HUBER/WORK RELEASE AGREEMENT

Date: Jail Start Date: Check-in Time: Length of Stay: HUBER/WORK RELEASE AGREEMENT You have been ordered to serve a jail sentence in the Pierce County Jail. You are to report to the lobby of the Pierce County Jail on the date and time listed on your Judgment of Conviction. DO NOT REPORT UNDER THE INFLUENCE OF ALCOHOL OR DRUGS! Failure to report on your scheduled report date/time will result in a warrant for your arrest. If you would like to report early, or transfer to an approved county that is listed on your Judgment of Conviction, please contact a Huber Officer at 715-273-1124. I,, have been provided with a copy of the rules governing the conduct of the Huber/Work Release inmates sentenced to the Pierce County Jail. I understand it is my responsibility to obey all the rules of the Pierce County Jail and a violation of any Jail rule or Huber/Work Release rule may result in disciplinary action up to and including permanent revocation of my Huber/Work Release privileges. In accepting Huber/work release privileges, I understand that I will be required to submit to a blood, urine, or breath sample for analysis to determine the presence of alcohol or controlled substances upon demand. Refusal or failure to provide such a sample will result in the same disciplinary action that would be imposed for the use of alcohol or controlled substance. I understand the Pierce County Jail will not be held responsible for any personal property that is lost, broken, or stolen while I am in custody. I have read, or have read to me, this agreement and fully understand my obligations. Inmate s signature: Home address: Current phone #: Date: Jailer receiving: Date: Original Jail; Copy Inmate Revised 8/1/2015 Page 1 of 17

PIERCE COUNTY JAIL HUBER REGISTRATION PACKET Pierce County Jail 432 W Main Street Ellsworth WI 54011 Deputy Melanie Anderson, Lead Huber Officer Deputy Cole Clements, Huber Officer PHONE: 715-273-1124 FAX: 715-273-6856 Revised 8/1/2015 Page 2 of 17

PIERCE COUNTY JAIL HUBER REGISTRATION PACKET Pierce County Jail 432 W Main Street Ellsworth WI 54011 PHONE: 715-273-1124 FAX: 715-273-6856 Basic Huber Information... Page 4 Huber Checklist... Pages 5 Appearance, Child Care, Court Ordered Programs... Page 6 Drug Testing, Getting To and From Work... Page 6-7 Housekeeping, Huber Fees... Page 7 Jail Property, Job Requirements, Laundry... Page 8-9 Medical, Meals & Canteen... Page 9 Parking, Paychecks, Search... Page 9 Self Employment, Special Release Requests... Page 10 Visitation, Violations... Page 10 Work Search... Page 11 Tuberculosis Testing... Pages 12-13 Employment Record / Employee Form... Page 14 Work Schedule, Weekly Itinerary... Page 15-16 Items Allowed in Jail... Page 17 Revised 8/1/2015 Page 3 of 17

BASIC HUBER INFORMATION Huber/work release is a privilege that has been designed to assist those individuals that are employed to retain their jobs and continue to support their families and meet other obligations. Although the Court granted this privilege, you must meet the criteria set forth by jail policy in order to exercise Huber privileges. Prior to checking in to serve your sentence, you must schedule a meeting with the Lead Huber Officer and pick up a Huber Registration Packet. Huber packets may be picked up at the Pierce County Jail or downloaded online from the Pierce County website. Appointments may be scheduled by contacting the Lead Huber Officer at melanie.anderson@co.pierce.wi.us. It is your responsibility to set this up before checking in to serve your sentence. You are expected to bring in the completed Huber Registration Packet to your appointment. If you do not schedule an appointment, you will have to stay in until a Huber Officer can review your information. Keep in mind: The approval of any job is up to the discretion of the Sheriff or his/her representative. You are expected to follow the rules and regulations which have been adopted for the purpose of maintaining proper custody and control of the inmate population. Read, understand, and follow the rules and you will have no problem serving your sentence at this facility. If you don t understand something about a rule, memo, procedure or verbal correspondence from a jailer, you may ask or write for clarification. Ignorance of these rules is no excuse or defense for any rule that you violate. Revised 8/1/2015 Page 4 of 17

