SOP 209.11-att-9: Restrictive Housing Assignment - Juvenile Offender Administrative Segregation: Checklist (RHA-JOAS Checklist)

Division:: Facilities
Effective Date:: April 11, 2016
Topic Area:: 209 Policy-Facilities Control/Discipline/Segregation
PowerDMS:: View on PowerDMS
Length:: 214 words

Summary

This is a daily monitoring and documentation checklist used by GDC staff to track juvenile offenders placed in restrictive housing/administrative segregation. The form records meal service, shower access, exercise time, cell sanitation, medical visits, and general conduct observations for each shift during the offender's segregation assignment. It requires administrative review and officer signatures and must be retained in the offender's case history file upon completion.

Key Topics

restrictive housing
administrative segregation
juvenile offenders
JOAS
segregation checklist
daily monitoring
meal service
exercise time
shower access
cell sanitation
conduct documentation
administrative review
GDC number tracking

Full Text

Attachment 9
WARDEN/DESIGNEE'S REVIEW SOP 209.11
AFTER DISCHARGE (SIGN :) ________________________ (04/11/16)
Page 1
RESTRICTIVE HOUSING ASSIGNMENT - JUVENILE OFFENDER ADMINISTRATIVE SEGREGATION: CHECKLIST

OFFENDER’S NAME: ___________________________________________GDC NUMBER:__________________ RACE: __________
PRIOR LIVING UNIT: __________ COUNSELOR: ______________________________
DATE COMMITTED: __________________ EXPECTED DISCHARGE DATE: _____________________
TIME COMMITTED: ____________ ACTUAL DISCHARGE DATE & TIME: ________________________________________
REASON FOR ASSIGNMENT: ________________________________________________________________________________
PERTINENT INFORMATION_________________________________________________________________________________

STATUS CHANGE

DATE COMMITTED: _________________EXPECTED DISCHARGE DATE_____________________STATUS___________
TIME COMMITTED__________________ACTUAL DISCHARGE DATE &TIME___________________________
___________________________________________________________________________________________________________

PERTINENT INFORMATION: ____________________________________________________________________

|Date|Shift|Meals|Col4|Col5|SH|EXER|CELL
SANT|COMMENTS
(Include note/sig. of staff
visits, such as medical)|ADM
REV:|OFFICER
SIG:|
|---|---|---|---|---|---|---|---|---|---|---|
|

Date
|

Shift
|B |L |S |S |S |S |S |S |S |
|
MON.|1st||||||||||
|
MON.|2nd||||||||||
|
TUES.|1st||||||||||
|
TUES.|2nd||||||||||
|
WED.|1st||||||||||
|
WED.|2nd||||||||||
|
THURS.|1st||||||||||
|
THURS.|2nd||||||||||
|
FRI.|1st||||||||||
|
FRI.|2nd||||||||||
|
SAT.|1st||||||||||
|
SAT.|2nd||||||||||
|
SUN.|1st||||||||||
|
SUN.|2nd||||||||||

EXPLANATORY NOTES: Meals - Yes(Y) or No(N) or Refused(R); Shower(SH) - Same codes as meals; Exercise (Exer) - Enter actual time period (e.g. 9:15AM -
10:30AM Inside)
PERTINENT INFORMATION: Epileptic, Diabetic, Religious Diet, Suicidal, Assaultive, etc.
COMMENTS: General conduct, attitude, hygiene, sanitation of cell (continue on back if needed).
ADMINISTRATIVE REVIEW: Deputy Warden or Duty Officer, Shift OIC/Captain, as appropriate

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

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