Attachment

Chapter 4, Part 2– Program Activities

Participant File Monitoring Checklist

Subrecipient Name / Participant Name (First and Last Name)
Contract Number / Participant CalJOBS WIOA Application #
Type of Youth Program / Enrollment Date
Reviewed by (First and Last Name) / Date of File Review / Date of Birth

Please indicate (yes, no or n/a) if meeting the criteria (below).

ELIGIBILITY / Yes / No / N/A / Comments

Eligibility Certification Review Form (ECRF)

a)Correct form
b)All sections complete
c)1st & 2nd review initials
d)Dates & signatures PRIOR or AT enrollment
e)Eligibility expiration date within 90 days

The following eligibility documents are in file:

a)Region & address

b)Social Security Number

c)Date of birth & age

d)Right to work

e)Selective service

f)Veteran’s priority

g)School status (in school or out of school)

h)Employment barriers

(At least one must be verified in CalJOBS)

Low Income (If applicable)– Economically Disadvantaged Categories:

a)Youth received, or is a member of a family which receives cash payments under a federal, state, or income-based public assistance program;

b)A youth is low-income if he or she receives or is eligible to receive a free or reduced price lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.);

c)Living in high poverty area; or

d)The youth is receiving SNAP or was determined eligible to receive food stamps in the six-month period prior to program application

Family size and income determination (if applicable)

Youth with disabilities income determination (for ISY only) Documentation needs to be kept in a separate file

5% Eligibility Exception Request Form (if applicable)

a)Correct form

b)All sections complete

c)Dates & signatures PRIOR or AT enrollment

d)Approved by SDWP Program Specialist

Applicant Statement and Telephone Verification (if applicable)

a)Correct form
b)All sections complete
c)Dates & signatures PRIOR or AT enrollment
d)Case notes in CalJOBS

Foster Youth Programs

a)Enrolled in San Pasqual Academy

b)Enrolled in the County of San Diego's Independent Living Skills Program
ENROLLMENT / Yes / No / N/A / Comments

Universal Participant Agreement Form (UPAF)

a)Correct form

b)All sections complete

c)Dates & signature PRIOR or AT enrollment

d)Minors <18 signed by parent or legal guardian

Multimedia Publicity/Privacy Release Form

a)Correct form

b)All sections complete

c)Dates & signature PRIOR or AT enrollment

d)Minors <18 signed by parent or legal guardian

CalJOBS Data Validation

a)Eligibility & enrollment information matches in CalJOBS
LITERACY/NUMERACY / Yes / No / N/A / Comments

Literacy/Numeracy assessments may be used for the following:

a)Eligibility
b)Objective assessment
c)Measurable skills gain

Documentation

CalJOBS Data Entry

a)Activity codes (Reference CalJOBS Activity Codes)
b)CalJOBS Case notes
OBJECTIVE ASSESSMENT / Yes / No / N/A / Comments

Objective assessment has been conducted for the following areas:

a)Basic skills

b)Literacy and numeracy skill level

c)Occupational skills

d)Prior work experience

e)Employability
f)Interests
g)Aptitudes
h)Supportive service needs
i)Mental health services
j)Development needs

Documentation

a)Documented on Individual Service Strategy

CalJOBS Data Entry

a)CalJOBS Activity Code 412
b)CalJOBS Case notes
INDIVIDUAL SERVICE STRATEGY (ISS) / Yes / No / N/A / Comments

Documentation

a)Correct forms
b)All sections complete
c)Dates & signatures AFTER enrollment
d)Completed within 30 days AFTER enrollment
e)Updated every 3-6 months

CalJOBS Data Entry

a)CalJOBS Activity Code 413
b)CalJOBS Case notes
PROGRAM SERVICES / Yes / No / N/A / Comments

Active and consistent engagement with participant

a)Open activities every 90 days
b)System exit with no case notes

Provides at least one of the Program Components

(Includes the 14 required elements)

a)Educational Services
b)Career Pathways
c)Work Readiness Training
d)Work Experience Opportunities
e)Youth Development

Attempts to re-engage

If youth is not actively engaged, then attempts to re-engage are entered in CalJOBS with a case note
SELECTIVE SERVICE / Yes / No / N/A / Comments
Males who turn 18 while receiving program services must register for selective service with 30 days after their birthday
WORK EXPERIENCE / Yes / No / N/A / Comments
Has youth participated in work experience? If not, skip this section.

Documentation may be available in the following

a)Participant file
b)Youth service provider records
c)Third party staffing agency
d)Payroll processing agency
e)Not applicable

Documentation

a)Work permit from the school (if applicable)
b)I-9 Employment Eligibility Verification
c)W-4 Employee’s Withholding Allowance Certificate
d)Worksite Agreement & Training Plan
e)Timesheets (see criteria below)

Documentation – Timesheets

Timesheets must be paper or electronic, at minimum, and include the following:

a)Start and end of each work period
b)Meal periods taken
c)Split shift interval
d)Total hours worked daily and for total pay period
e)Initials from participant and supervisor if changes made
f)No whiteout
g)Timesheets approved by supervisor

CalJOBS Data Entry

a)CalJOBS Activity code (Reference CalJOBS Activity Codes)
b)CalJOBS Case notes
INCENTIVES / Yes / No / N/A / Comments
Has participant received incentives? If not, skip this section.

