SOP 209.01-att-11: Disciplinary Report Form
Summary
Key Topics
- disciplinary report
- disciplinary hearing
- inmate discipline
- institutional charges
- offense documentation
- hearing officer
- disciplinary sanctions
- isolation
- TPM extension
- offender appeals
- institutional file
- charge codes
Full Text
SOP 209.01
Attachment 11
11/06/2017
DISCIPLINARY REPORT
INSTITUTION NAME CODE # TPM/MAX DATE
I. Offender:
Name: Last, First, M.I. Security ID Number
II. Offense Data:
A. Charge Code Plea Finding Charge Code Plea Finding
1 4
2 5
3 6
Date Time of Offense Signature of Reporting Official
B. Factual Statement:
Reviewed by the appropriate supervisor:
Signature M/o./day/year
C. Charges served on accused:
Mo./day/year/time Signature of Serving Official
III. Investigative Report:
A. Summary of Investigation:
B.
Title Signature Mo./day/year
C. Advocate’s Name:
IV. Hearing Officer’s Recommendation:
Greatest High Moderate Low
Signature Mo./day/year
V. Disposition of Disciplinary Hearing:
A. Justification for Findings:
B. Action Recommended:
C. TPM Extension: Isolation:
D. Offender advised of his/her right to appeal:
Yes No
Signature of Disciplinary Hearing Officer Time of Hearing Mo/Day/Year
VI. Reviewing Officer:
____________________________ ______________________ ___________________
Signature Title Mo/Day/Year
Retention Schedule: Upon completion, this form shall become part of the offender’s institutional file and shall be maintained
according to the official records retention schedule for institutional files.