SOP 209.09-att-12: Tier III Program Over 2-Years 90-Day Quarterly Review Hearing Form

SOP 209.09
Attachment 12

04/23/25
Page 1 of 3

Special Management Unit: Tier III Program Over 2-Years Quarterly Review Hearing Form

Current Date: __________________
Date of Initial Assignment to Tier III: __________________

Current Phase and Date Assigned: __________________
Date of last 60/90-Day Mental Health Evaluation: _________________
Mandatory Release Date (MRD): _________________
Within 12-months/6-Months of Release: ____ YES or ____ NO

I. Offender: ______________________________ GDC#: _________________________

II. Reason for Assignment to the Special Management Unit: Tier III Program:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

III. Meets Criteria for Tier III Program Assignment Over 24-Months _(check all that apply)_ :

`☐` #1 - Committed Murder while Incarcerated

`☐` #2 - Escape outside secure fencing of facility

`☐` #3 - Caused Serious Bodily Injury to an offender, staff, contractor, or volunteer

`☐` #4 - Taken offender, staff, contractor, or volunteer hostage

`☐` #5 - Crime so egregious offender placed in Tier III Program upon entering GDC custody

`☐` #6 - Due to unique position of influence and authority over others, poses exceptional, credible,

and articulable risk to the safe operation of the prison system or to the public, that no
facility other than the Tier III Program is sufficient to contain the risk

IV. In accordance with the Special Management Unit: Tier III Program SOP, the following were
considered as part of the offender’s Over 2-Years Quarterly Review:

a. Length of time in Current Phase: ________________________________________________

b. Length of time assigned to Tier III Program: _______________________________________

c. Behavior in SMU, including involvement in self-improvement activities and progress on
Offender Management Plan:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

d. Potential Risk for harm to the offender, other offenders, staff, volunteers, contractors, or the

public, if the offender is released from the Tier III Program:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

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

SOP 209.09
Attachment 12

04/23/25
Page 2 of 3

e. Number, type, and frequency of disciplinary reports:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

f. Offender within 12-Months or 6-Months of MRD Consideration:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

V. Offender’s Oral Statement at the Over 2-Years Quarterly Review:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

VI. Did Offender Present Documents: Yes: ____ No: _____
_(If Yes, attach to Attachment 12)_

VII. Did Offender Provide Written Statement: Yes: ____ No: _____

_(If Yes, attach to Attachment 12)_

VIII. Over 2-Years Quarterly Review Panel Member Observations:

a. Director, Fac Ops (or designee): __________________________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

b. Med Director (or designee): ______________________________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

c. MH Director (or designee): ______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

d. Legal Services: _________________________________________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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

SOP 209.09
Attachment 12

04/23/25
Page 3 of 3

IX. The above-named offender has been given an Over 2-Years Quarterly Review with the following
recommendation given for his/her assignment:

`☐` Remain in Current Phase

`☐` Move to the Next Phase

`☐` Return to Lower Phase

`☐` Release/Transfer to Tier III STEP Program

Director, Fac Ops (or designee): ____________________________________ Date: ______________

Med Director (or designee): ________________________________________ Date: ______________

MH Director (or designee): _________________________________________ Date: ______________

Legal Services: ___________________________________________________ Date: ______________

X. Offender’s Acknowledgment of Over 2-Years Quarterly Review Panel Recommendation

____________________________________ ____________________
Offender Signature Date

XI. Commissioner or Assistant Commissioner Review Date Received: ______________

I concur / disagree with the Over 2-Years Quarterly Review Panel Recommendation and the following
decision(s) has/have been made in this case:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

____________________________________ ____________________
Commissioner or Assistant Commissioner Date

XII. Offender’s Acknowledgment of Final Over 2-Years Quarterly Review Decision

_____________________________________ _____________________
Offender Signature Date

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