SOP_NUMBER: 203.03-att-1
TITLE: Incident Report Form (Attachment 1)
REFERENCE_CODE: IIA04-0002
DIVISION: Facilities
TOPIC_AREA: 203 Policy-Facilities Reporting/Operations
EFFECTIVE_DATE: 2025-04-01
WORD_COUNT: 300
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106137
URL: https://gps.press/sop-data/203.03-att-1/

SUMMARY:
This is the standard incident report form used by the Georgia Department of Corrections to document all incidents occurring at correctional facilities. Staff members must complete this form to record incident details including type of incident, individuals involved, use of force, injuries, contraband, and notifications made. The form is reviewed and approved by facility leadership and retained for three years.

KEY_TOPICS: incident report, facility incident, use of force, inmate injury, staff injury, contraband, weapon, cell extraction, assault, escape attempt, PREA allegation, medical emergency, injury documentation, incident investigation, facility operations, emergency response

ATTACHMENTS:
  1. Incident Report Form (Attachment 1)
     URL: https://gps.press/sop-data/203.03-att-1/
  2. Incident Report Supplement Form
     URL: https://gps.press/sop-data/203.03-att-2/

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FULL TEXT:
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SOP 203.03

**Incident Report** Attachment 1
04/01/2025

Major Minor



Incident ID:



Facility:



Incident Date: Time:



Location/Dorm:


Operator Name:



Did incident result in serious injury? (Outside Medical Care) No Staff Inmate


Video Used? Y N If Yes, Type? Handheld Body Building Phone/Tablet Other


Evidence of Weapon Used? Y N If Yes, was it Found Not Found



Use of Force? Y N UOF Equipment Used? Y N Taser Chemical Firearm Hands-On Other:


Does this incident report contain hard contraband? Y N If Yes, it was found: Inside Grounds Outside Grounds

Is the contraband associated with a throw-over? Y N


Incident Category: Check **all** that apply:

Accident Escape- Secure Facility Detail TC Inmate Internet Violation Property
Attempted Suicide Escape Attempt Inmate Special Transport Quarantine
Cell Extraction Failure to Execute Policy Inmate Strip Cell Status Self-Injurious Behavior
Contraband - Hard Fight Inmate to Inmate Assault Shakedown
Contraband - Nuisance Fire Incident Inmate to Staff Assault Staff Shakedown
Damaged Property Flooding Institutional Drill Staff to Staff Assault
Death Four/Five Point Restraint Keys/Tools Suicide
Disruptive Behavior Homicide Maintenance Incident Taking Hostage
Disruptive Event Hunger Strike Personal Dealings with Inmate Unauthorized Contact
Drone Illness PREA - Allegation Use of Force
Employee Contact with Blood Injury Projecting Bodily Fluids Visitor Incident



**Directly Involved**

**OR**
**Witness**

Involved Witness



**Involved INMATE Name** **GDC #** **UOF** **DR**



**Injury**



**Sex.**
**Weapon**
**Alleg.**



Involved

Involved

Involved

Involved

Involved

Involved

Involved



Witness

Witness
Witness
Witness
Witness
Witness
Witness



**Involved Staff Name / Title** **Employee ID#** **Race** **Sex** **Force Used** **Staff Equip.** **Equip. Type**



**WITNESS Name** **Number / Title** **WITNESS Name** **Number / Title**



**Number / Title**



**WITNESS Name**



**Name/Agency Notified** **Date** **Time** **Name/Agency Notified** **Date** **Time**



**Reporting Official Signature:** **Date:** **Supervisor Signature:**


**WARDEN / SUPERINTENDENT REVIEW:** Was this incident forwarded for investigation? Yes No



**Date:**


Warden's Comments:



**Warden/Superintendent Signature**



**Date**



**Retention Schedule: (3) years and then destroy.**