SOP 209.08-att-2: Administrative Segregation: Tier II Program Assignment Memo

Division:
Facilities
Effective Date:
April 11, 2016
Reference Code:
IIB09-0003
Topic Area:
209 Policy-Facilities Control/Discipline/Segregation
PowerDMS:
View on PowerDMS
Length:
124 words

Summary

This is a formal assignment memo form used to document when an offender is being placed into the Administrative Segregation Tier II Program. The form requires the facility to document the offender's identity, current assignment, reason(s) for the segregation placement, and must be signed by the warden or designee. The offender and staff must acknowledge receipt of the memo and related appeal forms, with copies retained in the offender's case file.

Key Topics

  • administrative segregation
  • Tier II program
  • segregation assignment
  • placement memo
  • disciplinary segregation
  • offender assignment
  • case file documentation
  • warden authorization
  • segregation appeal

Full Text

Attachment 2
SOP 209.08 (IIB09-0003)

(04/11/16)
Administrative Segregation: Tier II Program
Assignment Memo

FACILITY: _____________________________________ Date: _____________

RE: Administrative Segregation: Tier II Assignment

Offender: ____________________________________________________________GDC #:__________________________

Present Assignment: ___________________________________________________________________________________

The above named offender is being assigned to the Administrative Segregation: Tier II Program for the
reasons indicated:

______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ___________ Warden’s/Designee Signature: __________________________________________

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

|_| I acknowledge the receipt of this Assignment Memo for placement in A/S: Tier II Program.

Date: ___________ Offender’s Signature: __________________________________________

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

|_| I acknowledge that the offender received the A/S: Tier II Program Assignment Memo on this Date.
|_| I acknowledge that the offender received the A/S: Tier II Program Appeal form on this Date.

Date: ___________ Staff Signature: __________________________________________

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

Attachments (10)

  1. Tier II Program Assignment Recommendation and 1Initial Segregation Review (496 words)
  2. Administrative Segregation: Tier II Program Assignment Memo (124 words)
  3. Administrative Segregation: Tier II Program Assignment Appeal Form (160 words)
  4. Administration Segregation: Tier II Program Handout (1,207 words)
  5. Administrative Segregation: Tier II Program 90-Day Review (187 words)
  6. Administrative Segregation: Tier II Program 90 Day Review Assignment Appeal Form (149 words)
  7. Administrative Segregation: Tier II Program - Cell Check Sheet (110 words)
  8. Administrative Segregation: Tier II Program Checklist (212 words)
  9. Administrative Segregation: Tier II Program Checklist - 30-Minute and 15-Minute Watch Form/Observation Record (108 words)
  10. Administrative Segregation: Tier II Program Performance Recording Sheet (39 words)
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