SOP 215.07-att-2: Resident Activity Pass Authorization Form

Division:
Facilities
Effective Date:
May 27, 2020
Reference Code:
IID03-0004
Topic Area:
215 Policy-Transitional Center
PowerDMS:
View on PowerDMS
Length:
74 words

Summary

This form is used to request and authorize activity passes for transitional center residents who need to leave the facility for approved purposes. The form captures resident identification, pass details (location, dates, times), transportation information, and purpose of the activity. It requires approval from counselor, security, chief of security, and superintendent/assistant superintendent before the resident may depart.

Key Topics

  • activity pass
  • resident pass
  • transitional center
  • pass authorization
  • resident movement
  • off-facility activity
  • pass approval
  • counselor approval
  • security clearance
  • superintendent approval
  • resident leave

Full Text

SOP 215.07
Attachment 2
5/27/20

ACTIVITY (PASS) AUTHORIZATION FORM

NAME: __________________________________ GDC#:____________________

Room & Bed #:_______Today’s Date: ___________Date of Pass:_______________

Location & Address: ___________________________________________________

____________________________________________________________________

____________________________________________________________________

Phone Number at destination: ____________________________________________

Departure Time: ____________________ Return Time: ____________________

Transportation: _______________________________________________________

Purpose:_____________________________________________________________

( ) Approved ( ) Disapproved

____________________________________ ______________________
Counselor Date

( ) Approved ( ) Disapproved

____________________________________ ______________________
Security Date

( ) Approved ( ) Disapproved

____________________________________ ______________________
Chief of Security Date

( ) Approved ( ) Disapproved

____________________________________ ______________________
Asst. Superintendent/ Superintendent Date

Retention Schedule: Upon completion, this form shall be placed in the resident’s institutional file and maintained according to
the official retention schedule for that file.

Attachments (2)

  1. Resident Pass Application and Authorization (331 words)
  2. Resident Activity Pass Authorization Form (74 words)
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