Physical Address: Mailing Address (if different than above): Telephone Number: The Facility Is: Military Private for Profit Private not for Profit Municipal County Federal Facility Type: Community treatment center Halfway house Restitution center Mental health facility Alcohol or drug rehabilitation center Other community correctional facility Facility Mission: Facility Website with PREA Information: Have there been any internal or external audits of and/or accreditations by any other organization? Yes No Director Name: Telephone: Facility PREA Compliance Manager Name: Title: Email: Telephone: Facility Health Service Administrator Name: Title: Email: Telephone: Facility Characteristics Designated Facility Capacity: Current Population of Facility: Number of residents admitted to facility during the past 12 months Number of residents admitted to facility during the past 12 months who were transferred from a different community confinement facility: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 30 days or more: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 72 hours or more: Number of residents on date of audit who were admitted to facility prior to August 20, 2012: Age Range of Adults Juveniles Youthful residents Population: Average length of stay or time under supervision: Facility Security Level:
Physical Address: Mailing Address (if different than above): Telephone Number: The Facility Is: Military Private for Profit Private not for Profit Municipal County Federal Facility Type: Community treatment center Halfway house Restitution center Mental health facility Alcohol or drug rehabilitation center Other community correctional facility Facility Mission: Facility Website with PREA Information: Have there been any internal or external audits of and/or accreditations by any other organization? Yes No Director Name: Telephone: Facility PREA Compliance Manager Name: Title: Email: Telephone: Facility Health Service Administrator Name: Title: Email: Telephone: Facility Characteristics Designated Facility Capacity: Current Population of Facility: Number of residents admitted to facility during the past 12 months Number of residents admitted to facility during the past 12 months who were transferred from a different community confinement facility: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 30 days or more: Number of residents admitted to facility during the past 12 months whose length of stay in the facility was for 72 hours or more: Number of residents on date of audit who were admitted to facility prior to August 20, 2012: Age Range of Population: Adults Juveniles Youthful residents Average length of stay or time under supervision: Facility Security Level:
NEW%20Community%20Confinement%20Audit%20Report%20Template%20Rev%2005-2018.docx