SOP 209.01-att-7: Disciplinary Appeal Form

SOP 209.01
Attachment 7

11/6/17

DISCIPLINARY APPEAL FORM

Facility: ___________________________________ Disciplinary Report #: ______________________________

Offender’s Name: _____________________________ Offender’s ID#: __________________________________
(Please Print)

TO: WARDEN/SUPERINTENDENT: (Submit within fifteen (15) calendar days after hearing).

REASON FOR APPEAL:

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Offender’s Signature Date

WARDEN'S/SUPERINTENDENT'S DECISION: (Within thirty (30) calendar days of receipt of
appeal).

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Warden's/Superintendent's Signature Date

2nd Appeal: (Within five (5) business days of Warden's Response)

TO: Inmate Affairs Unit
P.O. Box 310
Hardwick, Georgia 31034

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Offender's Signature Date

EXECUTIVE ASSISTANT'S DECISION:

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Executive Assistant's Signature Date

(Reproduce locally)

Retention Schedule: Upon completion, this form shall become part of the offender’s institutional file, except for those overturned or
dismissed, and shall be kept according to the official records retention schedule for institutional files.