SOP 209.07-att-4: Tier I Program Segregation-Isolation Checklist

Division:
Facilities
Effective Date:
April 30, 2015
Reference Code:
IIB09-0002
Topic Area:
209 Policy-Facilities Control/Discipline/Segregation
PowerDMS:
View on PowerDMS
Length:
276 words

Summary

This form is used to document and track offenders placed in Tier I Program segregation/isolation. It records offender information, daily activities including meals, showers, and exercise, observation notes, and medical or behavioral concerns during the segregation period. Staff must complete the checklist for each shift and conduct regular monitoring observations (15 or 30-minute intervals) to ensure offender safety and compliance with segregation procedures.

Key Topics

  • segregation
  • isolation
  • Tier I Program
  • segregation checklist
  • inmate monitoring
  • disciplinary confinement
  • cell observation
  • segregation isolation record
  • meal tracking
  • exercise schedule
  • offender supervision
  • 15-minute watch
  • 30-minute watch
  • segregation review

Full Text

Attachment 4
WARDEN/DESIGNEE'S REVIEW SOP IIB09-0002 (209.07)
AFTER DISCHARGE (SIGNATURE): ________________________ 04/30/15
SEGREGATION: TIER I PROGRAM ISOLATION CHECKLIST (Page1 of 2)

OFFENDER NAME: ___________________________________________ GDC ID: ____________________ RACE: ___________
PRIOR LIVING UNIT: __________ COUNSELOR: ______________________________ PRIOR JOB DETAIL______________
DATE COMMITTED: __________________ EXPECTED DISCHARGE DATE: _____________________ STATUS: _________
TIME COMMITTED: ____________ ACTUAL DISCHARGE DATE & TIME: ________________________________________
REASON FOR ASSIGNMENT: ________________________________________________________________________________
____________________________________________________________________________________________________________
PERTINENT INFORMATION:____________________________________________________________________

|Date|Shift|Meals|Col4|Col5|SH|EXER|COMMENTS
(Include note/sig. of staff
visits, such as medical)|ADM
REV:|OFFICER
SIG:|
|---|---|---|---|---|---|---|---|---|---|
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Date
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EXPLANATORY NOTES: Meals - Yes(Y) or No(N) or Refused(R); Shower(SH) - Same codes as meals; Exercise (Exer) - Enter actual time period (e.g. 9:15AM -
10:30AM Inside)
PERTINENT INFORMATION: Epileptic, Diabetic, Religious Diet, Suicidal, Assaultive, etc.

COMMENTS:General conduct, attitude, hygiene, sanitation of cell,(continue on back if needed).

SEGREGATION REVIEW: Asst. Warden or Duty Officer, shift OIC/Captain, as appropriate

SEGREGATION: TIER I PROGRAM ISOLATION CHECKLIST Attachment 4
30-MINUTE OR 15-MINUTE WATCH SOP IIB09-0002 (209.07)

|Col1|Col2|Col3|Col4|Segregation|Col6|n/Isolation Observation|Col8|n Record|Col10|Col11|Col12|04/30/15 Page 2 of 2|Col14|
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TIME/INITIALS|
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Copy: Offender File
RETENTION SCHEDULE: Upon completion of this form, it will be placed in the offender’s//probationer’s case history file.

Attachments (5)

  1. Segregation: Tier I Program 96 Hour Segregation Hearing Report (112 words)
  2. Segregation: Tier I Program Assignment Appeal Form (143 words)
  3. Tier I Program Segregation-Isolation Checklist (276 words)
  4. Segregation: Tier I Program 30 Day Review Form (115 words)
  5. Segregation: Tier I Program 30 Day Review Appeal Form (139 words)
Machine-readable: JSON Plain Text