SOP 209.09-att-4: Special Management Unit: Tier III Program 90-Day Review Hearing Form

SOP 209.09
Attachment 4

04/23/25
Page 1 of 3

Special Management Unit: Tier III Program 90-Day Review Hearing Form

Current Date: __________________

Date of Initial Assignment to Tier III: __________________

Current Phase and Date Assigned: __________________

Date of 90-Day Mental Health Review: __________________

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

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

IV. 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:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

V. Offender within 12-months or 6-months of MRD consideration:

_____________________________________________________________________________________
_____________________________________________________________________________________

VI. Initial Recommendation of the Special Management Unit: Tier III Program Classification
Committee:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

VII. 48-Hr Notice of Hearing (Date/Time): ____________________________________________________

VIII. Offender’s Acknowledgement of Service: _________________________________________________

IX. Date/Time 48-Hr Hearing Held: _________________________________________________________
_(must be 48-hours after Notice Date/Time above)_

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

SOP 209.09
Attachment 4

04/23/25
Page 2 of 3

X. Offender’s Demeanor with Staff during Review:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

XI. Offender’s Oral Statement at the 48-Hour Hearing:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

XII. Did Offender Present Documents: Yes: ____ No: _____
_(If Yes, attach to Attachment 4)_

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

_(If Yes, attach to Attachment 4)_

XIV. Final Recommendation of the Special Management Unit: Tier III Program Classification Committee:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

The above-named offender has been informed that a 90-Day Review was conducted 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 (Forward to Director of Field Operations**
Only)**

Chief of Security: __________________________________________ Date: ______________
MH Staff: _________________________________________________ Date: ______________
GP Counselor: _____________________________________________ Date: ______________
DW Security/Date (Chairman): _______________________________ Date: ______________

XV. SMU Warden’s (or designee) Review: Date Received: _____________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Recommendation and the following recommendation(s) has/have been made in this case:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

____________________________ ____________________
SMU Warden (or designee) Date

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

SOP 209.09
Attachment 4

04/23/25
Page 3 of 3

**Forward to Director of Field Operations (or designee) if recommended for release to Tier III STEP
Program**

Date Review Sent to Director, Field Operations (or designee): ____________________
_(Send within 10 business days of receipt from Superintendent)_

XVI. Director of Field Operations Review (or designee) Date Received: _____________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Recommendation and the following recommendation(s) has/have been made in this case:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

_____________________________________ ____________________
Director, Field Operations (or designee) Date
_(Send within 10 business days of receipt from Warden)_

**Forward to Assistant Commissioner of Facilities if recommendation for release to Tier III STEP Program is
Denied**

XVII. Assistant Commissioner of Facilities Review Date Received: _____________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Recommendation and the following decision(s) has/have been made in this case:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

_________________________________ ____________________
Assistant Commissioner for Facilities Date

XVIII. Offender’s Acknowledgment of Final 90-Day Review Hearing Decision

_______________________________________________
_Signature/Date_

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