name: Phone: Community Corrections Staff Use Only: Date of Phone Verification: Date of on-site Check: Page 18 of 31

19 Daviess County Community Corrections Employer s Work Agreement Keep this document for your records. Daviess County Community Corrections Program Policies Are As Follows: 1. All wages earned by the participant in the Community Corrections Program shall be paid to the participant. No loans or advance payments may be given to the participant. 2. A participant must receive wages commensurate with those received by comparable workers. 3. Failure of a Participant to perform his work task in a satisfactory manner or failure of a Participant to attend work shall be reported to the Community Corrections Staff. 4. While employed, the Participant shall be covered by the employer s insurance and/or Workman s Compensation Insurance as required by law; Community Corrections is not liable for any claim. 5. Work time cannot exceed 12 hours per day. 6. Participants whose employment requires more than one job site per shift must have an employer that will provide documentation verifying the Participants location throughout their shift on a daily basis. What Daviess County Community Corrections Staff will request from you, the employer: 1. Furnish pay stubs that include pay period dates, hours worked and pay rate. 2. Provide work performance information upon request. 3. Notify DCCC Staff of all positive alcohol and drug tests. 4. Notify DCCC Staff immediately of any absences, tardiness and/or disciplinary action including terminations. 5. Allow DCCC Staff the ability to verify attendance via phone and on site checks. 6. Notify DCCC Staff if a Work Release/Home Detention Participant leaves the worksite without DCCC Staff approval. Contact Information: Phone: Fax: Mail: Daviess County Community Corrections 415 W. Walnut Street Washington, IN Please complete the attached form and return to Daviess County Community Corrections via fax or mail. Page 19 of 31

20 Name: Daviess County Community Corrections WORK RELEASE JOB SEARCH VERIFICATION Date Time Arrived Time Departed Business Address Phone Supervisor Signature Date Time Arrived Time Departed Business Address Phone Supervisor Signature Date Time Arrived Time Departed Business Address Phone Supervisor Signature Date Time Arrived Time Departed Business Address Phone Supervisor Signature Date Time Arrived Time Departed Business Address Phone Supervisor Signature Page 20 of 31

21 WORK RELEASE REQUEST FORM Date: Participant: To: REGARDING: ****************************************************************************** FOR DEPARTMENT USE ONLY STAFF RESPONSE: Community Corrections Page 21 of 31

22 WORK RELEASE INFORMATION FORM Locker # Name: Home Base Address: Phone number for Home Base (Land Line) Cell phone numbers for phones you carry: Names of people living at home base Emergency Contact: Name Home phone: Cell Phones: Are you ordered to pay support? What county paid in? Employer: Supervisor: Schedule: (if it is not a set schedule then state Varies) Address of Employer: Phone number for Employer (include any cell phone numbers): Information for all vehicles that you drive to jail and/or work: (Make, Model, color, year, plate #): If you do not have a valid driver s license then name of person for transportation and their cell phone numbers: Continue on back: Page 22 of 31

23 All Medications that you are currently taking and reason for them: Bank/Pay day (ie. Friday every week, Thursday every other week) Next pay day will be: Church you want to attend WHEN allowed: Service Start and Finish times: (Must be in Daviess Co.) Address of Church: Pastor: Person you are attending with: Phone numbers for person you are attending with: Meetings you are attending: (Day of week, beginning and ending times, location of meeting and name of leader) GED RARE: AA: NA: Light House: Counseling: Other Information: Name/Signature Date Page 23 of 31

24 Office- 415 W. Walnut Street, Washington, Indiana Daviess County Community Corrections WR Facility- 101 NE 4 th Street, Washington, Indiana Phone: FAX: Diana Snyder, Director Sheila Petty, Administrative Assistant Joe Hamdan, Community Service Coordinator/HD Case Manager Evett Arney, Work Release Case Manager Brandy Chapman, Home Detention Case Manager Terence Wright, Home Detention Case Manager Laura Petty, Program Assistant Mike Healy, Field Officer Steve Sturgis, Field Officer MEETING/SUPPORT GROUP VERIFICATION Date: was at (Name of Participant) (Agency or Business) for the purpose of Arrival Time Depart Time (Signature) (Phone) MEETING/SUPPORT GROUP VERIFICATION Date: was at (Name of Participant) (Agency or Business) for the purpose of Arrival Time Depart Time (Signature) (Phone) MEETING/SUPPORT GROUP VERIFICATION Date: was at (Name of Participant) (Agency or Business) for the purpose of Arrival Time Depart Time (Signature) (Phone) MEETING/SUPPORT GROUP VERIFICATION Date: was at (Name of Participant) (Agency or Business) for the purpose of Arrival Time Depart Time (Signature) (Phone) Page 24 of 31

