KS Prison Visitation Application Form – Fill Out and Use This PDF

KANSAS DEPARTMENT OF CORRECTIONS

	INTERNAL	SECTION NUMBER		PAGE NUMBER
	MANAGEMENT	10-113		1 of 10
	POLICY AND	SUBJECT:
	PROCEDURE	PROGRAMS AND SERVICES: Inmate Visitation
Approved By:		Original Date Issued:		01-06-92
		Current Amendment Effective:		07-12-13
		Replaces Amendment Issued:		12-14-09
Secretary of Corrections
POLICY

Consistent with K.A.R. 44-7-104 and the procedures established herein, each facility shall establish general orders pertaining to inmate visitation. At a minimum, such general orders shall address: hours of visitation, the facility's schedule of visiting room/area operations, and procedures for processing visitors, assigning space, and length of visiting periods. (ACI 3-4445) Limited available space, personnel constraints, or other substantial reason to justify restricting the number of visitors or length of visits shall be approved by the Deputy Secretary of Facility Management. (ACI 3-4440) When approved by the Deputy Secretary of Facility Management, wardens may establish, through general order, a restricted visitation schedule for specialized inmate populations.

Inmates on Level I, Level II, and Level III may identify one [1] person as a primary visitor to be included in the maximum number of twenty [20] visitors permitted, in accordance with procedure Section II.B. of this policy. Those inmates residing within KDOC facilities on 19 March, 2004 shall not, however, have any visitors removed from their lists as a result of the most recent revisions to K.A.R. 44-7-104 affecting total visitors allowed and the method of counting them. Such inmates shall, however, become subject to those revisions should they be released from a KDOC facility and be subsequently returned as a violator or as a new court commitment. Inmates in a KDOC facility as of March 19, 2004 who have more than 20 persons approved to visit may not add another person to their visiting list until the total number of visitors falls below 20.

Inmates who are married by license or common law, per IMPP 01-126, shall not list any person as a primary visitor other than their spouse. Unmarried inmates may declare any person as their primary visitor, consistent with the following criteria: must be at least eighteen (18) years of age and may not be listed as the primary visitor for any other inmate. Application and verification of all persons designated as primary visitors shall be in accordance with Section I. of this policy. Inmates may remove a designated primary visitor from their Approved Visitors List, per provisions of Section II.B., however a change of the primary visitor shall not be made more often than every six (6) months.

All procedures and provisions for visitation, consistent with this IMPP and facility rules, shall be applicable and extended to inmates and their primary visitors.

Except when precluded due to a substantiated security risk, sound security practices, and/or other inmate management considerations, inmate visitation shall permit an informal environment, which permits face- to-face communication. (ACI 3-4441)

In order ensure that detailed information is available to inmates for notification of their family and friends regarding the visitation procedures at the respective KDOC facilities, each facility warden or designee shall be responsible to develop written information regarding the facility’s location, visitation program and additional information as may be useful to the inmates’ visitors. Procedures shall be developed to ensure that the written information is provided to each inmate within 24-hours of his or her arrival at the facility. It shall be the inmate’s responsibility to provide this information to persons from whom they wish to receive visits.

Page 2 of 10, IMPP 10-113

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The written information shall include, but not be limited to:

•The facility’s address and phone number, directions to the facility, and information about local transportation;

•The days and hours of visitation, per the visiting schedule (Section V.);

•The approved dress code and identification requirements for visitors;

•Authorized items that visitors may have in the visiting room or that they may give to inmates;

•Special rules for children; and,

•Conditions for special visits, per Section VIII of this IMPP. (ACI 3-4441-1)

The procedures for inmate visiting privileges for recent admissions and inmates without approved visiting lists shall ensure consistency with the provisions of the offender Privilege and Incentive Level System, per IMPP 11-101. Visitation privileges shall be determined by the incentive level assigned to each inmate in the following manner:

Intake Level	Inmates assigned to the Intake Level shall be limited to visits from attorneys,
	clergy, and law enforcement.
Level I	Inmates assigned to Level I shall be limited to visits from attorneys, clergy, law
	enforcement, a primary visitor, and immediate family members.
Levels II & III	Inmates assigned to Levels II and III shall be allowed visits from any approved
	visitors per the provisions of this IMPP.