Documentation

a)Incentive receipt form
b)Incentive receipt such as check, gift card with serial number or non-cash award. No gift cards for entertainment activities
c)Proof of reason for incentive. Must match approved incentive policy.

CalJOBS Data Entry

a)Activity code (Reference CalJOBS Activity Codes)
b)Case notes include type of incentive, amount of incentive and reason for incentive

Justification for receiving an incentive should be linked to a goal on the ISS and participant should only receive an incentive after successfully completing a milestone.

The youth must acknowledge the receipt of incentive payment and formal acknowledgement must be maintained in participant file.

Timesheets or attendance records, if applicable, are maintained to support the incentive paid

a)Timesheets are signed by the participant and his/her supervisor

b)Any changes on time sheets are initialed by the participant or the supervisor
STIPENDS / Yes / No / N/A / Comments

Has the participant received stipends? If not, skip this section.

If stipends are provided to the Youth, a stipend plan was developed and approved by the Workforce Program Specialist before stipends are given. (overall for the contract)

If the stipend paid is based on the hours of participation, the stipend paid is below the Federal or California State minimum hourly wage, whichever is higher.

Evidence, such as participation or attendance records, or certification of achievement, are maintained to support that the participant met the terms and conditions of the stipends paid.

Evidence document(s) (i.e., timesheet, attendance records, or certification of achievement) are signed by the participant and supervisor.

Any change of time sheets or attendance records are initialed by the participant or his/her supervisor.

The payment is not based on online or virtual participation.

The ISS has specified the goal or criteria that must be met to earn the stipends.

Justification for the payments of stipends is documented in the participant file.

The type of payment method and amount is specified in the participant file.

A worksheet showing how the payment amount was calculated is maintained in the participant file.

Activity code 419 Support Services - Stipend is entered into CalJOBS.

SUPPORTIVE SERVICES / Yes / No / N/A / Comments

Has the participant received supportive services? If not, skip this section.

Determination of need:
a)Listed on individual service strategy
b)Based on results of objective assessment
Allowable supportive services may include:
a)Housing/shelter
b)Transportation
c)Clothing/uniforms
d)Work related tools/equipment
e)License/certification fees
f)Optical needs such as eyeglasses or protective eye gear
g)Short term child care
h)Other needs related to training or employment retention

Documentation

a)SDWP Supportive service form
b)Receipt of purchase
c)Tracking of supportive services (maximum of $800 per program year)
d)Transportation: copy of bus pass with serial number
e)Transportation: determination of distance (map)

CalJOBS Data Entry

a)Activity codes (reference CalJOBS activity code list)
b)Case notes include:
  • Type of supportive services,
  • Amount expended,
  • Link to program activities such as educational or employment related activities.

PERFORMANCE / Yes / No / N/A / Comments
Does participant have performance outcomes? If not, skip this section.

Placement includes any of the following (1st, 2nd, & 4th quarters after exit):

a)Education

b)Occupation Skills Training

c)Unsubsidized Employment

d)Apprenticeship

e)Military

Attainment includes any of the following (2nd quarter after exit):

a)Recognized postsecondary credential

b)Secondary school diploma or its recognized equivalent and must have a placement

Measurable Skills Gain includes any of the following (if youth is in an education or training program and must be attained within program year):

a)Educational Functioning level (EFL) gain
b)Secondary Diploma/Equivalent
c)Transcript/Report card
d)Training milestone

e)Skills progression

Median EarningsGain (2nd quarter after exit)

CalJOBS Data Entry

a)Documentation

b)Outcome form is completed

c)Case notes include information regarding outcome

GLOBAL EXCLUSIONS / Yes / No / N/A / Comments

Was the participant exited with a global exclusion? If not, skip this section.

Reasons for global exclusions:

a)Institutionalized
b)Health/Medical
c)Deceased
d)Reservist called to Active Duty
e)Relocated to a Mandated Program (Foster Youth)

Documentation

CalJOBS Data Entry

a) Documentation

b) Closure form complete

c) Case notes include information regarding global exclusion

FOLLOW UP SERVICES / Yes / No / N/A / Comments

Is the participant in follow up services? Is form and activity completed?

If participant is not exited, skip this section.

Quarter 1

Quarter 2

Quarter 3

Quarter 4

CalJOBS Data Entry

a)Activity codes (reference activity code list F series)
b)Case notes regarding follow up status

Attempts to engage

a)CalJOBS case notes with attempts to contact

1

Revised March 2018