CRC Initial Intake and Orientation Form

IDAHO DEPARTMENT OF CORRECTION
CRC Initial Intake and Orientation Form
Inmate's Name: IDOC#:
Facility Intake Section:
Location: ❑ EB-CRC ❑ IF-CRC ❑ N-CRC ❑ PWCC-CCU ❑ SICI-CRC ❑ TF-CRC
Transfer Type: ❑ Resident Worker ❑ Rider ❑ Work Release
Is the resident able to read and write? Does the resident speak English?
Explain, discuss, point out, or provide pursuant to the SOP. (Initial each as completed)
Facility emergency procedures: Location of fire extinguishers:
Location of first aid kits: Location of evacuation plans:
Property management procedures: Employment procedures:
Visiting procedures: Healthcare procedures:
Inmate funds management procedures: Access to policies and forms procedures:
Bed assignment procedures: Laundry procedures:
Inmate Emergency Data Form: Current photo:
Insert#of and/or item(s) provided
Linens: (Sheets ) (Blanket )
Hygiene items:
CRC living guide:
Findings, concerns, issues documented as C-note entry: ❑ Yes ❑ No ❑ N/A
Inmate Acknowledgment and Agreement
I have received the community release center(CRC) orientation and intake information and items listed
above. I understand that policies, standard operating procedures (SOPs), and facility field memorandums
(FMs)that are allowed for inmate disclosure, are available to me or for my viewing upon request.
I agree to abide by all of the CRC rules and instructions given to me by staff during this orientation and
while housed at the CRC.
I have been provided a copy or access to a copy of the CRC living guide. I agree that it is my
responsibility to read, understand, and abide by all of the rules or procedures outlined in the living guide.
I agree that if I do not understand anything from my orientation or the contents of the living guide it is my
responsibility to seek clarification from staff or another resident.
Inmate's Signature Date
Facility Intake Staff's Name and Associate Number Date
(Note: When this section of the form is fully complete per the SOP, forward it to the case manager for
further processing.)
Inmate's Name: IDOC#:
301.04.03.001 Page 1 of 2
(Last updated 03/13/2017)

IDAHO DEPARTMENT OF CORRECTION
CRC Initial Intake and Orientation Form
Case Plan Intake Section:
Review, update, explain, discuss, collect, or assist(as needed) pursuant to the SOP. (Initial each as
completed)
Reclassification: Financial obligations: Pathways/case plan requirements:
Reentry needs: Expectations/consequences: Prison rape elimination:
Waiver of Extradition: Inmate Emergency Data Form:
Indicate status and location (valid, suspended, expired, or central file, on person, at home, unknown, etc.)
Birth certificate:
State ID card:
Drivers' license:
Social security card:
Findings, concerns, issues documented as C-note entry: ❑ Yes ❑ No ❑ N/A
Case Manager's Name and Associate Number Date
(Note: If the inmate is a resident worker or rider and this section of the form is fully complete per the SOP,
forward the Waiver of Extradition, Inmate Emergency Data Form, and this intake form to facility records
staff for filing. If the inmate is a work release inmate, forward the Waiver of Extradition and the Inmate
Emergency Data Form to facility records staff for filing, and forward this form to the employment
coordinator for further processing.)
Employment Intake Section: (Only Complete for Work Release Inmates)
Employment Coordinator
Find out, provide, discuss, or explain pursuant to the SOP. (Initial each as completed)
Limitations that would prevent employment: Information related to employment:
Employment rules:
Findings, concerns, issues documented as C-note entrv: ❑ Yes ❑ No ❑ N/A
EC's Initials Date
Facility Head
C-note entries reviewed: ❑ Yes ❑ No
Pathways/case plan reviewed: ❑ Yes ❑ No
Work release approved: ❑ Yes ❑ No
Work release approval or denial documented as C-note entry: ❑ Yes ❑ No
Facility Head's Initials Date
(Note: If the inmate is a work release inmate and this section of the form is fully complete per the SOP,
forward it to facility records staff for filing.)
301.04.03.001 Page 2 of 2
(Last updated 03/13/2017)