Form M-10E Form M-10E Influx Care Facility Personnel File Checklist

	Updated: 12/7/2022
						OMB 0970-0564 [valid through MM/DD/2026]
	THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow ORR contractor monitors to ensure that influx care facilities are meeting ORR policies and procedures related to the maintenance of personnel files during quarterly site visits. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
Personnel File Checklist
	Facility
	Name
	Date of Hire
	Reviewer
	Date of Review
	Current Position
	Past Qualifying Positions
1. General Documentation		In file Y/N	Date, if applicable	Notes
	Only complete items 1.8 to 1.17 if required in policy or the contract.
1.1	Personal References (at least one) (Effective: 01/14/19)
1.2	Professional licensure, if applicable (Effective: 04/15/17)
1.3	Meet minimum educational and work experience requirements
1.4	Criteria for the employee's selction, hiring, suspension, or termination (Effective: 04/15/17)
1.5	Annual Performance Review (annual, signed, with employee's written comments, must incl. questions about any prior misconduct since last background investigation) (Effective: 02/22/15)
1.6	Code of Conduct (signed by applicant (staff hired since Feb. 2019), acknowledging receipt)) (Effective: 01/14/19)
1.7	Prevent and Report Sexual Abuse and Harassment (signed by applicant (staff hired since Feb. 2019), acknowledging receipt) (Effective: 01/14/19)
1.8	Resume
1.9	Job Description
1.10	Employment Application (to include asking about past work and volunteer experiences)
1.11	Professional References
1.12	Educational records/diploma
1.13	I-9 Employment Eligibility Documents (I-9 form and copies of required I.D documents.)
1.14	Results of medical exam (as required by State licensing, including results of TB tests)
1.15	Child Abuse Mandated Reporter Agreement Acknowledgement (signed.)
1.16	Confidentiality Policy Acknowledgement (Effective: 04/15/17)
1.17	Fraud Scheme Acknowledgement (signed; Fraud Scheme training document signed by employee is acceptable)
2. Background Investigation Documentation:		In file Y/N	Initial Clearance Date	Notes (What to look for: Clearance Letter or ORR Waiver). The Adjudication List can be helpful to review.	Updated Clearance Date	Notes
2.1	FBI fingerprint check of national and state criminal history repositories (Documentation of the review and conclusion. Completed prior to employment start date)
2.2	CPS check (child abuse and neglect record check) with the staff's State(s) of U.S. residence for the last 5 years (Documentation of the review and conclusion. Completed prior to employment start date)
2.3	Background Investigation updates at a minimum of every 5 years of the staff/contractor/volunteer's start date or last background investigation update. (Documentation of the review and conclusion)
2.4	Driver's Record and Clearance (if transporting children and youth.) (Effective: 04/15/17)
2.5	Efforts to ask applicants about previous misconduct and employee's response (Effective: 02/22/15)
2.6	Efforts to contact past employers where applicant had access to children and youth, including asking about any substantiated allegations of sexual abuse and sexual harassment (Effective: 02/22/15)
3. Pre-Service Trainings (Before the employee has access to UAC)		In file Y/N	Date	Notes (i.e. #hours obtained, topic title if different from ORR, etc.)
3.1	ORR Standards to Prevent, Detect, and Respond to SA and SH involving UAC. New employees must complete training before hire. (per training list under 4.3.6) (Effective: 02/22/15)
3.2	How to detect and assess signs of SA and SH (Medical and MH staff ONLY)
3.3	How to preserve physical evidence of SA (Medical and MH staff ONLY)
3.4	How to respond effectively and professionally to juvenile victims of SA and SH (Medical and MH staff ONLY)
3.5	Forensic Examinations (Medical staff that conduct forensic exams ONLY)
3.6	Pre-Service trainings include date, number of hours, subject-matter, a confirmation that the employee understood each training, and the name of the individual and/or entity providing the training (spot check)
5. Annual Trainings		In file? Y/N	Current Date	Notes (i.e. #hours obtained, topic title if different from ORR, etc.)	Previous FYs Date	Hours: length of the class Topic: Some programs title the training differnet from what ORR has in policy Notes (i.e. #hours obtained, topic title if different from ORR, etc.) (Hover for additional comments)
	Only complete items 5.9 to 5.12 if required in policy or the contract.
5.1	ORR Policies and Procedures (10 hours per year) (Effective: 04/15/17)
5.2	ORR-provided refresher training about avoiding inappropriate relationships and reporting sexual abuse and sexual harassment (every six months) (Effective: 01/14/19)
5.3	ORR Standards to Prevent, Detect, and Respond to SA and SH involving UAC (per training list under 4.3.6)
5.4	How to detect and assess signs of SA and SH (Medical and MH staff ONLY)
5.5	How to preserve physical evidence of SA (Medical and MH staff ONLY)
5.6	How to respond effectively and professionally to juvenile victims of SA and SH (Medical and MH staff ONLY)
5.7	Forensic Examinations (Medical staff that conduct forensic exams ONLY)
5.8	Annual trainings include date, number of hours, and topic area, a confirmation that the employee understood each training, and the name of the individual and/or entity providing the training (spot check. Effective: 04/15/17) (Hover for additional comments)
5.9	40 hours per year
5.10	Flores Settlement Agreement, HSA 2002, TVPRA 2008, and Perez-Olano (2 hours per year)
5.11	State licensing requirements (Foster Parents)
5.12	Strengths-based behavior management approaches and trauma-informed care approaches, such as using conflict resolution, problem solving skills, using rewards and consequences, de-escalation techniques and helping children and youth learn accountability and self-control
7. COMMENTS