HUBER CHECKLIST Huber law inmates are required to complete the following list of items before reporting to jail. You will not be released for work until the list is complete. Signed copy of the Huber/Work Release Agreement Completed Employment Record/Employee Form Letter from your employer verifying you are employed by them. The letter should be on company letterhead and include: position, length of employment, and rate of pay. Copy of your most recent paycheck and stub Completed Work Schedule signed by you and your supervisor Proof of Workman s Compensation and/or Health Insurance Proof of valid driver s license if you are a driver. If getting a ride, proof that your driver has a valid driver s license. Complete detailed vehicle information of the vehicle you are driving and/or riding in, and proof of current vehicle insurance for each driver. If required by judgment of conviction, provide written proof of Ignition Interlock Device installation (Completed MV3598 Form) SS303.08(10r) The Sheriff may not permit a prisoner who is subject to an order under SS343.301(1g) to leave the jail under sub. (1) Unless, within 2 weeks after the court issues the order, the person submits proof to the Sheriff that an ignition interlock device has been installed in each motor vehicle to which the order applies. If self-employed, fill out and sign, then attach an itinerary of where you will be working and for whom (complete name, address, and phone number). Selfemployed persons may also be required to submit the following if applicable: Federal and/or State ID tax numbers Previous year s tax returns Five previous employer contracts dates within the last six months, unless contracts are long term Current invoices and/or job bids along with records/receipts Proof of a business checking account and/or bank statements Seller permits Cash totaling $250.00. This will pay for the first two weeks of your Huber Law charges plus your drug test. Huber fees are automatically deducted from your canteen account on Sunday morning for the following week. This is not adjustable. You must have a positive balance at all times. You will be required to have completed the Risk-based Tuberculosis Screening Questionnaire or have documentation of a negative Mantoux test. If you have never had a Mantoux test, you will need to have one done prior to reporting to jail if your sentence is 14 days or greater. If you have had a negative Mantoux test in the past, you only need to fill out the Risk-based Tuberculosis Screening Questionnaire. You will give all prescription drugs to the jailer at booking. We will dispense. Revised 8/1/2015 Page 5 of 17

APPEARANCE You will keep yourself clean, shave regularly, have a neat haircut and wear workappropriate clothing. No gang-related attire may be worn at any time. CHILD CARE The court may grant child care; however, to exercise this privilege the children must be your biological children or under your legal guardianship. If your occupation is being a caretaker for your children, you will be required to fill out a Pierce County Childcare Release form. Once this form is completed it must be approved by the Lead Huber Officer. COURT ORDERED PROGRAMS If part of your sentencing is to go to AODA classes, you will need proof that your initial AODA assessment is complete and/or scheduled. DRUG TESTING All Huber inmates will submit to a drug test before being released for work. You will be required to pay for this test at a cost of $12.00. If you fail your first drug or alcohol test you will be held from work for a minimum of five (5) days and/or subject to loss of Huber/Work Release privileges. You will not be released to go to work until you have passed the drug test. You will be required to pay $12.00 for all positive tests. In accepting Huber/Work Release privileges you may at any time be required to submit to a blood, breath, or urine test. Refusal or failure to do so will result in disciplinary action. At any time during your sentence if you fail a drug or alcohol test jail staff may petition the court to revoke your Huber privileges. GETTING TO AND FROM WORK You must go directly to work and return directly to jail after work. Jail staff must know your exact location at all times. If you are getting a ride, your driver must take you directly to and from the job via the shortest route possible without stopping, loitering, or deviating from the route while you are in the vehicle. You will not stop for gas, coffee, food, etc. If you are driving, you will be allowed reasonable travel time and must receive prior approval to stop for gas. If you are getting a ride, your driver must come into the jail lobby for you to be released. Inmates will be checked at their place of employment periodically. Any inmate not at his/her place of employment during his/her scheduled working hours will lose his/her Huber/Work Release privileges. This includes lunch breaks. You will spend all non-working hours in the Jail. You will not go home, attend meetings, religious services, or make appointments, etc., without permission from the Lead Huber Officer. Revised 8/1/2015 Page 6 of 17

