DOC Form OP-040204 Attachment B "Segregation Housing Order" - Oklahoma

What Is DOC Form OP-040204 Attachment B?

This is a legal form that was released by the Oklahoma Department of Corrections - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2013;
  • The latest edition provided by the Oklahoma Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DOC Form OP-040204 Attachment B by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Corrections.

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Download DOC Form OP-040204 Attachment B "Segregation Housing Order" - Oklahoma

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Attachment B
OP-040204
Page 1 of 3
SEGREGATION HOUSING ORDER
SECTION A – Placement
Name of Facility
Facility Code
Date
/
/
Offender Name
ODOC Register Number
Medical Notified (immediate upon placement) ________________________________
Name/Date/Time
Placement in Segregation/ Short Term Administrative Segregation (insert date on appropriate
line)
I.
Pre-hearing Detention
/
/
Disciplinary Detention
/
/
Transit Detention
/
/
Medical Observation
/
/
Admin. Segregation
/
/
(Pending transfer to
OSP/MBCC)
Pending Investigation
/
/
II.
Placement for:
Protective Measures
Protective Custody
____ Offender has requested placement into protective measures / custody.
_____ I request special housing placement for my own protection
Offender Signature
____ Offender has not requested placement into protective measures/custody, but a real and
serious threat exists against this offender.
____ I request removal from protective measures / custody.
Offender Signature
Offender given a copy of this form on:
Date
/
/
Time
(a.m. or p.m.)
Date
/
/
Approving Authority
SECTION B –Reviews
72 Hour Review
Reviewing Authority (Name, Title, Date)
Additional Reviews: Attach classification team documents or other reports for determining
continued confinement / release.
Date of Release:
/
/
Approving Authority:
Original:
Facility Head – Field
st
1
Copy: Offender
nd
2
Copy: Shift Supervisor of Segregation Housing Unit
Attachment B
OP-040204
Page 1 of 3
SEGREGATION HOUSING ORDER
SECTION A – Placement
Name of Facility
Facility Code
Date
/
/
Offender Name
ODOC Register Number
Medical Notified (immediate upon placement) ________________________________
Name/Date/Time
Placement in Segregation/ Short Term Administrative Segregation (insert date on appropriate
line)
I.
Pre-hearing Detention
/
/
Disciplinary Detention
/
/
Transit Detention
/
/
Medical Observation
/
/
Admin. Segregation
/
/
(Pending transfer to
OSP/MBCC)
Pending Investigation
/
/
II.
Placement for:
Protective Measures
Protective Custody
____ Offender has requested placement into protective measures / custody.
_____ I request special housing placement for my own protection
Offender Signature
____ Offender has not requested placement into protective measures/custody, but a real and
serious threat exists against this offender.
____ I request removal from protective measures / custody.
Offender Signature
Offender given a copy of this form on:
Date
/
/
Time
(a.m. or p.m.)
Date
/
/
Approving Authority
SECTION B –Reviews
72 Hour Review
Reviewing Authority (Name, Title, Date)
Additional Reviews: Attach classification team documents or other reports for determining
continued confinement / release.
Date of Release:
/
/
Approving Authority:
Original:
Facility Head – Field
st
1
Copy: Offender
nd
2
Copy: Shift Supervisor of Segregation Housing Unit
Attachment B
OP-040204
Page 2 of 3
Instructions for Completing Segregation Housing Order
Offenders placed in Segregation Housing for Disciplinary Infractions
1.
The staff member initiating the segregation housing placement will be responsible for filling out a
Segregation Housing Order (SHO). When completing Section A.I., the offender will normally be
placed on “Pending an Investigation” status. Offenders may remain on “Pending an Investigation”
status for no longer than 14 days.
2.
Once the offender has been issued an offense report, his/her status will be changed to
“Prehearing Detention” on the SHO. The offender will initial the change in status on the SHO and
a copy will be provided to the offender.
3.
Once the disciplinary hearing has been held, the following actions will be implemented:
a.
The warden or designee will sign the Disciplinary Hearing Action Form.
b.
The appropriate unit manager/designee will ensure that a Facility Classification
Committee (FCC) is held if the offender is to be transferred, and the status changed to
“Transit Detention” and so indicated on the SHO. The offender will initial the change in
status on the SHO and a copy will be provided to the offender.
c.
Or, change status to “Disciplinary Segregation” on the SHO following a disciplinary
hearing if the offender is to remain at the facility and has received sanction for disciplinary
segregation and SHU space is available for the serving of the sanction at that time. If
SHU space is not available, the offender will be placed on the “Disciplinary Segregation
Waiting List,” which shall be maintained by the chief of security and the offender shall be
released to the general population until such time as the disciplinary segregation sanction
can be served.
d.
If charges are dismissed, the offender shall be released from SHU unless transfer is still
deemed to be warranted and the offender is placed on “Transit Detention” status.
Offenders Requesting Protective Measures/Custody
1.
Procedures for protective custody or protective measures will be implemented as per OP-060106
entitled “Special Offender Management System.”
2.
If immediate temporary placement in segregation housing is necessary, the staff member
initiating the SHU placement will complete a SHO and place the offender on “Pending an
Investigation” status. Section II of the Segregation Housing Order will be completed, and the
offender will acknowledge consent by signing the appropriate line.
Offenders who have
requested protective measures/custody will not be housed or exercised with non-protective
custody offenders.
3.
The appropriate unit manager/designee will ensure that a FCC/UCC is held and paperwork
submitted to transfer the offender. This will normally be accomplished within 24 hours of the
conclusion of the investigation for protective measures (excluding weekends and holidays).
Exceptions as to why the FCC/UCC is not conducted within 24 hours will be documented by the
appropriate unit manager and forwarded to the deputy warden.
4.
Once the FCC/UCC has been completed, the offender’s status will change to “Transit Detention”
and so indicated on the SHO. The offender will initial the change in status on the SHO and a
copy will be provided to the offender.
General
The appropriate unit manager or designee will be responsible for ensuring that the necessary changes in
status are made on the SHO as they occur and ensure that the affected offender initials the change and
receives a revised copy.
Attachment B
OP-040204
Page 3 of 3
Objective:
To document the confinement of an offender to a segregation housing unit for
the purpose of removing that offender from the general offender population.
Placement Authority:
The facility head may delegate authority to place an offender in a segregation
housing unit to:
1. Shift supervisor or higher ranking security officer
2. Deputy warden/assistant superintendent
3. Duty officer
Offenders may be confined to a segregation housing unit when they are:
1. In transit or en route to another facility
2. Pending a disciplinary hearing (pre-hearing detention)
3. Pending investigation
4. Pending transfer
5. In need of protection (protective measures/custody)
6. Waiting for a cell in general population; however, entitled to the
same privileges as general population offenders
7. Assigned to administrative segregation
8. Assigned to disciplinary segregation
9. In need of isolation for the purpose of medical/psychological
evaluation/observation
Document the date of placement on the appropriate line.
Should the offender be removed from one type of segregation and placed in another type of segregation,
the same form may be used by noting the date of change on the appropriate line. The offender will initial
the form and receive a copy.
(R 3/13)
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