SOP_NUMBER: 209.01-att-11
TITLE: Disciplinary Report Form
REFERENCE_CODE: IIB02-0001
DIVISION: Facilities
TOPIC_AREA: Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2017-11-06
WORD_COUNT: 171
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105927
URL: https://gps.press/sop-data/209.01-att-11/

SUMMARY:
This is the official form used to document disciplinary charges and proceedings against incarcerated individuals in GDC facilities. The form captures offense details, investigation summaries, hearing officer recommendations, and final disciplinary decisions including any sanctions such as isolation or TPM extensions. The form must be completed by reporting officials, investigators, and hearing officers, and becomes part of the offender's permanent institutional file.

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

ATTACHMENTS:
  1. Offender Rights Statement
     URL: https://gps.press/sop-data/209.01-att-1/
  2. Disciplinary Investigation Summary
     URL: https://gps.press/sop-data/209.01-att-2/
  3. Offender Appearance Waiver
     URL: https://gps.press/sop-data/209.01-att-3/
  4. Prohibited Acts Offender Disciplinary Charge Codes
     URL: https://gps.press/sop-data/209.01-att-4/
  5. Authorized Disciplinary Sanctions List
     URL: https://gps.press/sop-data/209.01-att-5/
  6. Staff Advocate Form
     URL: https://gps.press/sop-data/209.01-att-6/
  7. Disciplinary Appeal Form
     URL: https://gps.press/sop-data/209.01-att-7/
  8. Use of Witness(s) Hearing Documentation Form
     URL: https://gps.press/sop-data/209.01-att-8/
  9. MH/MR Evaluation for Disciplinary Action
     URL: https://gps.press/sop-data/209.01-att-9/
  10. Negotiated Plea Form
     URL: https://gps.press/sop-data/209.01-att-10/
  11. Disciplinary Report Form
     URL: https://gps.press/sop-data/209.01-att-11/
  12. Disciplinary Warning Report
     URL: https://gps.press/sop-data/209.01-att-12/
  13. Guidelines for Issuing Disciplinary Reports (By Offense)
     URL: https://gps.press/sop-data/209.01-att-13/

========================================================================
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.