You will not enter bars or go into any establishment that serves intoxicants unless it is your approved place of employment. You will not consume intoxicants. You will not use or possess any controlled substance or non-prescription drugs. All prescription drugs shall be delivered to the Jail staff and will be issued by the jailer on duty as the prescription indicates. You must immediately report all police contacts (traffic stops, criminal investigations, tickets, etc.) to the Jail staff. HOUSEKEEPING Your bunk will be made with the blankets tucked under the mattress before leaving for work. Wall lockers are to be kept in an orderly fashion. All Huber inmates will be responsible for keeping the Huber dorm clean and for emptying the trash on a regular basis. HUBER FEES Per section 303.08(3) Wisconsin Statutes, all of your earnings must be turned over to the jailer on the day you get paid. You cannot cash your check! In addition you will need to turn in your pay stub which documents the hours worked and the money earned. If you have direct deposit it must be changed to a paper check before you report to Jail. The only exception is an inmate who is sentenced to less than 30 days in Jail. Inmates sentenced to less than 30 days must provide a copy of their direct deposit statement and a check, cash, or money order equal to the amount of the direct deposit from that account. The charge for Huber privileges is $16.11 per day plus 5.5% tax. This must be paid in advance. This is collected by the Jail and paid to the County Treasurer on a monthly basis. All Huber costs must be paid in full before you are released at the end of your sentence. You will be returned to court for further action if you fail to comply. If you need money for bills, personal expenses, etc., you will need to fill out a Payment Request Form. Payment Request Forms have to be filled out 72 hours in advance. Huber payments and other obligations including fines, restitution, etc., will be deducted first. If you have a balance at the end of your sentence it will be returned to you when you are released from custody. In family situations, Huber expenses will be deducted and the rest can be released to your spouse for paying bills. There shall be no exchange of money between Huber inmates for any reason. Revised 8/1/2015 Page 7 of 17

JAIL PROPERTY A phone is available in the Huber dorm to make calls. Criminal charges will be recommended to the District Attorney s Office for any damage to equipment, defacing or writing on walls, tampering with lighting systems, ventilators, or windows. JOB REQUIREMENTS You will be allowed to continue your regular employment if working a minimum of 24 hours per week. If unemployed you will be given reasonable opportunity to secure employment, not to exceed 14 days. You will immediately notify the Jail staff of any change in your employment status. You must work at gainful employment in which you earn at least minimum wage. No cash jobs! You will not be released to do jobs for which you don t get paid. You will not be released to do work around home or for family members. An inmate must remain in the Jail at least one day each week. For this purpose, the week starts on Sunday and ends on Saturday. Your work schedule will not fluctuate nor will your in-custody day without prior approval of the Lead Huber Officer. You cannot work more than six days in a row. A detailed work schedule must be submitted by the inmate. Only the employer may call and change the hours, upon approval by the Lead Huber Officer. No inmate will be released for work until the schedule is on file. Schedules are due every Saturday by 10:00 p.m. No on-call status! Your employer cannot call on a day-to-day basis if there is work available. Any shift that exceeds the hours listed in your work schedule requires you to deliver a signed written request from your employer on company letterhead before leaving the jail. You are required to bring a written request from your employer on company letterhead if you are to work a holiday, even if it falls within your normal schedule. Generally, self-employed Huber inmates will not be released on holidays. All Huber inmates must bring in proof that their employer carries Workman s Compensation insurance policy prior to being released for work. LAUNDRY All Huber laundry will be done by the Pierce County Kitchen/Laundry Department. No inmate will go to the local laundromat or take his/her laundry out of the jail unless it is authorized by the Lead Huber Officer. When you check into the Huber program, you will be issued two (2) large green laundry bags and one (1) small white laundry bag to keep in your assigned locker. The number on the laundry bags will match the number on your locker. Every Friday morning by 6:00 a.m. the jailer will collect your bags and take them to the laundry room. There will be a form you must mark indicating how many laundry bags you submit. You and the jailer will initial the form. Revised 8/1/2015 Page 8 of 17

The cost of laundry will be deducted from your Canteen account. You will be charged $5.00 per large laundry bag and $3.00 per small laundry bag. You must keep a positive balance to have your clothes washed. MEDICAL Any sickness or injuries are to be reported to the jailer on duty. Inmates are responsible for their own medical, dental, mental health care, and medication expenses while incarcerated in the Jail. Huber inmates that require necessary medical, mental health, and/or dental care will be permitted to attend the appointment once it has been verified and authorized. A medical form must be filled out and received 72 hours in advance. In the event of an emergency, you may seek immediate medical care and notify the Jail Staff as soon as possible thereafter. If you have medical problems and/or are taking medication, please contact the Pierce County Jail Nurse at 715-273-6869. She will assist you with what you need to do prior to reporting for your sentence. Pierce County Jail does not allow narcotic medications. MEALS & CANTEEN Meals will be served at 7:30 a.m., 11:30 a.m., and 5:30 p.m. Huber inmates will be provided three meals each day. No outside food is allowed in the Huber dorm. You are not permitted to cook, use coffee warmers, or have fires of any kind. PARKING Parking for your vehicle is to be in the southeast corner of the Pierce County Office Building at 412 W Kinne Street, Ellsworth. PAYCHECKS Paychecks must be turned in on pay day. You must, at a minimum, be paid bi-weekly. When submitting your paycheck to the jail, you must have a paystub that outlines the dates, days, and hours worked along with deductions. You are required to fill out the Huber Employee Timesheet to turn in with your paycheck. If your paycheck is returned due to non-sufficient funds, you are still required to have that amount deposited into your account. You are also responsible for the returned check fee. SEARCH You will submit to a search upon leaving and returning to the Jail. Revised 8/1/2015 Page 9 of 17

