SOP_NUMBER: 209.09-att-10
TITLE: Tier III Program Checklist
REFERENCE_CODE: IIB09-0004
WORD_COUNT: 281
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/517156
URL: https://gps.press/sop-data/209.09-att-10/

ATTACHMENTS:
  1. Tier III Program Assignment Request Form
     URL: https://gps.press/sop-data/209.09-att-1/
  2. Special Management Unit: Tier III Program Assignment Memo
     URL: https://gps.press/sop-data/209.09-att-2/
  4. Special Management Unit: Tier III Program 90-Day Review Hearing Form
     URL: https://gps.press/sop-data/209.09-att-4/
  5. Special Management Unit: Tier III Program 60-Day Review Hearing Form
     URL: https://gps.press/sop-data/209.09-att-5/
  6. Special Management Unit: Tier III Program Privileges Chart
     URL: https://gps.press/sop-data/209.09-att-6/
  7. Tier III Program 90-Day Review_Classification Appeal Form
     URL: https://gps.press/sop-data/209.09-att-7/
  8. Tier III Program 60 Day Review_Classification Appeal Form
     URL: https://gps.press/sop-data/209.09-att-8/
  9. Special Management Unit: Tier III Program Cell Check Sheet
     URL: https://gps.press/sop-data/209.09-att-9/
  10. Tier III Program Checklist
     URL: https://gps.press/sop-data/209.09-att-10/
  11. Special Management Unit: Tier III Program Offender Management Plan
     URL: https://gps.press/sop-data/209.09-att-11/
  12. Tier III Program Over 2-Years 90-Day Quarterly Review Hearing Form
     URL: https://gps.press/sop-data/209.09-att-12/

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FULL TEXT:
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**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<br>Time/Initials|Col3|Monday<br>Time/Initials|Col5|Tuesday<br>Time/Initials|Col7|Wednesday<br>Time/Initials|Col9|Thursday<br>Time/Initials|Col11|Friday<br>Time/Initials|Col13|Saturday<br>Time/Initials|Col15|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|**Breakfast Meal**|||||||||||||||
|**Lunch Meal**|||||||||||||||
|**Dinner Meal**|||||||||||||||
||||<br> <br>|<br> <br>|<br>|<br>|||||<br>|<br>|||
|**Recreation Time Out**|**N/A**|**N/A**|<br> <br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|**N/A**|**N/A**|
|**Recreation Time In**|**N/A**|**N/A**|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|**N/A**|**N/A**|
|**Table Time Out**|**N/A**|**N/A**|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|**N/A**|**N/A**|
|**Table Time In**|<br>**N/A**|<br>**N/A**|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|**N/A**|**N/A**|
|**Out-of-Cell Program Start**|**N/A**|**N/A**|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|<br>|**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**|<br>||<br>||<br>||<br>||<br>||**N/A**|**N/A**|
|**Kiosk (2x/wk.)**|**N/A**|**N/A**|||||||||||||
|**Haircut (as needed)**|**N/A**|**N/A**|<br>||<br>||<br>||<br>||<br>||**N/A**|**N/A**|
|**Haircut (as needed)**|**N/A**|**N/A**|||||||||||||
|**Shower/Shave (3x/wk.)**|**N/A**|**N/A**|<br>||**N/A**|**N/A**|<br>||**N/A**|**N/A**|<br>||**N/A**|**N/A**|
|**Shower/Shave (3x/wk.)**|**N/A**|**N/A**|||||||||||||
|**Sanitation (3x/wk.)**|**N/A**|**N/A**|<br>||<br>||<br>||<br>||<br>||**N/A**|**N/A**|
|**Sanitation (3x/wk.)**|**N/A**|**N/A**|||||||||||||
|**Book Cart (1x/wk.)**|**N/A**|**N/A**|<br>||<br>||<br>||<br>||<br>||**N/A**|**N/A**|
|**Book Cart (1x/wk.)**|**N/A**|**N/A**|||||||||||||
||||||||||||||||
|**Supervisor**|||||||||||||||
|**Counselor**|||||||||||||||
|**Medical**|||||||||||||||
|**MH**|||||||||||||||
|**Admin Review**|||||||||||||||