Lists of persons requested by the inmate and approved by the warden, once established, shall be transferable from facility to facility and shall remain in effect unless revised per the inmate's request or administrative cause. Conditions for special visits, as authorized by K.A.R. 44-7-104, shall be established within facility procedures. (ACI 3-4442)

Prior to approval of visitors, designated facility officials shall provide potential visitors and, on request, other interested parties information and instructions regarding the facilities order on visitation and the Department's policy on searches and control of contraband. Where there is reasonable suspicion that a visitor is in possession of contraband items, the warden or warden's designee may demand that the visitor submit to a search of the visitor's person, in accordance with K.A.R. 44-7-104 and IMPP 12-115. The visitor may refuse to submit to such search. In that event, the visitor may be denied contact visiting privileges, or access to, or removed, or permanently barred from the facility. Wardens shall establish alternative steps, when appropriate, to preserve visiting privileges although violation of statutes, regulations, and/or facility rules shall be cause for the termination of a visit or barring of a visitor from KDOC facilities.

The visiting program at each facility shall be under the direct supervision of the Deputy Warden of Programs.

Any inmate who is identified as a sex offender per IMPP 11-115 shall only be allowed visitation in concert with the provisions of that IMPP.

DEFINITIONS

Admission: Any inmate or post-incarceration supervision conditions violator received at a KDOC facility from another jurisdiction. Offenders being returned to custody in pre-revocation status are considered admissions.

Immediate family: Parents, step-parents, siblings, spouses of siblings, half-siblings, step-siblings, children, spouses of children, step-children, grandchildren, step-grandchildren, spouse, parents of spouse, grandparents, or any person who filled the role of a parent de facto with respect to the inmate as confirmed by the warden upon review of the social history.

Page 3 of 10, IMPP 10-113

Effective 07-12-13

PROCEDURES

I.Approval of Visitors

A.Each warden or designee shall be responsible to solicit information from potential visitors and conduct investigations necessary to verify the relationship to the visitor claimed by the inmate and to confirm that no reason exists for disapproving visitation. Wardens may disallow visitation when:

1.The claimed relationship cannot be verified; or,

2.The potential visitor is not eligible for visitation per provisions of K.A.R. 44-7-104.

a.Except as approved for specific programs, volunteers shall not be eligible for inmate visitation programs.

B.Application for Visiting Privileges

1.Inmates shall provide those persons from whom they wish to receive visits with an Application for Visiting Privileges Form (Attachment A, Form #10-113-001).

a.The inmate shall obtain the Application for Visiting Privileges Form from his/her unit team manager or designee.

b.The mailing of these forms shall be at the inmate's expense.

c.More than one application at a time may be mailed in the same envelope in order to minimize the inmate's cost.

d.Inmates shall not be permitted to send a visiting application to the victim of their crime and should be informed of such when obtaining the Application for Visiting Privileges form.

2.Completed applications shall be returned via U.S. mail directly to the warden’s designee(s).

3.Members of the inmate's immediate family may be allowed visitation pending completion of the approval process for the first thirty (30) days after the inmate's transfer from an RDU to a facility for general population confinement.

a.When an inmate is admitted at RDU, the inmate may submit a thirty (30) day temporary visitor’s list, which shall follow the inmate when transferred to another facility.

C.Verification/Review of Applications

1.Each returned application shall be reviewed and verified by staff designated by the warden.

2.To the extent possible, the following application information shall be verified:

a.The applicant's relationship to the inmate as claimed on the application;

b.Parole or probation status of the applicant;

c.Whether or not the applicant is a former inmate; and,

d.Whether the applicant is currently, or within the past two (2) years has been, an employee of the KDOC or any of the Department's contract service providers.

Page 4 of 10, IMPP 10-113

Effective 07-12-13

e.Whether the inmate is a sex offender. If so, determine the applicant’s age and whether or not the applicant was the inmate’s victim.

3.Application information may be verified through any one or combination of the following means:

a.Review of social history information;

b.Kansas Bureau of Investigation (KBI) criminal history record check;

c.National Crime Information Center (NCIC) records check;

d.Review of the KDOC Management Information System data base; and/or,

e.Review of the SHARP information system database.

f.Contact with the Victims Service Liaison.

4.If the person applying for visiting is determined to be the victim of the offender, either through self-identification or by the Victim Services Liaison, the case will be screened by the Liaison prior to a decision about visiting.

a.In addition to talking with the victim, the Liaison will review the following:

(1)Court documents surrounding the case

(2)Victim’s file

(3)Any current or past protection orders or no-contact orders

(4)Any previous parole violations/revocations

(5)Any other information determined to be relevant to the visiting decision.

b.The Liaison will provide a summary of this information, including the Liaison’s recommendation for approval or disapproval of the application, to the Warden or designee by email.

