SOP_NUMBER: 209.09-att-12 TITLE: Tier III Program Over 2-Years 90-Day Quarterly Review Hearing Form REFERENCE_CODE: IIB09-0004 WORD_COUNT: 508 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/606444 URL: https://gps.press/sop-data/209.09-att-12/ 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/ ======================================================================== FULL TEXT: ======================================================================== 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.