CHECKLIST – INFORMATION SENT BY CERTIFICATE HOLDER PRIOR TO ASSESSMENT
SITE ASSESSMENT – 2016
The purposes of this checklist are: (1) to identify for the PIECP Manager the information to be sent to NCIA headquarters and (2) to assist the assessor in verifying that pertinent documentation has been provided.
Please submit this completed checklist with requested documentation/information by July 8, 2016 to:
Wil Heslop
NCIA
800 North Charles St., Ste. 550B
Baltimore, MD 21201
IMPORTANT: As you submit documentation and/or fill in information please mark each check box with an “X”
Failure to provide all the requested information by the due date (July 8, 2016) may result in the transmission to BJA of a final assessment report with a non-compliance recommendation.
Certificate Holder: ______
System-wide Information:
q 1. Any new or changed legislation affecting PIECP CACs enacted since the last desk or site assessment.
q 2. Definition of “displacement” used by the Certificate Holder.
q 3. Definition of “locality” used by the Certificate Holder.
q 4. Sample copy of voluntary form showing types of deductions, percentages, and any other financial agreement by PIECP workers.
Documentation for each CAC (please provide for each CAC to be assessed):
q 5. Wage verification letters:
q 5a. Letters from Certificate Holder to the state DES requesting the 10th percentile wage determination in effect for May 2015 and May 2016, including SOC codes.
-AND-
q 5b. Written responses from the state DES, including SOC codes with the approved wage determinations in effect for May 2015 and May 2016.
IMPORTANT: If the CAC uses a training wage, the letter from the Certificate Holder must request the approval of a training wage/period, and the written response from the state DES must include approval of a training wage/period for each applicable SOC code.
q 6. Written description of any exemption from 10th percentile wage floor that the state DES or BJA may have granted (if applicable). A copy of the decision should be included.
q 7. Date annual update was implemented for each CAC being assessed (please fill in).
q 7a. Date of annual wage update in effect for the May 2015 payroll______
q 7b. Date of annual wage update in effect for the May 2016 payroll______
Certificate Holder may attach additional documentation if there are multiple CACs and each CAC has a different annual wage update.
q 8. Copies of official payroll and deduction reports for the months of May 2015 and May 2016 for each PIECP worker in the CAC. This documentation may include accounting payroll reports, check stubs, PIECP worker account reports, or any other documents that provide the following information:
8a. PIECP worker name
8b. SOC code for each PIECP worker (must be included; may be handwritten if necessary)
8c. Rate of pay (converted to hourly if piece rate)
8d. Number of hours worked during pay period
8e. Gross wages for pay period
8f. Allowable deductions from gross wages
8g. Net pay (gross minus all allowable deductions)
8h. Overtime pay (if applicable)
q 9. Piecework (if applicable – please fill in):
9a. If yes, DES 10th percentile hourly wage for each SOC code (may submit additional documentation if you have multiple SOC codes):
______
9b. Industry standard production rate (units per hour) for 100% productivity: ______
9c. Production rate (units per hour) for 100% productivity used in this CAC: ______
9d. Explanation of any differences: ______
9e. Pay rate per unit produced: ______
Certificate Holder may attach additional documentation to answer Piecework #9a - #9e
q 10. Split wage (if applicable) – If the Certificate Holder utilizes a split wage, please attach the following documentation:
10a. Criteria for selecting PIECP workers for the split wage
10b. Tracking method and calculations (for tracking the split wage)
q 11. Training wage (if applicable) – submit documentation tracking the number of hours worked for PIECP workers receiving training wages. Documentation must contain the PIECP workers’ start date and number of hours worked since beginning work in the CAC.
q 12. Wage plan (if any)
q 13. Wage-related grievances by PIECP workers (include process for resolution) (if any)
q 14. Victim Compensation – If the Certificate Holder deducts for Victim Compensation, please submit documentation showing the deposits made into the appropriate victim compensation/assistance fund.
q 15. Workers’ Compensation (you must submit one of the items below for each CAC)
q 15a. Copy of Certificate of Insurance (for Workers’ Compensation)
-OR-
q 15b. Self-insured or comparable Workers’ Compensation programs – please complete the following chart:
Benefit / Description of benefit provided to PIECP worker / Description of benefit provided to comparable worker (employer model = private sector worker; customer/manpower model = correctional industry worker)Temporary and partial disability lost income formulas
Permanent disability lost income and lump sum payment criteria and payment maximums
Death benefits, including payment maximums
You must also submit program documentation describing the following benefits provided to both PIECP workers and the comparable group (private sector counterparts for employer model CACs or correctional industries workers in customer/manpower model CACs):
· Temporary and partial disability lost income formulas
· Permanent disability lost income and lump sum payment criteria and payment maximums
· Death benefits, including payment maximums.
q 16. Any displacement issues since the time of the last assessment (if any)
q 17. Issues of concern (if any):
If you have any questions about this checklist or any of the requested documentation or information, please contact Wil Heslop at 410-230-3972 or
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