(1)Any information provided by the Office of Victim Services should remain confidential, and should not be imaged with the visiting application materials or placed in the offender’s file.

5.Application verification shall be documented by a completed Visitor Background Verification Form (Attachment B, Form #10-113-002).

a.This form shall bear the signature of either the:

(1)Warden;

(2)Deputy Warden;

(3)Chief of Security; or,

(4)Warden's designee.

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Effective 07-12-13

6.Visitor applications and background verification forms shall be filed in the inmate's Unit Team file.

7.If the inmate is a sex offender, the unit team counselor will update OMIS to reflect visitation decisions.

D.Re-Verification of Visitor’s Lists Information

1.All inmates returned from post-incarceration supervision with a new sentence shall require a re-verification of the information regarding the approved visitor’s list.

2.No re-verification of the visitor’s list shall be required for inmates who are returned to custody following release to post incarceration supervision with no new sentence:

a.If they have been on post-incarceration supervision for two (2) years or less; or,

b.Unless there is a recommendation from the Field Service staff or other criminal justice employee to re-verify the information on previously approved visitors.

II.Visitor Lists

A.The names of persons approved for visitation shall be placed on the Approved Visitors List Form (Attachment C, Form #10-113-003).

B.Once the maximum number of twenty (20) visitors are on the list, one visitor's name must be deleted from the list before another name may be added. Any inmate may add or delete a visitor as often as desired, consistent with time restraints indicated in Section II.B.3., below, so long as the number of visitors does not exceed a maximum of twenty (20) at any given time.

1.Adults who accompany the inmate's minor child(ren) or immediate family members under the age of eighteen (18) years of age, per provisions of K.A.R. 44-7-104, shall be required to be on the inmate's visitor list.

2.Once a person's name is removed, that person shall not be added to the same or another inmate's visiting list for a minimum of 180 days.

C.Complete and current visitor lists shall be:

1.Provided to the visiting room supervisor in the appropriate visiting area/unit;

2.Provided to the facility access control officer at the appropriate unit or visiting area; and,

3.Filed in the inmate's Unit Team file.

III.Inmate Visiting Documentation

A.Inmate visiting documentation shall be assembled at the time of transfer from RDU to a KDOC facility where visiting is permitted.

Page 6 of 10, IMPP 10-113

Effective 07-12-13

1.Inmates at RDU may submit a thirty (30) day temporary visitor’s list.

a.RDU staff shall not send out questionnaires to the persons on the temporary list and shall not conduct investigations of any potential visitors.

2.When transferred from RDU to another unit or to another KDOC facility for placement and housing, designated staff of the receiving facility shall:

a.Review the thirty (30) day temporary list of visitors with the inmate to begin the development of a permanent approved visitor’s list;

b.Provide the inmate with Applications for Visiting Privileges to be mailed to potential visitors;

c.Conduct the investigations required, per Section I.C., and approve or disapprove the potential visitor; and,

d.Collect and file the documentation on the potential visitors, maintaining such documentation in the Unit Team file.

B.The Unit Team file shall be the repository for the following:

1.Applications for visiting privileges forms (Attachment A);

2.Visitor Background Verification Form (Attachment B); and,

3.The Inmate's Approved Visitors List (Attachment C).

C.Visiting documentation shall be maintained as per the requirements set forth within IMPP 05-104.

D.Whenever an inmate is transferred to another KDOC facility the approved visitor’s list shall follow the inmate in the Unit Team file.

1.The permanent visitor’s list shall be effective and active at each receiving facility; and,

2.The inmate shall not be required to submit a new list of prospective visitors and the receiving facility shall not be required to conduct investigations of, nor re- approve, persons on the permanent approved visitor’s list at the time of transfer.

E.After the inmate's permanent approved visitor’s list has been developed, except as provided below, the inmate shall not be required to divert back to a temporary list upon transfer to another KDOC facility.

1.If, at the time of a transfer between facilities, the inmate's permanent approved visitor's list does not arrive at the receiving facility, as confirmed by the records office of the receiving facility, the following actions shall be taken to ensure the inmate's visits:

a.The inmate shall submit a temporary list to the facility which shall be used by the facility until the permanent list of approved visitors is received from the sending facility; and,

b.The receiving facility records office shall take steps to obtain the inmate's permanent list of approved visitors as soon as possible.

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IV. Visiting Areas

A.Each facility permitting visits shall establish visiting room(s) for inmates and their approved visitors.

