SOP_NUMBER: 227.02-att-1
TITLE: Offender Grievance Form
REFERENCE_CODE: IIB05-0001
DIVISION: Unknown
TOPIC_AREA: 227 Policy-Facilities Conditions of Confinement
EFFECTIVE_DATE: 2019-05-10
WORD_COUNT: 157
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105702
URL: https://gps.press/sop-data/227.02-att-1/

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

ATTACHMENTS:
  1. Offender Grievance Form
     URL: https://gps.press/sop-data/227.02-att-1/
  2. Staff Local Investigative Report and Recommendation Form
     URL: https://gps.press/sop-data/227.02-att-2/
  3. Witness Statement Form
     URL: https://gps.press/sop-data/227.02-att-3/
  4. Warden's/Superintendent's Grievance Response Form
     URL: https://gps.press/sop-data/227.02-att-4/
  5. Grievance Appeal to Central Office Form
     URL: https://gps.press/sop-data/227.02-att-5/
  6. Accepted_ Notification of Referral to Office of Professional Standards
     URL: https://gps.press/sop-data/227.02-att-6/
  7. Codes for Rejected Grievance (Formal)
     URL: https://gps.press/sop-data/227.02-att-7/
  8. Grievance Resolution/Drop Form (Attachment 8)
     URL: https://gps.press/sop-data/227.02-att-8/
  9. Central Office Appeal Response Form
     URL: https://gps.press/sop-data/227.02-att-9/
  10. Active Grievances Process Form
     URL: https://gps.press/sop-data/227.02-att-10/
  11. Warden's_Superintendent's Rejected Grievance Response
     URL: https://gps.press/sop-data/227.02-att-11/
  12. Rejected_ Notification of Referral to the Office of Professional Standards
     URL: https://gps.press/sop-data/227.02-att-12/
  13. Rejected_ Notification of Referral to the Facility ADA Coordinator
     URL: https://gps.press/sop-data/227.02-att-13/
  14. Accepted_ Notification of Referral to the Facility ADA Coordinator
     URL: https://gps.press/sop-data/227.02-att-14/

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FULL TEXT:
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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.


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**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.