25 Office- 415 W. Walnut Street, Washington, Indiana Daviess County Community Corrections WR Facility- 101 NE 4 th Street, Washington, Indiana Phone: FAX: Diana Snyder, Director Sheila Petty, Administrative Assistant Joe Hamdan, Community Service Coordinator/HD Case Manager Evett Arney, Work Release Case Manager Brandy Chapman, Home Detention Case Manager Terence Wright, Home Detention Case Manager Laura Petty, Program Assistant Mike Healy, Field Officer Steve Sturgis, Field Officer WORK RELEASE ARRIVAL AND DEPARTURE FORM DATE: WAS AT (Name of Participant) (Agency or Business) FOR THE PURPOSE OF HE/SHE ARRIVED AT AND DEPARTED AT (Time) (Time) Signature Phone Number Page 25 of 31

26 Office- 415 W. Walnut Street, Washington, Indiana Daviess County Community Corrections WR Facility- 101 NE 4 th Street, Washington, Indiana Phone: FAX: Diana Snyder, Director Sheila Petty, Administrative Assistant Joe Hamdan, Community Service Coordinator/HD Case Manager Evett Arney, Work Release Case Manager Brandy Chapman, Home Detention Case Manager Terence Wright, Home Detention Case Manager Laura Petty, Program Assistant Mike Healy, Field Officer Steve Sturgis, Field Officer MEDICAL APPOINTMENT/INFORMATION RELEASE FORM is currently an inmate at the Daviess County Community Corrections, Work Release Program. In an attempt to discourage the abuse of prescription medications, it is a requirement that all inmates participating in the Work Release Program allow the disclosure of information. Diagnosis: Please do not use the ICD-9 code for the diagnosis Thank you Medication prescribed and directions (please include any over the counter medications recommended) *Note* A list of prescription drugs that are not allowed to be taken by Work Release inmates is listed on the back, all medications allowed in the facility will be passed at 8:00 a.m. and 8:00 p.m. I hereby respectfully request and authorize the office of to release information and/or records of a confidential or privileged nature you have to the Daviess County Community Corrections. Work Release Inmate (print name) Signature Date SSN: DOB: Arrival Time Departure Time Signature and Title Page 26 of 31

27 No participant in the Daviess County Community Corrections Work Release Program will be allowed to use, possess, transport, or consume drugs identified in the following classifications: o o o Opioids (Analgesics) Central Nervous System Depressants (Benzodiazepines, Barbiturates, Sedatives, Hypnotics) Stimulants (Amphetamines) These drugs include, but not limited to, the following: Non-Controlled Legend Drugs: Codeine Morphine Hydrocodone (Lortab, Vicodin) Oxycodone (Oxycontin, Percodan, Percocet) Hydromorphone (Dilaudid) Methadone Meperidine (Demerol) Propoxyphene (Darvon, Darvocet) Carisoprodol (Soma) Clonazepam (Klonopin) Diazepam (Valium) Alprazolam (Xanax) Lorazepam (Ativan) Chlordiazepoxide (Librium) Phenobarbital Methylphenidate (Ritalin) Phentermine (Adipex-P) Amphetamine (Adderall, Dexedrine) Zolpidem (Ambien) Lunesta Rozerem Cyclobenzaprine (Flexeril) Trazodone (Desyrel) Tramadol (Ultram, Ultracet) Baclofen (Lioresal) Elavil (Amitriptyline) OTC Drugs: Pseudoephedrine containing products (Sudafed) Dextromethorphan containing products (Coricidin Cold & Cough) Vicks Nasal Spray/Inhaler Diphenhydramine (Benadryl) Any products that contain alcohol This list is not all-inclusive and may be modified at any time. Effective date: December 5, 2008 Modified: January 7, 2013 Page 27 of 31

