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Florida Department of Health (DOH) Sexual Violence Prevention Program (SVPP) Programmatic Monitoring Tool
Site Visit
Education/Training #_________ Hotline #_________ Social Norms Campaign #_________ Special Project #________
Organization Name: Organization Phone Number: Organization Representative at site visit: DOH Contract Manager: Organization Program Director: Organization Mailing Address: Monitoring Date: Report Date: Follow-up needed?__ Yes __ No Date Needed: ____
Attachment 3
Not Met
PART I. Organization Contract Requirements Organization Contract Requirements Provide Evidence of the Following: Provide Evidence of the Following:
C. Community Outreach (continued) A. Staffing.
2. SVPP (or other) television and/or radio Public 1. Documents required for DOH contract (see Service Announcements (PSAs) are played Monitoring Tool Addendum for required list.)in the community. 2. Notification of staff changes (for staff paid by the 3. SVPP contract) posters and educational materials are distributed in the community. 3. Timesheets signed by supervisors for staff paid by 4. The Community Action Team (CAT) has had the contract. meeting(s). personnel policiesdate(s). 4. Written Provide meeting and procedures manual 5. The Community Action Team (CAT) has proposed maintained and accessible to staff. activities for each of the 6 contract that have 5. List of staff paid by thestrategic plan goals.a(Discuss) 6. The Community Action screened, & most background screening, dateTeams (CAT)by which significant success(s) and challenge(s). Provide short organization. synopsis. Organization Subcontracts Recordkeeping Assignments & 1. Section I, I, 1-4RequirementsSubcontracts of the 1. Contract recordsbeing met. Provider and standard contract is are kept in a secure confidential place and retained for subcontractor is held agreements/subcontracts indicate the required seven years. to the same standards as are in the DOH standard 2. The REVISE THIS? contract.provider ensures that shared costs apportioned to this contract Outreach equitable. Provide a copy of Community are fair and the cost allocation formulas. 1. If paid for by DOH contract funds, all publications, Property and Equipment media or program advertisements are pre-approved by 1. The provider does not purchase Disease Control SVPP and contain DOH and Centers for property or equipment valued at $1,000 verbiage. & Prevention (CDC) requiredor more with DOH funds. 2. Service location(s) are accessible and appear to be compliant with the Americans with Disabilities Act (ADA). 3. Service location(s) are clean, well organized, and well maintained.
Exceeded
N/A
Met
Comments
Did contract manager attend CAT meeting or meet with CAT members?
B. D.
C. E.
F. Audit Requirements
1. Expenditures of $500,000 or greater in state or federal funds are reported to DOH annually. 2. Annually, audits and/or financial reports are submitted to DOH in accordance with contract requirements. 3. Any weaknesses or reportable conditions in prior fiscal years audit report have been addressed. 4. Projected budgets using the SVPP template are 2012 Monitoring Tool submitted to SVPP yearly or as requested.
Attachment 3
Attachment 3
Not Met
Exceeded
N/A
Met
Comments
Please Check All That Apply: Organization is a certified Sexual Violence (SV) center. Organization is a certified Domestic Violence (DV) center. All travel costs appropriated to this contract are processed in accordance with S. 112.061, F.S., and Rule 3A-42, F.A.C, Rules of the Bureau of Auditing, governing travel expenses. Does organization have a working relationship with county health department(s) (CHD)? Organization serves more than one county. Organization has a disaster plan. Organization is becoming more eco-friendly.
YES
NO
NA
Comments
Contact Name: List Counties: Describe how services will continue. Describe greening efforts.
Attachment 3
PART II. Education & Training Assessment Provide Evidence of the Following:
A. Service Tasks
Monthly Narrative Report is adequately completed. Timeline of Activities completed monthly. Program evaluations & data collections are used. 4. Sexual violence prevention presentations adhere to the approved topics as defined in the contract. 5. The provider obtains first name only on sign-in sheets for each presentation. 6. The Tell Us What You Think... form is completed by 75% or more of attendees. 7. Seventy-five percent (75%) or more of the polled attendees answered Excellent or Good to the question Your Opinion of the Program Overall on the Tell Us What You Think... form. 8. Pre-tests are administered at the first multi-session presentation, and post-tests are administered at the last multi-session presentation at least 75% of the time.
Comments
C. Financial Reporting
1. Quarterly expenditure reports are correct, allowable, and received by SVPP on time. 2. The percentage of funds drawn down is equal or greater than the percentage of time into the contract year.
D. Presentation Observations
1. Curriculum is age appropriate and has been approved by SVPP prior to use. 2. Supplemental materials are age appropriate and have been approved by SVPP prior to use. (attach copy) 3. The educators focus is on primary prevention of sexual violence. 4. The presenter demonstrates knowledge of FL laws and other aspects of sexual violence.
2012 Monitoring Tool
Attachment 3
PART II. Education & Training Assessment Provide Evidence of the Following:
D. Presentation Observations (continued)
5. The presenter involves the attendees with engaging activities. 6. The presenter is enthusiastic, uses movement, creative tools or other methods that enhance participation and learning. 7. The presentation delivery style is culturally and age appropriate. 8. The presenter uses effective focusing techniques if the participants become disruptive. 9. Does the educator see indications that social norms re. sexual violence are changing? Yes/No? Please explain. OBSERVED PRESENTATION: Date: Location: Audience: Name & length of video (if used) Strengths: Areas for Improvement: Quality of presentation Quality of answers to questions:
Exceeded
Not Met
N/A
Met
Comments
Excellent
Good
Poor
Attachment 3
Hotline
Exceeded Not Met N/A Met
Comments
B. Financial Reporting
1. Quarterly expenditure reports are correct, allowable, and received by SVPP on time.
2012 Monitoring Tool
Attachment 3
Social Norms
Exceeded Not Met N/A Met
Comments
B. Financial Reporting
1. Quarterly expenditure reports are correct, allowable, and on time. 2. The percentage of funds drawn down is equal or greater than the percentage of time into the contract year.
Attachment 3
Special Projects
Not Met Exceeded N/A Met
Comments
B. Financial Reporting
1. Quarterly expenditure reports are correct, allowable, and on time. 2. The percentage of funds drawn down is equal or greater than the percentage of time into the contract year.
2012 Monitoring Tool
Attachment 3
Summary Report
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