SOP_NUMBER: 209.08-att-10
TITLE: Administrative Segregation: Tier II Program Checklist - 30-Minute and 15-Minute Watch Form/Observation Record
REFERENCE_CODE: IIB09-0003
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2015-04-11
WORD_COUNT: 108
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105953
URL: https://gps.press/sop-data/209.08-att-10/

SUMMARY:
This form is used to document observation and monitoring of offenders placed in Tier II administrative segregation who require either 30-minute or 15-minute watch intervals. Staff must record the time and their initials for each observation period throughout the day, seven days a week. The completed form is retained in the offender's case history file.

KEY_TOPICS: administrative segregation, Tier II program, offender observation, watch form, 30-minute watch, 15-minute watch, segregation monitoring, case history file, facility discipline, observation record

ATTACHMENTS:
  1. Tier II Program Assignment Recommendation and 1Initial Segregation Review
     URL: https://gps.press/sop-data/209.08-att-1/
  2. Administrative Segregation: Tier II Program Assignment Memo
     URL: https://gps.press/sop-data/209.08-att-2/
  3. Administrative Segregation: Tier II Program Assignment Appeal Form
     URL: https://gps.press/sop-data/209.08-att-3/
  4. Administration Segregation: Tier II Program Handout
     URL: https://gps.press/sop-data/209.08-att-4/
  5. Administrative Segregation: Tier II Program 90-Day Review
     URL: https://gps.press/sop-data/209.08-att-5/
  7. Administrative Segregation: Tier II Program 90 Day Review Assignment Appeal Form
     URL: https://gps.press/sop-data/209.08-att-7/
  8. Administrative Segregation: Tier II Program - Cell Check Sheet
     URL: https://gps.press/sop-data/209.08-att-8/
  9. Administrative Segregation: Tier II Program Checklist
     URL: https://gps.press/sop-data/209.08-att-9/
  10. Administrative Segregation: Tier II Program Checklist - 30-Minute and 15-Minute Watch Form/Observation Record
     URL: https://gps.press/sop-data/209.08-att-10/
  11. Administrative Segregation: Tier II Program Performance Recording Sheet
     URL: https://gps.press/sop-data/209.08-att-11/

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FULL TEXT:
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**Attachment 10**
**OFFENDER NAME: ______________** **SOP 209.08 (IIB09-0003)**
**GDC#:___________________________          ADMINISTRATIVE SEGREGATION: TIER II** **PROGRAM CHECKLIST** **(04/11/15)**
**30-MINUTE OR 15-MINUTE WATCH FORM/OBSERVATION RECORD**

|DATE|Col2|DATE|Col4|DATE|Col6|DATE|Col8|DATE|Col10|DATE|Col12|DATE|Col14|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|**MONDAY**|**MONDAY**|**TUESDAY**|**TUESDAY**|**WEDNESDAY**|**WEDNESDAY**|**THRUSDAY**|**THRUSDAY**|**FRIDAY**|**FRIDAY**|**SATURDAY**|**SATURDAY**|**SUNDAY**|**SUNDAY**|
|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|<br>**TIME/INITIALS**|
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**RETENTION SCHEDULE: Upon completion of this form, it will be placed in the offender’s case history file.**