SOP_NUMBER: 209.08-att-7
TITLE: Administrative Segregation: Tier II Program 90 Day Review Assignment Appeal Form
REFERENCE_CODE: IIB09-0003
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2016-04-11
WORD_COUNT: 149
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105960
URL: https://gps.press/sop-data/209.08-att-7/

SUMMARY:
This form allows inmates assigned to the Tier II Program in Administrative Segregation to appeal their 90-day review recommendation within 3 business days. The inmate submits a written rebuttal through their assigned counselor to the Warden, who then reviews and makes a final determination on whether to concur or disagree with the classification committee's action. The completed form is retained in the offender's case history file.

KEY_TOPICS: administrative segregation, Tier II Program, 90 day review, appeal process, inmate appeal, segregation assignment, classification committee, Warden decision, disciplinary segregation, inmate grievance

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 7**
**SOP 209.08 (IIB09-0003)**

**(04/11/16)**


**Administrative Segregation:** **Tier II Program**
**90 Day Review Assignment Appeal Form**

**I.  Offender: ___________________________ GDC #: __________________ DATE:____________**

**II.  Administrative Segregation: Tier II Program Assignment**


**In accordance with Administrative Segregation: Tier II Program SOP, a 90 Day Review was conducted with the**
**following recommendation:**
**_______________________________________________________________________________**

**_______________________________________________________________________________**

**III.  Offender's rebuttal: (within 3 business days submit to the assigned counselor who shall forward to the Warden).**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**_______________________________________________________________________________**

**DATE APPEAL RECEIVED: ________________________ BY:_________________________________________(COUNSELOR)**

**IV.  Review of Appeal**

**_____I** **concur /** **disagree with the Administrative Segregation: Tier II Program Classification Committee’s**
**Action. The following decision(s) has/have been made in this case.**

**___________________________________________________________________________________**

**_________________________________________________________________________________**

**___________________________** **_______________________**
**Warden’s Signature** **Date**

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

**OFFENDER RECEIPT FOR** **ADMINISTRATIVE SEGREGATION: TIER II PROGRAM ASSIGNMENT**


**OFFENDER’S NAME: ______________________________________ I.D. #: ______________________**

**I ACKNOWLEDGE RECEIPT OF THIS APPEAL FROM THE ABOVE OFFENDER.**

**DATE: ___/___/____** **COUNSELOR’S SIGNATURE: ____________________________**