Security Clearance Forms and Instructions.pdf

Fluvanna Correctional Center for Women Roof and Gutter Repairs

799-10887-1118

799‐10887‐1118 ROOF AND GUTTER REPARIS – FLUVANNA CORRECTIONAL CENTER FOR WOMEN

Authority for Release of Information

Instructions:

Included hereafter please find the noted Security Release form, and other submittal documents necessary for site access approval.

Note that the pre-bid site walkthrough is mandatory and in order to participate, a security clearance is required.

Therefore, upon receipt of this notice, each participant review the information herewith, complete all forms and submit for approval.

The complete forms and information shall be submitted to the following persons only:

david.baker@vadoc.virginia.gov

Do not submit this information to any other persons however, you must provide notification via email to marcia.powers@vadoc.virginia.gov of the names and date that the information was transmitted to the parties above, for approval.

Please refer to the following pages and read all documents, complete the required forms and submit information at once. It may take several weeks to attain approvals therefore your timely submittal is requested.

VIRGINIA

DEPARTMENT OF CORRECTIONS

Authority for Release of Information 101_F13_6-14

Revision Date: 7/02/20

Authority for Release of Information

TO WHOM IT MAY CONCERN:

I hereby authorize any investigator or duly accredited representative of the Department of Corrections bearing this release or a copy thereof, to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals relating to my activities. The information may include, but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary, and conviction records. I hereby direct the release of such information upon the request of the bearer.

This release also authorizes the National Personnel Records Center, or other custodian of my military service record, to release any information and/or copies of documents from my military service record. I understand that the information released is for official use by the Department of Corrections and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities.

I hereby release any individual, including records custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply with this authorization. Should there be any questions as to the validity of this release, you may contact me as indicated below.

Signature: (Full Name)

Print Full Name:

Other Names Used:

(Include All Maiden and Aliases)

Social Security Number:

Date:

Current Address:

Telephone Number:

Date of Birth:

Sex:

Male Female Race: ______________

Furnishing the requested information is voluntary, but failure to provide all or part of the information may result in a lack of further consideration for employment, or in the termination of your employment.

*A photocopy of your driver’s license (front and back) must be submitted along with this completed form.

VADOC CORRECTIONAL CENTER

RULES AND PRECAUTIONS

FOR CONSTRUCTION PROJECTS/CONTRACTORS

THE CORRECTIONAL CENTER ADMINISTRATION EMPHASIZES THE

INHERENTLY DANGEROUS NATURE OF A PRISON ENVIRONMENT AND

EVEN THOUGH EVERY EFFORT POSSIBLE WILL BE TAKEN TO ENSURE

YOUR PERSONAL SAFETY AND SECURITY, THE POSSIBLITY OF BODILY

HARM OCCURRING AND THE POSSIBILITY OF BEING TAKEN HOSTAGE

WHILE ON INSTITUTIONAL PREMISES DOES EXIST.

I. IDENTIFICATION OF WORKERS

PRESENTATION OF IDENTIFICATION – Carry valid, pictured signature

ID on person at all times.

CHECK IN WITH OFFICIALS – Project superintendent or his designee – check in and out each day with designated DOC staff personnel.

EX-OFFENDERS – Must be approved by the Warden.

II. PROHIBITED ITEMS

WEAPONS - No weapons of any type – including persons with concealed weapons permits not allowed to carry weapon on Institutional property.

DRUGS – No illegal drugs – prescription drugs and OTC must be in original container – only amount needed during time on premises – keep secured in vehicle.

ALCOHOLIC BEVERAGES – No alcoholic beverages of any type allowed on Institutional property.

TOBACCO – No tobacco use of any kind is allowed while on Institutional property. Tobacco products must be stored in a secured vehicle and not carried on your person.

III. VEHICLE – TOOLS & EQUIPMENT SECURITY

PARKING – Park in designated areas only. Do not block entrances or exits of

Institutional areas.

CONTENTS – No weapons, drugs, alcoholic beverages.

SECURITY – Vehicles must be locked and windows must be rolled up when unoccupied. Temporary office entry doors must be locked and windows secured when unoccupied.

SEARCH – All property, including vehicles, are subject to search at any time while on Institutional premises.

TOOLS, KEYS, AND EQUIPMENT - Must be accounted for at all times. Do not leave unattended or unsecured. All tools are removed from premises daily.

