SOP_NUMBER: 209.06-att-5
TITLE: 7-Day Segregation Status Review Form
REFERENCE_CODE: IIB09-0001
DIVISION: Facilities
TOPIC_AREA: Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2021-02-19
WORD_COUNT: 290
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/639043
URL: https://gps.press/sop-data/209.06-att-5/

SUMMARY:
This form documents the mandatory 7-day review conducted on offenders placed in segregation (administrative, disciplinary, medical, or protective custody). The reviewing staff member evaluates whether the offender continues to pose a security threat, exhibits negative behavior, or should be released back to general population. The form requires specific yes/no assessments and authorizes the Warden/Superintendent to make final decisions on whether segregation continues or the offender returns to regular housing.

KEY_TOPICS: 7-day review, segregation status review, administrative segregation, disciplinary segregation, protective custody, segregation placement, inmate behavior review, threat assessment, release from segregation, case notes, SCRIBE documentation, Warden recommendation

ATTACHMENTS:
  1. Offender Assignment to Segregation - Administrative Segregation Assignment Memo
     URL: https://gps.press/sop-data/209.06-att-1/
  2. 96-Hour Segregation Hearing Report
     URL: https://gps.press/sop-data/209.06-att-2/
  3. A, Segregation_Isolation Checklist-12 Hour Shift
     URL: https://gps.press/sop-data/209.06-att-3/
  4. Administrative Segregation Assignment Appeal Form
     URL: https://gps.press/sop-data/209.06-att-4/
  5. 7-Day Segregation Status Review Form
     URL: https://gps.press/sop-data/209.06-att-5/
  6. Administrative Segregation Orientation Handout
     URL: https://gps.press/sop-data/209.06-att-6/

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FULL TEXT:
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SOP 209.06

Attachment 5

2/19/21
# **7-Day Status Review Form**

__________________________________________________________________________________________________


**Type of Segregation:** Administrative          Disciplinary          Medical          Protective Custody

On _______________________, at ___________ hours, I, ______________________________________ conducted a


7-Day Status Review on Offender ________________________________ ID #______________.


Original Reason for Placement: ______________________________________________________________


Date Segregation began: ____________________________________________________________________


During this review, the following factors were considered with the results as indicated:
YES NO
1. Were there any negative comments documented on Attachment 3/3A?
2. Does the offender pose a threat to security/themselves/others/property?
3. Did any Unit staff member(s) report any negative behavior or acts since last review?
4. Is the offender unwilling or unable to live in general population? (PC Only, explain below)
5. Was the offender’s behavior defiant or insubordinate, during the review?
6. Has the offender received any disciplinary reports since the last review?
7. During your review did the offender make any statements that concerned you? If so, document below.

If any of the above factors are marked “YES”, the offender must continue their existing status, unless the
Warden/Superintendent determines otherwise. If all factors are marked “NO”, the offender may be released. Comments
regarding your review will be made below. The Authorized Staff Member conducting the Review shall be responsible for
entering the review results into the Offender’s Case Note in SCRIBE. If number 2, is “YES” the Authorized Staff Member
will notify the Segregation Unit Manager and the Mental Health Director/Counselor (complete a Mental Health Referral at
Non-Mental Health Facilities).

**COMMENTS:**
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

**For the reasons documented above, I recommend:**


 Remain in Administrative Segregation
 Return to appropriate housing unit

Authorized Staff Member: __________________________________ Date: _________________________

Warden’s Recommendation:


 Investigate and provide additional information on the following: ______________________________________
 Return to General Population (appropriate housing unit)
 Continue Current Segregation Status

Warden/Superintendent: ___________________________________ Date: _________________________


Retention Schedule: Upon completion, this attachment shall be maintained for one (1) year and then destroyed.