28 Daviess County Community Corrections 415 W. Walnut Street Washington, Indiana (812) CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION I,,, HEREBY CONSENT (Cause Number) TO RECIPROCAL COMMUNICATION BETWEEN DAVIESS COUNTY COMMUNITY CORRECTIONS AND THE FOLLOWING: 1. DAVIESS SUPERIOR COURT 6. DAVIESS COUNTY SHERIFF S DEPARTMENT 2. DAVIESS CIRCUIT COURT 7. ATTORNEY OF RECORD 3. DAVIESS COUNTY PROSECUTOR 8. SENTENCING COURT 4. DAVIESS COUNTY PROBATION 9. OTHER 5. CURRENT EMPLOYER The purpose and need for disclosure is to inform the above entities of my attendance, progress, and attitude toward my evaluation and required treatment, education or both in accordance with the court program s monitoring requirement. The extent of necessary information to be disclosed includes: 1. ASSESSMENT/DIAGNOSIS 6. DISCHARGE/COMPLETION 2. ATTENDANCE 7. PROBABLE CAUSE AFFIDAVIT 3. PROGNOSIS 8. PRE SENTENCE INVESTIGATION 4. PROGRESS NOTES 9. OTHER 5. TREATMENT PLAN I understand and agree that I am subject to an assessment under the Indiana Risk Assessment System as a condition of my participation in Daviess County Community Corrections Programs. I hereby authorize staff to enter results of the assessments conducted during my participation in Daviess County Community Corrections Programs in the Indiana Risk Assessment System database. I understand that the results of the assessment conducted during my participation in Daviess County Community Corrections Programs are accessible by any authorized Indiana Risk Assessment System database user in connection with his or her official duties. I understand that this consent will remain in effect and cannot be revoked by me until, there has been a formal and effective termination of my involvement with Daviess County Community Corrections Programs for the above referenced case, such as the discontinuation of all court supervision upon my successful completion of Daviess County Community Corrections Program requirements or upon sentencing for violation of the terms of my Daviess County Community Corrections Program involvement. (CLIENT SIGNATURE) (DATE) (STAFF WITNESS) (INTERPRETER ) (CLIENT DATE OF BIRTH) (CLIENT SOCIAL SECURITY NUMBER) (A PHOTOCOPY OF THIS COMPLETED FORM SHALL BE AS VALID AS THE ORIGINAL) *LINES LISTED AS OTHER MUST BE FILLED IN OR CROSSED OUT AT THE TIME OF SIGNING. Page 28 of 31

29 Office- 415 W. Walnut Street, Washington, Indiana Daviess County Community Corrections WR Facility- 101 NE 4 th Street, Washington, Indiana Phone: FAX: Diana Snyder, Director Sheila Petty, Administrative Assistant Joe Hamdan, Community Service Coordinator/HD Case Manager Evett Arney, Work Release Case Manager Brandy Chapman, Home Detention Case Manager Terence Wright, Home Detention Case Manager Laura Petty, Program Assistant Mike Healy, Field Officer Steve Sturgis, Field Officer WORK RECORD NAME: EMPLOYER: DATES: Date Day of Week Begin Work Stop Work Sunday Monday Tuesday Wednesday Thursday Friday Saturday SUPERVISOR SIGNATURE: This form MUST be turned in weekly to the Community Corrections Department in order to verify release and return hours. Any unnecessary lapses in time alterations of work records will result in your program being revoked. Page 29 of 31

30 MISCELLANEOUS INFORMATION Items allowed in your Work Release cell: 3 White t-shirts 3 White thermals 3 pairs of underwear 3 pairs of white socks 3 bras (no underwire) - Gray or any other color of t-shirts, thermals, and socks are unacceptable - No jewelry of any kind without prior approval 1 pillow (prior approval for more than 1) 1 white towel 1 blanket Jail Commissary Please refer to the Daviess County Security Center Inmate Handbook for additional items allowed You may wear your shower shoes in your cell and to/from the shower only. You cannot wear them while out in the dayroom or in the hallway. While in the dayroom, you must wear your full orange uniform and shoes. The only items that should be kept in your locker are the following: Wallet Keys Cellphone (turned off) Clothes and shoes (that were worn into the facility) - No backpacks or purses. No exceptions. Respecting others in the cell block: Remain respectful of others at all times Keep the noise level to a minimum at all times Be respectful of others work schedules No inappropriate conduct will be tolerated Page 30 of 31

31 MISCELLANEOUS INFORMATION Holiday Work Schedule: You will not be allowed out for work on 6 major holidays (New Year s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas) unless prior approval from Community Corrections. Only Community Corrections staff can schedule approval. Emergency Room: -If you choose to go the Emergency Room for a non-life threatening emergency, you will not be able to go to work the following day. You may go to Quick Care or a scheduled doctor s appointment. -If you have a life threatening emergency please go to the Emergency Room. Work Release Windows: You are prohibited from being at the window on the east side of the building (inside and outside). WR Handbook: You are responsible for keeping your WR Handbook nice. If any pages are ripped out or it is damaged in any way, you will be responsible for replacing it. You will be fined $ You will be responsible for returning your WR Handbook upon completion or termination from the Work Release Program. Page 31 of 31