SOP 209.08-att-1: Tier II Program Assignment Recommendation and 1Initial Segregation Review

Attachment 1
SOP 209.08 (IIB09-03)

04/11/16

Administrative Segregation: Tier II Program Assignment Recommendation

|Offender’s Name:|Col2|GDC ID #:|Col4|
|---|---|---|---|
|Date:||Classification
Committee
Chairperson’s Signature||

|Col1|The offender is noted as a threat to the safe and secure
operation of the Facility. This may include but is not
limited to offenders who have documented STG
activities/involvement, notoriety of crimes, high level of
supervision requirements, and offenders who have either
been threatened with bodily harm or threatened others
with bodily harm.|Col3|Two or more disciplinary infractions for possession of a
weapon within the past year.|
|---|---|---|---|
||Escape within the previous five (5) years involving
violence or serious threat of violence.||Three or more disciplinary charges within the previous
12 months that involve assaultive or excessive disruptive
behavior of either Great or High severity level as defined
in the Inmate Discipline SOP (IIB02-0001).|
||Escape (s) or escape attempts within the previous three
years (3) from a state prison, County CI, or private prison.||Offenders with assaultive histories.
|
||Leadership or Participation in a major disturbance or riot
during the previous five (5) years involving: (a) ten or
more offenders; and/or (b) the serious threat of loss of life
or actual major property damage.||Excessive destruction of state property.|
||Failure in the Tier I Program or refusal to participate.||Transfer from GDCP SMU to a Tier II-Phase 3 or Tier
II-Mental Health program.|
||Participation as a leader or involvement in a major
disruptive event, major disturbance, or directing the
assault or homicide of other offender(s) during the
previous five (5) years||Attempting to introduce or trafficking of cellular devices,
drugs, tobacco or other illegal contraband.|
||Possession of a firearm or of an explosive device within
the previous five years.|||

Describe Specific Reason if Additional Information Is needed:

In accordance with the Tier II Program SOP, the offender is recommended for placement to the Administrative Segregation: Tier
II for the following reasons:
_______________________________________________________________________________________________________________

________________________________________ ________________________________________
Tier II Unit Manager Date Security Member Date

________________________________________
Care & Treatment Member Date

**Referring Classification Committee Chair sends document to the Warden’s/Designee’s Office
Copies: Offender File
RETENTION SCHEDULE: Upon completion of this form, it shall be placed in the offender’s case history file.

Attachment 1A
SOP IIB09-0003(209.08)
3/17/15

Tier II Initial Segregation Review

Date: ___________________
I. Offender: ___________________________ GDC ID#: __________________

In accordance with the Tier II SOP, you were placed in Tier II for the following reasons:
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

III. Offender's Statement: _____________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

IV. Classification Committee: ____________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

A. Above Offender has been informed of reasons why he was placed in Tier II Program.
B. Recommendation: |_| Assignment to Administrative Segregation: Tier II Program.
|_| Reassignment to General Population
|_| Transfer to another Facility

_______________________ ___________________________ _________________________
Security Member/Date Care & Treatment Member/Date Unit Manager – Designee/Date

V. Warden’s/Designee’s Remarks: Approval |_| Disapproval |_| ___________________________________
Warden’s/Designee’s Signature / Date

Comments: ____________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

The offender has the right to appeal the above decision to the Facilities Director. Offender has three (3) business days to appeal
this decision on the attached form. (Assignment Appeal Form – Attachment 3)

Copies: Offender File
RETENTION SCHEDULE: Upon completion of this form, it shall be placed in the offender’s case history file.