1.Visiting rooms shall allow for ease and informality of communication and shall be arranged, to the extent possible consistent with sound security practices and/or other inmate management considerations, with the comfort and privacy of the visitor in mind. (ACI 3-4441)

2.Visiting shall be conducted in an environment as free from custodial constraint as is prudent.

a.Non-contact visits may be ordered by the warden consistent with sound security practices.

B.When facility design and security structure allows, open air visiting area(s) shall be established consistent with sound security practices.

1.Only those inmates with minimum or medium custody shall qualify for outside visiting privileges.

2.Rules governing the use of outside visiting areas shall be established by the warden or warden's designee.

C.At each facility where vending service is obtainable, vending machines shall be made available for the purchase of soft drinks and snack items.

1.Each facility shall establish rules regarding whether food and drink items purchased by visitors during visitation periods may be taken from the visiting room by the visitor at the conclusion of the visit.

D.All visits shall take place in the designated visiting areas, except when other arrangements are authorized by the warden or warden's designee.

E.Each facility shall post in the visiting room, or otherwise provide, information to visitors about transportation to the facility, including transportation between the facility and nearby public transit terminals.

V.Visiting Hours

A.Each facility shall establish, through general orders, a visiting schedule, which provides a minimum of four (4) hours per week of visiting for all inmates in the general population.

1.If state holiday visitation is allowed, it shall be restricted to Memorial Day, 4th of July, Thanksgiving Day, and Christmas Day.

a.If the state holiday falls on a Saturday or Sunday, then normal weekend visitation schedules shall apply, and additional visitation based on the celebration of the state holiday shall not be permitted.

B.A visiting schedule shall be posted in each visiting room and each housing unit.

C.General orders shall include provisions, which ensure sufficient time for the processing of visitors prior to the end of scheduled visitation and any exceptions or approvals required to deviate from the routine visitation schedule. It is recommended that visitors arrive at least one (1) hour before the end of the visiting period.

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VI.

Number of Visitors/Length of Visits

A.

The number of visitors an inmate may receive at any one time and the length of each visit

shall be limited only by the number of approved visitors, the facility's schedule, space

available, personnel constraints, or other substantial reasons to justify such limits. (

ACI 3-

4440

)

B.

When restrictions on the number of visitors or length of visits exist, such restrictions shall

be established in the facility's general orders. (

ACI 3-4440

)

VII.

Special Visitors Per Provisions of KAR (

ACI 3-4442

)

A.

Special visitors as provided for in K.A.R. 44-7-104(3) shall include:

1.

Members of the State Legislature;

2.

Judges of the Kansas State Courts;

3.

Members of the Kansas Parole Board;

4.

Attorney General;

5.

Governor; and

6.

Members of the consulate of the inmates’ country of origin.

B.

An inmate's attorney or clergy shall be allowed to visit at reasonable times (

ACI 3-4442

)

unless:

1.

A clear abuse of this privilege has occurred; or,

2.

Such visitation presents a clear danger to the security and order of the facility or

the rehabilitation of the inmate.

VIII.

Conditions for Special Visits of Persons Not on Visitors Lists (

ACI 3-4442

)

A.

Special visits by persons not on an inmate's approved visiting list may only be authorized

by the warden or designee.

B.

Circumstances under which special visits may be granted include, but shall not be limited

to:

1.

Requests for a single visit prior to background verification and approval of

subsequent visits;

2.

When the visitor has traveled a distance of 150 miles (one way) or more; or, (

ACI

3-4442

)

3.

When the special visit is in the best interest of the inmate's rehabilitative needs or

other correctional goals.

C.

All requests for special visits shall be initiated by the inmate through the inmate's unit

team via Form 9.

IX.

Termination and Suspension of Visits

A.A visit may be denied or terminated under the following circumstances by the unit team manager or, in the unit team manager's absence, by the highest ranking security officer on duty:

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1.Visitors under the influence of drugs or alcohol;

2.Insufficient space is available;

3 Refusal of visitor(s) to submit to search procedures per IMPP 12-115;

4.Refusal or failure to produce sufficient identification or the falsifying of information by the visitor;

5.Violation of facility visiting rules by visitor or inmate;

6.Failure to properly supervise children;

7.Excessive physical contact by the visitor and inmate. Contact visits are limited to an embrace or kiss briefly at the beginning and at the end of the visit; and,

8.Reasons necessary to preserve the security of the facility and reasonable order in the visiting area.

