SOP 227.02-att-1: Offender Grievance Form

Division:
Unknown
Effective Date:
May 10, 2019
Reference Code:
IIB05-0001
Topic Area:
227 Policy-Facilities Conditions of Confinement
PowerDMS:
View on PowerDMS
Length:
157 words

Summary

This form is used by offenders in GDC facilities to file formal grievances about conditions, incidents, or other concerns. The form requires offenders to provide specific details including dates, names of people involved, witnesses, a description of the incident, and the resolution being requested. Grievances must be filed within 10 days of the incident, with exceptions requiring explanation.

Key Topics

  • offender grievance
  • grievance form
  • inmate complaint
  • facility conditions
  • grievance procedure
  • incident reporting
  • 10-day filing requirement
  • counselor receipt
  • grievance documentation

Full Text

SOP 227.02
_CONFIDENTIAL_ Attachment 1
5/10/19
Offender GRIEVANCE FORM (Facsimile)

_____________________________________________________________________________________________

YOU MUST INCLUDE SPECIFIC INFORMATION CONCERNING YOUR GRIEVANCE TO INCLUDE DATES, NAMES OF PERSONS INVOLVED, AND
WITNESSES.

DESCRIPTION OF INCIDENT:

RESOLUTION REQUESTED:

Offender Signature Date

Is this grievance being filed within the 10-day time limit? Please answer Yes or No. If the answer is No, please explain why.

-- -- -- -- -- -- ---- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ---- -- -- -- -- -
RECEIPT FOR GRIEVANCE AT COUNSELOR'S LEVEL
OFFENDER'S NAME _______________________________________________________ GDC I.D. #: ______________________________________

I ACKNOWLEDGE RECEIPT OF GRIEVANCE FORM FROM THE ABOVE INMATE.

DATE: ______/______/_______ COUNSELOR'S SIGNATURE ____________________________________________________________________________

_Form PI-2001_

Retention Schedule: Upon Completion, this form shall be maintained with the grievance packet for four (4) years and then destroyed.

Attachments (14)

  1. Offender Grievance Form (157 words)
  2. Staff Local Investigative Report and Recommendation Form (64 words)
  3. Witness Statement Form (638 words)
  4. Warden's/Superintendent's Grievance Response Form (96 words)
  5. Grievance Appeal to Central Office Form (198 words)
  6. Accepted_ Notification of Referral to Office of Professional Standards (177 words)
  7. Codes for Rejected Grievance (Formal) (205 words)
  8. Grievance Resolution/Drop Form (Attachment 8) (93 words)
  9. Central Office Appeal Response Form (68 words)
  10. Active Grievances Process Form (249 words)
  11. Warden's_Superintendent's Rejected Grievance Response (382 words)
  12. Rejected_ Notification of Referral to the Office of Professional Standards (173 words)
  13. Rejected_ Notification of Referral to the Facility ADA Coordinator (154 words)
  14. Accepted_ Notification of Referral to the Facility ADA Coordinator (184 words)
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