SINGLE-CELL REVIEW FORM¶
BP-A1121 MAR 24 U.S. DEPARTMENT OF JUSTICE¶
No inmate will be assigned alone in a locked cell unless there is a compelling reason and immediate approval is obtained from the Warden. For the duration of the inmate’s single-cell status, this form is to be reviewed on day watch by the Unit Manager and by a Lieutenant on evening and morning watch, and weekly at the multi-disciplinary meeting.¶
| Inmate Name | Security Level | ||||
|---|---|---|---|---|---|
| Register Number | CIM Assignment | ||||
| Date | Time | ||||
| Reason for Single Cell | C Risk of Violence to Others: (details) | ||||
| E Severe Mental Health Problems “Disorganization”: (details) | |||||
| E Other: (details) | |||||
| Unit | |||||
| Date arrived at Institution | C less than 30 days Arrival Date: | ||||
| Index Offense | ❑ High Profile ❑ Pretrial | ❑ Sex Offense ❑ Other: | |||
| MH Care Level | E 3 ❑ 1 ❑ 2 ❑ 4 | ||||
| Medical Care Level | ❑ 1 ❑ 2 ❑ 4 ❑ 3 | ||||
| Psych Advisory List | ❑ Yes ❑ No (as annotated in TRUSCOPE) | ||||
| Psych Alert | ❑ Yes ❑ No (per review of a PP44) | ||||
| Currently Intoxicated | ❑ Yes ❑ No | I Evidence of Substance Withdrawal | ❑ Yes ❑ No | ||
| Alternatives considered |
The following employee eview for any known contraindications. Afterhours, the Lieutenant will call each employee for recommendations for/against single cell and note the recommendation was obtained verbally. Each employee will sign on the next business day.¶
| Employee | Afterhours review | Known Contraindications | Signature | Date |
|---|---|---|---|---|
| Lieutenant | ❑ Yes C No | O Yes O No | ||
| Unit Manager | C Verbal | ❑ Yes O No | ||
| Specific Concerns | ||||
| Captain | C Verbal | C Yes O No | ||
| Specific Concerns | ||||
| Chief Psychologist | C Verbal | I CI Yes O No | I | I |
| Specific Concerns |
| SINGLE CELL DECISION | ||||||
|---|---|---|---|---|---|---|
| Warden Signature | Time/Date | Decision | ||||
| El Verbal | O Approved | ❑ Denied | ||||
| Rationale and Special Instructions | ||||||
| A copy of this form will be maintained in Central File | ||||||