SOP 209.08-att-9: Administrative Segregation: Tier II Program Checklist
Summary
Key Topics
- administrative segregation
- Tier II program
- segregation monitoring
- disciplinary housing
- offender tracking
- meals in segregation
- exercise time
- shower access
- cell sanitation
- segregation checklist
- behavioral documentation
- warden review
- offender case file
Full Text
Attachment 9
WARDEN/DESIGNEE'S REVIEW SOP 209.08 (IIB09-0003)
AFTER DISCHARGE (SIGN :) ________________________ (04/11/16)
ADMINISTRATIVE SEGREGATION: TIER II PROGRAM CHECKLIST
OFFENDER NAME: ___________________________________________ GDC #: ____________________ RACE: ___________
PRIOR LIVING UNIT: __________ COUNSELOR: ______________________________
DATE COMMITTED: __________________ EXPECTED DISCHARGE DATE: _____________________
TIME COMMITTED: ____________ ACTUAL DISCHARGE DATE & TIME: ________________________________________
REASON FOR ASSIGNMENT: ________________________________________________________________________________
PERTINENT INFORMATION_________________________________________________________________________________
STATUS CHANGE
DATE COMMITTED: _________________EXPECTED DISCHARGE DATE_____________________STATUS___________
TIME COMMITTED__________________ACTUAL DISCHARGE DATE &TIME___________________________
___________________________________________________________________________________________________________
PERTINENT INFORMATION: ____________________________________________________________________
|Date|Shift|Meals|Col4|Col5|SH|EXER|CELL
SANT|COMMENTS
(Include note/sig. of staff
visits, such as medical)|ADM
REV:|OFFICER
SIG:|
|---|---|---|---|---|---|---|---|---|---|---|
|
Date
|
Shift
|B |L |S |S |S |S |S |S |S |
|
MON.|1st||||||||||
|
MON.|2nd||||||||||
|
TUES.|1st||||||||||
|
TUES.|2nd||||||||||
|
WED.|1st||||||||||
|
WED.|2nd||||||||||
|
THURS.|1st||||||||||
|
THURS.|2nd||||||||||
|
FRI.|1st||||||||||
|
FRI.|2nd||||||||||
|
SAT.|1st||||||||||
|
SAT.|2nd||||||||||
|
SUN.|1st||||||||||
|
SUN.|2nd||||||||||
EXPLANATORY NOTES: Meals - Yes(Y) or No(N) or Refused(R); Shower(SH) - Same codes as meals; Exercise (Exer) - Enter actual time period (e.g. 9:15AM -
10:30AM Inside)
PERTINENT INFORMATION: Epileptic, Diabetic, Religious Diet, Suicidal, Assaultive, etc.
COMMENTS: General conduct, attitude, hygiene, sanitation of cell,(continue on back if needed).
ADMINISTRATIVE REVIEW: Deputy Warden or Duty Officer, shift OIC/Captain, as appropriate
Copies: Offender File
RETENTION SCHEDULE: Upon completion of this form, it shall be placed in the offender’s case history file.