SOP_NUMBER: 209.11-att-2
TITLE: Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Memo
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2016-04-11
WORD_COUNT: 141
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105979
URL: https://gps.press/sop-data/209.11-att-2/

SUMMARY:
This is a form used to document the assignment of a juvenile offender to restrictive housing/administrative segregation. The form requires facility staff to record the offender's information, reasons for placement, and obtain acknowledgment signatures from the warden/designee, the juvenile offender, and witnessing staff. The completed form becomes part of the offender's case history file.

KEY_TOPICS: restrictive housing, juvenile offender, administrative segregation, RHA, JOAS, segregation assignment, placement memo, juvenile discipline, case history file, acknowledgment form

ATTACHMENTS:
  1. RHA-JOAS Program Assignment Recommendation and 1, RHA-JOAS Program Initial Segregation Review
     URL: https://gps.press/sop-data/209.11-att-1/
  2. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Memo
     URL: https://gps.press/sop-data/209.11-att-2/
  3. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Appeal Form
     URL: https://gps.press/sop-data/209.11-att-3/
  4. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation Program Handout
     URL: https://gps.press/sop-data/209.11-att-4/
  5. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation 30 Day Review
     URL: https://gps.press/sop-data/209.11-att-5/
  6. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation 30 Day Review Memo
     URL: https://gps.press/sop-data/209.11-att-6/
  7. RHA-JOAS Program 30 Day Review_Assignment Appeal Form
     URL: https://gps.press/sop-data/209.11-att-7/
  8. Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Cell Check Sheet
     URL: https://gps.press/sop-data/209.11-att-8/
  9. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation: Checklist (RHA-JOAS Checklist)
     URL: https://gps.press/sop-data/209.11-att-9/
  10. RHA-JOAS Checklist - 30-Minute and 15-Minute Watch Form_Observation Record
     URL: https://gps.press/sop-data/209.11-att-10/
  11. Restrictive Housing Assignment - Juvenile Offender Administrative Segregation Performance Recording Sheet
     URL: https://gps.press/sop-data/209.11-att-11/

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FULL TEXT:
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**Attachment 2**
**SOP 209.11**
**04/11/16**

**Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment Memo**

**FACILITY: _____________________________________** **Date: _____________**

**RE:** **Restrictive Housing Assignment – Juvenile Offender Administrative Segregation Assignment**

**Juvenile Offender: ___________________________________________________GDC #:__________________________**

**Present Assignment: __________________________________________________________________________________**

**The above named juvenile offender is being assigned to the Restrictive Housing Assignment – Juvenile**
**Offender Administrative Segregation for the reasons indicated:**

**______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**_______________________________________________________________________________________________________**

**Date: ___________  Warden’s/Designee Signature: __________________________________________**

********************************************************************************************************

**|_| I acknowledge the receipt of this Assignment Memo for placement in Restrictive Housing**
**Assignment – Juvenile Offender Administrative Segregation.**

**Date: ___________  Juvenile offender’s signature: __________________________________________**

********************************************************************************************************

**|_|  I acknowledge that the offender received the Restrictive Housing Assignment – Juvenile Offender**
**Administrative Segregation Assignment Memo on this Date.**
**|_|  I acknowledge that the offender received the Restrictive Housing Assignment – Juvenile Offender**
**Administrative Segregation Appeal form on this Date.**

**Date: ___________  Staff Signature: __________________________________________**


**Attachment 2**
**SOP 209.11**
**04/11/16**

**Copies:** **Juvenile Offender**

**RETENTION SCHEDULE:  Upon completion of this form, it shall be placed in the juvenile offender’s case history file.**