Attachment J-8 Monthly Program Activity Report.docx
DOCX document 39 KB Posted
- Attached to
- Supportive Housing Services (Up to 180 Days)
- Solicitation number
- 9594CS26Q0075
About this file
This is a Monthly Program Activity Report template designed for contractors providing Supportive Housing Services to the Court Services and Offender Supervision Agency (CSOSA) under solicitation 9594CS26Q0075. The form serves as a standardized reporting mechanism for tracking and documenting monthly service delivery activities related to housing support for individuals under CSOSA supervision for periods up to 180 days.
The template functions as an appendix or attachment to the solicitation and does not contain specific pricing information, response deadlines, or detailed service requirements. Rather, it establishes the reporting framework that successful contractors must utilize to monitor and communicate program performance metrics, service activities, and compliance with contract obligations on a monthly basis. Contractors awarded under this solicitation would be required to complete and submit this report form as part of their regular contract administration and oversight duties with CSOSA.
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Text version
TABLE 6: Unusual Incidents Please attach copies of all incident reports (via secured email method) to this monthly report.
Attachment J-8: Monthly Program Activity Report
Contractor Name: Contract Number:
Program Address:
Treatment Modality:
Submitted By: Telephone Number:
PERFORMANCE TARGETS
For the Month of Year
Instructions: Please complete the numbers and names required for the below tables. Attach additional pages if necessary.
TABLE 1 (Non- RSC Cases)
A. Total Number of active cases at the end of the previous month
B. Total Scheduled Placements
No Shows
Actual Admissions
C. Total Discharges
Successful Program Completions (Number and Percentage)
Unsuccessful Program Completions
Discharge for non-compliance
Dropout against clinical advice
Absconded
Rearrested/remanded
Medical/hospitalized
Administrative
Supervision period ended
Total number of active cases at the end of the month
| ADMITTED |
| NO-SHOWS |
| SUCCESSFUL COMPLETIONS |
| UNSUCCESSFUL COMPLETIONS |
(Please attach discharge reports for each name listed below)
TABLE 3 (RSC Cases)
A. Total Number of active cases at the end of the previous month
B. Total Scheduled Placements
No Shows
Actual Admissions
C. Total Discharges
Successful Program Completions (Number and Percentage)
Unsuccessful Program Completions
Discharge for non-compliance
Dropout against clinical advice
Absconded
Rearrested/remanded
Medical/hospitalized
Administrative
Supervision period ended
Total number of active cases at the end of the month
TABLE 2 (Non-RSC Cases):
Please include the names and PDID numbers of individuals for each category
| ADMITTED |
| NO-SHOWS |
| SUCCESSFUL COMPLETIONS |
| UNSUCCESSFUL COMPLETIONS |
(Ple ase attach discharge re ports for each name liste d be low)
TABLE 5: Monthly CSOSA Contract Staff Changes
| New Hires Name | |
| (Please attach the medical clearance, resumes, licenses | and |
certifications)
| Position Title |
| Hire |
Date Security Clearance Submission Date
| Resignations or Terminations |
| Position Title |
| Separation Date |
TABLE 4 (RSC Cases):
Please include the names and PDID numbers of individuals for each category
A. Total Number of unusual incident reports for the month:
Date of incident Date report was submitted to CSOSA
B. Type(s) of unusual incidents for the month.
Death, serious illness, injury or incapacitation
Physical, sexual or verbal abuse of an Patient by staff or others
Fire
Theft
Destruction of loss of property, or sudden/serious problems in the facility
Patient criminal charges, arrest, or incarceration
Infestations or outbreak of communicable disease
Inappropriate relationships/fraternization between an Patient and contract staff
Chronic complaints from Patient’s families or Patients themselves
Monthly Physical Plant Issues (Provide narrative, describing all serious facility maintenance problems):
File details come from the government source that posted it. Updated .