SELF EMPLOYMENT Self-employed inmates will be required to submit at least two of the following if applicable: Federal and/or State ID tax numbers Previous year s tax return Five previous employer contracts dates within the last six months, unless contracts are long term Current invoices and/or job bids along with records/receipts Proof of a business checking account and/or bank statements Seller permits Some exceptions to these rules may be made at the discretion of the Lead Huber Officer. SPECIAL RELEASE REQUESTS You must notify the Jail at least 72 hours in advance and in writing for any court appearance, appointment to see your probation officer, doctor, dentist, counseling, etc. Special Release Request Forms are available for this purpose and need to be turned in with your appointment card. Appointments will be verified. If you travel to different job sites, you must contact the jail and speak to the on-duty jailer and advise them of the new location in which you are going. If your job sites differ in location, you must complete a detailed Itinerary Form and submit it to the Lead Huber Officer. VISITATION Visits with attorneys and clergy will be allowed at reasonable times of the day for reasonable lengths of time. You are not allowed to socialize or meet with your spouse, significant other, family, friends, or anyone else while you are away from jail. No person shall visit you at the job site, while you are traveling to and from work, or at any other time you are released into the public from Jail. This includes other Huber inmates. VIOLATIONS For violation of any of the Jail or Huber/Work Release rules, the Jail staff, Huber Officer, Jail Sergeants, Jail Administrator, Chief Deputy or Sheriff may hold you without Huber privileges for a period of up to five (5) days for each violation. You can also lose good time. The court can also be petitioned to have your Huber privileges permanently revoked. If the rules violation constitutes the commission of a crime, you may be charged with that offense. If you are held from work for violating a Huber or jail rule, you will still be charged the daily Huber fees. If you are on probation and violate a rule you may be placed on a hold from your Probation Officer. If you are put on a probation hold you will be moved out of the Huber dorm into general population and not charged the daily Huber fees. Revised 8/1/2015 Page 10 of 17

WORK SEARCH You will not be allowed out of the jail to conduct work search. Friends/relatives may provide you job applications by mailing them to the jail. If an interview is scheduled and verified, it is your responsibility to make transport arrangements and request permission from the Lead Huber Officer in advance. Revised 8/1/2015 Page 11 of 17

NAME: DATE: PIERCE COUNTY JAIL RISK-BASED TUBERCULOSIS SCREENING QUESTIONNAIRE This brief survey will identify those who need a TB test (skin test or blood test) and/or a medical evaluation and chest x-ray. It is meant to identify persons at risk of either active TB disease or with risk of progressing from TB infection to active TB disease. Thank you for completing the survey honestly. A. I have one or more of the following: (check all that apply) cough lasting longer than three weeks unplanned weight loss night sweats None of the above fevers cough with bloody sputum B. I have one or more of the following medical conditions I do not have any of the following medical conditions HIV Infection Diabetes mellitus Immunosuppressive therapy (including steroids, chemo-or radio- therapy, immunomodulators for arthritis, Crohn s disease, etc.) Chronic renal failure Hematologic disorders such as leukemia or lymphoma Malignant cancer such as cancer of the head or neck Pulmonary silicosis Gastrectomy or jejunoileal bypass C. One or more of the following applies to me None of the following apply to me I have lived or worked or volunteered in a TB high risk area, in a prison or jail, health care facility, nursing home or long-term care facility, shelter for homeless, or overseas clinic. (Note: Pierce County is not a TB high risk area) I was born in a country other than the US, Canada, Western Europe or Australia My parents were born in a country other than the US, Canada, Western Europe or Australia I have lived in inner-city Milwaukee I have traveled to an area with high rates of TB (China, India, Indonesia, Brazil, Bangladesh, Nigeria, Pakistan) I have been homeless I have used illegal drugs I have used excessive alcohol or am an alcoholic I know and have been in contact with someone who has or had TB I have been treated before for TB D. My TB test had been positive in the past complete My TB test has always been negative When most recent? Where? I have never had a TB test will need Mantoux skin test done prior to reporting or while at jail Nurse s signature Date Revised 8/1/2015 Page 12 of 17