9.Visitor in possession of a cell phone and /or tobacco products upon entering the building to check in and undergo search procedures.

B.A less restrictive measure shall be attempted, when appropriate, prior to the termination of a visit. Such alternatives include:

1.Warning the inmate and/or visitor of improper conduct; and,

2.Transferring the visit to a non-contact visiting area.

C.If a visit is terminated or relocated to a non-contact visiting area, the highest-ranking security officer on duty taking the action shall prepare an incident report.

D.Based on information provided by staff and by the inmate and/or visitor, the warden or deputy warden of programs may remove an individual's name from an approved visitor’s list, and suspend the visitor's visiting privileges.

1.A written notice of the decision, including a statement of reasons, shall be given to the inmate and visitor; and,

2.The statement of reasons may be deleted if it would jeopardize the security of the facility or the safety of any individual.

E.The duration of visiting suspension shall be determined by the warden in accordance with K.A.R. 44-7-104.

1.If a visitor is suspended from visitation at any KDOC facility, that individual's visiting privileges shall be suspended at all other KDOC facilities for the duration of the initial suspension period.

a. Such suspensions shall be documented in the Unit Team file.

F.A less restrictive measure shall be taken, when appropriate, prior to suspending a visitor's visiting privileges. Alternatives include:

1.Warning the visitor of the improper conduct; and,

2.Allowing the visitor to visit only in a non-contact visiting area.

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X.Visitor Registration/Identification (ACI 3-4445)

A.Each visitor shall register before and sign out after the visit is terminated.

1.Registration shall include at least the visitor's name, address, and relationship to the inmate.

B.Visitors shall be required to properly identify themselves with a picture ID issued by a governmental agency, such as a driver's license, or a state ID card.

1.A marriage license or birth certificate is acceptable for persons under the age of 16 who cannot produce a photo ID.

C.The warden may establish procedures, which require an inmate's visitors to wear an identification badge issued by the facility at the time of registration, in accordance with IMPP 12-132.

D.Visitors unable to produce positive identification shall be denied visiting privileges.

XI.	Visitor Searches
	A.	All visitors are subject to search in accordance with IMPP 12-115.
	B.	The search of visitors shall only be conducted to prevent the introduction of any items
		considered to be contraband if taken into or from a facility, per K.A.R. 44-02-103.

NOTE: The policy and procedures set forth herein are intended to establish directives and guidelines for staff and offenders and those entities who are contractually bound to adhere to them. They are not intended to establish State created liberty interests for employees or offenders, or an independent duty owed by the Department of Corrections to either employees, offenders, or third parties. Similarly, those references to the standards of various accrediting entities as may be contained within this document are included solely to manifest the commonality of purpose and direction as shared by the content of the document and the content of the referenced standards. Any such references within this document neither imply accredited status by a Departmental facility or organizational unit, nor indicate compliance with the standards so cited. The policy and procedures contained within this document are intended to be compliant with all applicable statutes and/or regulatory requirements of the Federal Government and the state of Kansas. This policy and procedure is not intended to establish or create new constitutional rights or to enlarge or expand upon existing constitutional rights or duties.

REPORTS REQUIRED

None.

REFERENCES

K.S.A. 75-5210 (d)

IMPP 01-126, 11-101, 11-115, 12-115, 12-132

ACI 3-4440, 3-4441, 3-4441-1, 3-4442, 3-4445

K.A.R. 44-2-103, 44-7-104, 44-7-104(3), 44-12-315, 44-12-321

ATTACHMENTS

Attachment A - Application for Visiting Privileges, - 2 pages

Attachment B - Visitor Background Verification Form, - 1 page

Attachment C - Approved Visitors List, - 1 page

	Page 1 of 2, Attachment A, IMPP 10-113
		Effective 07- 12-13
Kansas Department of Corrections
Application For Visiting Privileges
Facility and Address	Inmate To Be Visited
_________________________________________	_____________________________________________
	Name	Number
_________________________________________
_________________________________________
Date: ____________________________________	_____________________________________________
	Unit Team/Cellhouse

Please read carefully. All questions must be answered. Omissions or falsification could result in permanent denial of visiting privileges. The application should be returned separate from any other correspondence to the address shown above.

1.Name:(Mr./Mrs./Miss) __________________________________________________________________

2.Maiden/Other Names Used:

______________________________________________________________________

3.Relationship To Inmate (Father, Wife, Friend, etc.)____________________________________________

4.Current Contact Information:

____________________________________________________________________________________

		Street			City	State	Zip
	____________________________________________________________________________________
		Phone number
5.	Driver's License: State				Number___________________________
6.	Date of Birth*:			Social Security #______________________

*NOTE: A certified copy of a birth certificate is required for each visitor under eighteen (18) years of age.

