SOP_NUMBER: 209.07-att-5
TITLE: Segregation: Tier I Program 30 Day Review Form
REFERENCE_CODE: IIB09-0002
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2015-04-30
WORD_COUNT: 115
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105948
URL: https://gps.press/sop-data/209.07-att-5/

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

ATTACHMENTS:
  1. Segregation: Tier I Program 96 Hour Segregation Hearing Report
     URL: https://gps.press/sop-data/209.07-att-1/
  3. Segregation: Tier I Program Assignment Appeal Form
     URL: https://gps.press/sop-data/209.07-att-3/
  4. Tier I Program Segregation-Isolation Checklist
     URL: https://gps.press/sop-data/209.07-att-4/
  5. Segregation: Tier I Program 30 Day Review Form
     URL: https://gps.press/sop-data/209.07-att-5/
  6. Segregation: Tier I Program 30 Day Review Appeal Form
     URL: https://gps.press/sop-data/209.07-att-6/

========================================================================
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.**