PIERCE COUNTY JAIL INSTRUCTIONS FOR MANTOUX TUBERCULOSIS TESTING FOR HUBER INMATES 1. All inmates who will be entering the Pierce County Jail to serve a Huber sentence 14 days or greater are required to obtain a Mantoux Tuberculosis test prior to entering the jail. The test must be given and read prior to entering the facility. 2. A Mantoux test may be obtained from a physician or from most local health departments. Pierce County Health Department offers the screening by appointment for a fee of $25.00. 3. The test is administered one day and needs to be read 48-72 hours later. 4. The following information must be provided to the Pierce County Jail. 5. If you have had a positive Mantoux in the past or have a history of active TB disease, you must report the History and Evaluation of Tuberculosis form. Date applied: Date read: Time: Time: Results in millimeters: Staff Name (Print) Staff Signature: Facility Name Address and Phone: Inmate s Name (Print) Inmate s Signature: Date: In the event that an inmate presents himself/herself to the jail without a Mantoux Tuberculosis test, he/she will be given one by the Jail Nurse. Mantoux tests are given on the first and third Tuesday of each month and read 48-72 hours after it has been given. The inmate will not be permitted to leave until the test has been given and read. The inmate will be charged a fee of $25.00 for this test. Revised 8/1/2015 Page 13 of 17

EMPLOYMENT RECORD/EMPLOYEE FORM Inmate s name (print): Type of job: Employer s name: Employer s address: Employer s phone number(s): Supervisor s name: Wages: Hourly $ or Weekly $ or Bi-Weekly Paid: Weekly or Bi-Weekly Paid what day of the week: Date of next check: Hours per day: Work begins: Work ends: Days per week: Distance (miles) from PC Jail to work: Approx. travel time: Drive yourself: Ride: If you drive: Vehicle type: Plate #: State: Vehicle color: Year: Insurance company: (copy of current policy) If you ride: Who you ride with: Time picked up: Time brought back: Vehicle type: Plate #: State: Vehicle color: Year: Insurance Company: (Must provide copy of current policy) As per Wisconsin Law SS. 303.08(3) Huber prisoners shall report and submit all income to the Sheriff s Department while out on Huber Law. All money will be deposited in a bank account and disbursements such as board, expenses, and obligations will be paid by the Sheriff s Department from said account. At the end of your sentence, any money remaining in your account will be returned to you. Revised 8/1/2015 Page 14 of 17

WORK SCHEDULE A schedule signed by your supervisor must be on file with the Pierce County Jail prior to being released for work. Any shift that exceeds normal working hours, any holiday, or any change in your normal Huber hours requires written approval by the Lead Huber Officer. Any such change must be submitted on this form 24 hours prior to the change request and signed by the Inmate s supervisor. You must have at least eight hours off between shifts Indicate AM or PM, beginning, and ending times. Drive time each way? Date Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours Date Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours Date Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours Date Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours Inmate Name (print) Inmate Signature Date Supervisor Name (print) Supervisor Signature Date Jail Staff s initials when entered into JMS Date Revised 8/1/2015 Page 15 of 17

WEEKLY ITINERARY Inmate: Dates: / / to / / Include job site(s), addresses, phone numbers, and times (must be detailed).* Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: *This sheet must be completed and accurate before you will be approved to leave the jail. You will be held accountable and subject to disciplinary lockdown if you are not at the listed job site at the time(s) you have indicated. If this changes during the course of a day, you must call and notify the on-duty Huber Officer or jailer. Revised 8/1/2015 Page 16 of 17

ITEMS ALLOWED IN JAIL The following is a list of items allowed in the Pierce County Jail that can be kept in your locker: All items allowed in Huber dorm Jewelry Cologne Wallet Keys Work clothes and shoes/boots The following is a list of items allowed in the Pierce County Jail Huber dorm: Alarm clock (battery operated or wind up; watches) Two bath towels and two wash cloths Shampoo and conditioner One comb or brush Hair spray/hair gel Toothbrush, toothpaste, and floss Nail clippers Deodorant Q-tips Lotion Soap or body wash Underwear (white socks, white boxers or briefs, white sports bra, plain white t-shirts or white thermals) Eyeglasses or contacts (contact solution in a sealed box) Mail and magazines with subscriptions received here Three (3) photos Work training material or school material Pencils (non-mechanical) Feminine hygiene Razor and shaving cream (no electric razors) Canteen items Medical items (only if approved by the Pierce County Jail Nurse) Jail uniform, sandals, and Jail-issued laundry Religious books Items approved by the Lead Huber Officer Any item not listed above will be considered contraband! Absolutely NO pocket knives, box cutters, weapons, lighters, matches, or tobacco products. Revised 8/1/2015 Page 17 of 17