SOP_NUMBER: 508.20-att-1
TITLE: Restrictive Housing Rounds Log
REFERENCE_CODE: VG40-0001
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy-MH Administration/Staff/Certification
EFFECTIVE_DATE: 2022-08-02
WORD_COUNT: 84
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/423934
URL: https://gps.press/sop-data/508.20-att-1/

SUMMARY:
This form documents mental health staff rounds conducted in restrictive housing units. Mental health personnel use this log to record which offenders in restrictive housing require mental health services during their rounds, including the unit, date, time, and staff involved. The completed form must be retained in the mental health area for up to three years.

KEY_TOPICS: restrictive housing, mental health rounds, mental health services, segregation, restrictive housing log, offender mental health monitoring, mental health documentation, rounds documentation, Form M40-01-01, mental health staff

ATTACHMENTS:
  1. Restrictive Housing Rounds Log
     URL: https://gps.press/sop-data/508.20-att-1/
  2. Restrictive Housing Rounds - 48 Hour / Weekly Progress Note
     URL: https://gps.press/sop-data/508.20-att-2/
  3. Restrictive Housing Rounds - 30/90 Day Progress Note
     URL: https://gps.press/sop-data/508.20-att-3/

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FULL TEXT:
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SOP 508.20
Attachment 1

8/2/22

# **Georgia Department of Corrections** **Mental Health Services** **Restrictive Housing Rounds Log**


Restrictive Housing Unit: _____________________________________ Date: _________________________

Staff Person Conducting Rounds: _______________________________ Time In: ______________________

Officer(s) on Duty: ___________________________________________ Time Out: _____________________

**Offenders in Need of Mental Health Services:**

|Offender|Number|Description|
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________________________________________________ ____________________________________
Signature/Title of Mental Health Staff Person Mental Health Unit Manager Signature


Form no. M40-01-01 Page 1 of _____

Retention Schedule: Upon completion, this form shall be maintained in the mental health area until replaced or obsolete, and up to three (3) years.