SOP 209.07-att-5: Segregation: Tier I Program 30 Day Review Form

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

Summary

This form is used to document the mandatory 30-day review of offenders placed in Tier I segregation. The reviewing official (Warden or designee) must conduct the review, record their recommendation, and have the offender acknowledge receipt of the memo and appeal form. The form ensures compliance with segregation review requirements and maintains documentation in the offender's case file.

Key Topics

  • segregation review
  • Tier I program
  • 30-day review
  • administrative segregation
  • offender discipline
  • segregation appeal
  • warden review
  • facility discipline

Full Text

Attachment 5
IIB09-0002 (209.07)
04/30/15
SEGREGATION: TIER I PROGRAM
Segregation 30 Day Review Memo

FACILITY: _____________________________________ Date: _____________

RE: Segregation: Tier I 30 Day Review Memo

Offender: ____________________________________________________________GDC #:__________________________

Present Assignment:
____________________________________________________________________________________

In accordance with Segregation: Tier I SOP, a 30 Day Review was conducted with the following
recommendation:

______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ___________ Warden’s/Designee Signature: __________________________________________

************************

|_| I acknowledge the receipt of this Segregation: Tier I 30 Day Review.

Date: ___________ Offender’s Signature: __________________________________________

************************

|_| I acknowledge that the offender received the Tier I 30 Day Review Memo on this Date
|_| I acknowledge that the offender received the Tier I 30 Day Review Appeal form on this Date

Date: ___________ Staff Signature: __________________________________________

Copies: Offender
Offender File
RETENTION SCHEDULE: Upon completion of this form, it will be placed in the offender 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)
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