SOP_NUMBER: 227.02-att-10
TITLE: Active Grievances Process Form
REFERENCE_CODE: IIB05-0001
WORD_COUNT: 249
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/239938
URL: https://gps.press/sop-data/227.02-att-10/

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
Attachment 10
5/10/19


**Active Grievances Process Form**


Offender Name: Date:


Offender GDC#: Grievance #


From: Grievance Coordinator


The attached grievance has exceeded your filing limit. Per SOP, you may only have two (2) active
grievances at the local level. You have the option to drop one (1) of your active grievances
(#___________) or (#__________). If you do not wish to drop one (1) of your active grievances,
this grievance will not be processed.


If you choose to drop one (1) of the two (2) active grievances noted above, return this form and
the attached grievance to your counselor within five (5) calendar days of receipt. Please note
below the grievance number you wish to drop and sign and date. The active grievance you choose
to drop will not be reviewed further and any ability to file a grievance or otherwise seek
administrative review will be forfeited. Wardens/Superintendents must still act on the information
contained in a rejected grievance that concerns the health or safety of any person in accordance
with good prison management.


I, ____________________________________GDC#______________________ wish to drop


my previous grievance (#___________________).


________________________________ ____________


Offender Signature Date


If the Counseling Department does not receive this form and the attached grievance back, your
active grievances will continue to be investigated and the attached grievance will not be processed.
It will not be reviewed further and any ability to file a grievance or otherwise seek administrative
review will be forfeited.


Retention Schedule: This form is form shall be utilized as instructed in the SOP and does not need to be
retained after use.