SOP_NUMBER: 215.07-att-2
TITLE: Resident Activity Pass Authorization Form
REFERENCE_CODE: IID03-0004
DIVISION: Facilities
TOPIC_AREA: 215 Policy-Transitional Center
EFFECTIVE_DATE: 2020-05-27
WORD_COUNT: 74
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106211
URL: https://gps.press/sop-data/215.07-att-2/

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

ATTACHMENTS:
  1. Resident Pass Application and Authorization
     URL: https://gps.press/sop-data/215.07-att-1/
  2. Resident Activity Pass Authorization Form
     URL: https://gps.press/sop-data/215.07-att-2/

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FULL TEXT:
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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.