7.Are you approved to visit another inmate? No ______ Yes ______

If yes:_____________________________________________________________________________________

		Name	Number	Facility
8.	Have you ever been convicted of a criminal offense? No ______			Yes ______
	If Yes, fill in the following:
	Offense	Approximate Date		Disposition
	_____________________________________________________________________________________
	_____________________________________________________________________________________
9.	Are you on probation or parole? No ______		Yes ______

If Yes, what county and state?_____________________________________________________________

Page 2 of 2, Attachment A, IMPP 10-113

Effective 07- 12-13

10.Have you ever been, or are you currently, an employee of the Kansas Department of Corrections, an employee of any contractor to the Kansas Department of Corrections, or a volunteer within the Kansas

Department of Corrections? No Yes____

If yes, please provide the details of that past or present employment:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

11.Were you a victim of the person you wish to visit or were any of your immediate family a victim of the person you wish to visit? No____ Yes _____ (If YES, you must initiate this

request through the Department’ Victim Services.) Victim Services can be reached by writing to:

Office of Victim Services

Kansas Department of Corrections

900SW Jackson 4-N Topeka, KS 66612

or by calling, 1-866-404-6732.

WARNING

K.S.A. 21-3826 provides that: (a) Traffic in contraband in a correctional institution is introducing or attempting to introduce into or upon the grounds of any correctional institution or taking, sending, attempting to take, or attempting to send from any correctional institution or any unauthorized possession while in any correctional institution or distributing within any correctional institution any item without the consent of the administrator of the correctional institution. (b) For the purposes of this section, "correctional institution" means any state correctional institution or facility, conservation camp, state security hospital, juvenile correctional facility, community correction center or facility for detention or confinement, juvenile detention facility or jail. (c) Traffic in contraband in a correctional institution of firearms, ammunition, explosives or a controlled substance defined in K.S.A. 65-4101(e), and amendments thereto, is a severity level 5, non-person felony. (d) Traffic in all other forms of contraband in a correctional facility is a severity level 6, non-person felony.

Effective March 17, 2003, all department facilities, offices, and grounds shall be tobacco-free, at which time all tobacco products shall be declared contraband in accordance with KSA 21-3826 (Traffic in Contraband in a Correctional Institution). On and after this date, the use or possession of all tobacco products by any person is prohibited on department property. The only exception shall be for visitors to secure tobacco and tobacco-based products in their personal motor vehicles in the facility parking lot, unless they are intended for distribution within a facility. Violations of this policy may result in termination of visits, suspension of visiting privileges, and/or possible prosecution.)

Any visitor's possession of a cell phone on the grounds of a correctional facility [except within the confines of his or her vehicle] is prohibited. Violation may result in termination of visits, suspension of visiting privileges, and/or possible prosecution.

Signature:		Date:____________________
Form	#10-113-001

Attachment B, IMPP 10-113

Effective 07- 12-13

Kansas Department of Corrections

Visitor Background Verification Form

Inmate Name:			_		Number:________________________
Name of Prospective Visitor:___________________________________________________________________
							Method of
					Yes	No	Verification
1.	Application For Visiting Privileges form sent to prospective visitor				____	XXXX	XXXXXXXXXX
	Date Sent:

2.Application For Visiting Privileges form returned by prospective

	visitor.				____	____	XXXXXXXXXX
	Date Received:
3.	Relationship of prospective visitor to inmate verified.				____	____	______________
	Date Verified:
4.	Probation/Parole status of prospective visitor verified.				____	____	______________
	Date Verified:
5.	Former KDOC inmate status of prospective visitor verified.				____	____	______________
	Date Verified:

6.Previous employment status with KDOC of prospective visitor

verified.	____ ____ ______________
Date Verified:_________________

7.Is the inmate a sex offender? _____________________________________________________________

8.Have the contact requirements of IMPP 11-115 been met? ______________________________________

The verification process for the above-identified prospective visitor has been completed per the requirements of IMPP 10-113. This person has ___1. BEEN APPROVED and his/her name may be added to the inmate's visiting list, OR ___2. NOT BEEN APPROVED.

NOTE: The name may be added to the inmate's Visitors List only if the visitor has been approved.

Approved:

Date:________________________

Form # 10-113-002