SOP_NUMBER: 209.08-att-2
TITLE: Administrative Segregation: Tier II Program Assignment Memo
REFERENCE_CODE: IIB09-0003
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2016-04-11
WORD_COUNT: 124
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105955
URL: https://gps.press/sop-data/209.08-att-2/

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

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 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.**