If tools are stored in sheds or containers on Institutional grounds they must be secured when unattended.

IV. ACTIVITIES

SEARCH – Subject to search anytime on Institutional premises – includes search by narcotics canines.

DRESS –Complete dress consisting of shirt, pants, and shoes at all times. No blue jeans, orange colored or camouflage patterned clothing is allowed.

Page 3of 7

INTERACTION WITH OFFENDERS – Should not have any interaction with offenders – May speak to offenders, but not engage in any conversation.

Bring no article or leave any item for offenders. Do not accept any articles from offenders.

ON PREMISES – LEAVING PREMISES – Only authorized activity within specifications of project agreement. Entry into security perimeter not allowed unless project requires and prior approval is obtained. Let designated DOC staff personnel know upon arriving and when leaving Institutional premises.

Clean up work site daily – no littering.

WORK TIMES – No work on weekends or State holidays, unless prior approval is granted. Work only daylight hours. Any exception must be approved in advance by Warden.

Any exceptions to any requirement must have prior approval from the Warden or Designee.

I HAVE HAD THE RULES AND PRECAUTIONS REGARDING THE NAMED

TOPICS EXPLAINED TO ME BY A VADOC CORRECTIONAL CENTER

STAFF PERSON(S). I UNDERSTAND THE RULES AS EXPLAINED AND I

AGREE TO ABIDE BY THEM WHILE PERFORMING THE STATE PROJECT

ON PREMISES.

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Pa ge f 7

VIRGINIA DEPARTMENT OF CORRECTIONS

Prison Rape Elimination Act (PREA) Training Acknowledgement

Effective Date: December 1, 2018 Operating Procedure 038.3 Attachment 6

Revision Date: 11/7/18

Prison Rape Elimination Act (PREA) Training Acknowledgement

Level 1 (Contractors and Interns who have no contact with offenders/Program Visitors) By signing below, I acknowledge that I have been informed of my responsibilities to prevent, detect, monitor, and report allegations and incidents of sexual abuse and sexual harassment of offenders and probationers. I further acknowledge that I received a copy of the brochure titled “A Guide to Maintaining Appropriate Boundaries with Offenders for Contractors and Volunteers of the Virginia Department of Corrections” and I have reviewed Operating Procedure 038.3, Prison Rape Elimination Act (PREA).

Level 2 (Contractors, Interns, and Volunteers whose duties do not require contact with offenders, but the possibility for contact exists)

By signing below, I acknowledge that I have been trained on my responsibilities to prevent, detect, monitor, and report allegations and incidents of sexual abuse and sexual harassment of offenders and probationers. I further acknowledge that the brochure “A Guide to Maintaining Appropriate Boundaries with Offenders for Contractors and Volunteers of the Virginia Department of Corrections” was discussed with me and a copy was provided.

Furthermore, I reviewed Operating Procedure 038.3, Prison Rape Elimination Act (PREA) and Operating Procedure 135.2, Rules of Conduct Governing Employees Relationships with Offenders and was provided the opportunity to ask questions on the material provided.

Level 3 (Contractors, Interns, and Volunteers whose duties require contact with offenders) By signing below, I acknowledge that I have been trained on my responsibilities to prevent, detect, monitor, and report allegations and incidents of sexual abuse and sexual harassment of offenders and probationers. I viewed The Prison Rape Elimination Act (PREA) Power Point Presentation and I was provided a copy of the brochure “A Guide to Maintaining Appropriate Boundaries with Offenders for Contractors and Volunteers of the Virginia Department of Corrections”. Furthermore, I reviewed Operating Procedure 038.3, Prison Rape Elimination Act (PREA) and Operating Procedure 135.2, Rules of Conduct Governing Employees Relationships with Offenders.

The listed Power Point Presentation, Brochure, and Operating Procedures were discussed with me and I was afforded the opportunity to ask questions on the material presented.

By my signature, I certify that I have been notified of the requirement that I must report to my supervisor or to the district/facility administration any known instances or suspicions of sexual abuse or harassment of offenders, whether in custody or on community supervision. I certify that I understand that the Virginia Department of Corrections has a zero tolerance policy for sexual abuse or sexual harassment between offenders and between staff/contractors/interns/volunteers and offenders and that I agree to abide by that policy and report any known instances or suspicions of sexual abuse or harassment of offenders.

Signature of Contractor/Volunteer/Intern/Program Visitor Date

Signature of PREA Trainer Date