SOP 209.09-att-10: Tier III Program Checklist

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file. SOP 209.09
Attachment 10

04/23/25

Special Management Unit: Tier III Program Checklist

Offender Name: GDC#: Week Begin:

Date/Time of Initial Assignment: Cell Assignment: Phase:

Pertinent Information: __________________________________________________________________________ Warden/Designee Review: ______________

|Task:|Sunday
Time/Initials|Col3|Monday
Time/Initials|Col5|Tuesday
Time/Initials|Col7|Wednesday
Time/Initials|Col9|Thursday
Time/Initials|Col11|Friday
Time/Initials|Col13|Saturday
Time/Initials|Col15|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|Breakfast Meal|||||||||||||||
|Lunch Meal|||||||||||||||
|Dinner Meal|||||||||||||||
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|Recreation Time Out|N/A|N/A|

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|N/A|N/A|
|Recreation Time In|N/A|N/A|
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|N/A|N/A|
|Table Time Out|N/A|N/A|
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|N/A|N/A|
|Table Time In|
N/A|
N/A|
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|N/A|N/A|
|Out-of-Cell Program Start|N/A|N/A|
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|N/A|N/A|
|Out-of-Cell Program End|N/A|N/A|||||||||||N/A|N/A|
|Visitation Time Out|N/A|N/A|||||||||||N/A|N/A|
|Visitation Time In|~~N/A~~|~~N/A~~|||||||||||~~N/A ~~|~~N/A ~~|
|Kiosk (2x/wk.)|N/A|N/A|
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||N/A|N/A|
|Kiosk (2x/wk.)|N/A|N/A|||||||||||||
|Haircut (as needed)|N/A|N/A|
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||N/A|N/A|
|Haircut (as needed)|N/A|N/A|||||||||||||
|Shower/Shave (3x/wk.)|N/A|N/A|
||N/A|N/A|
||N/A|N/A|
||N/A|N/A|
|Shower/Shave (3x/wk.)|N/A|N/A|||||||||||||
|Sanitation (3x/wk.)|N/A|N/A|
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||N/A|N/A|
|Sanitation (3x/wk.)|N/A|N/A|||||||||||||
|Book Cart (1x/wk.)|N/A|N/A|
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||N/A|N/A|
|Book Cart (1x/wk.)|N/A|N/A|||||||||||||
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|Supervisor|||||||||||||||
|Counselor|||||||||||||||
|Medical|||||||||||||||
|MH|||||||||||||||
|Admin Review|||||||||||||||