OMB 0970-0564 [valid through MM/DD/2026]
Revised: 3/16/2022
Staff Questionnaire – Interpreter – Unlicensed Facility (UF) Quarterly Health and Safety Visit
Interview Details |
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Program Name: |
Past and Current Position(s) at Program: |
Level of Care: |
Date/Time of Interview: |
Full Name: |
Interviewer: |
*Note: Before beginning the interview and/or providing this questionnaire to staff, provide a brief introduction, including monitor role and purpose of monitoring visit, confidentiality of staff interview, and clarify any questions. See Introduction Prompt for Staff for additional guidance as needed. Questions in bold should be asked during the interview if possible. Other questions are optional prompts to assist the interviewer.
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NOTES |
Please explain your role and responsibilities.
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What training were you provided when you started this position? Are there any additional areas of training that you would find beneficial?
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Describe how you collaborate with other teams (YCWs, CMs, etc.).
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Are interpretation/translation services consistently provided across different program areas? If not, please describe any additional needs.
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Do you feel that you have the support and resources necessary to do your job?
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In which language(s) are interpreter/translation services provided? Are there any UCs at the program who do not understand those languages? If so, how are they accommodated?
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Do the services (i.e. case management, religious, education, etc.) provided here seem culturally appropriate? If not, how could they be improved?
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Have you had any concerns about the treatment of UC in care? If so, please explain. |
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Do you have any additional concerns, recommendations, or suggestions?
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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 interview and document responses
from interpreters during unlicensed facility quarterly site visits.
Public reporting burden for this collection of information is
estimated to average 0.5 hours per response for the care provider
and 0.5 hours per response for the contractor monitor, 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
[email protected].
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Peavey, Alyssa (ACF) |
File Modified | 0000-00-00 |
File Created | 2023-11-19 |