EFTA00110620

BP-A295.052
APRIL 1994

SPECIAL HOUSING UNIT REVIEW

S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS

| Inmate Name: | Register Number: | Unit: | Institution: |
| :--- | :--- | :--- | :--- |
| Date Entered Special Housing: 07-16-2019 | Reason for Placement: PENDING SIS INVESTIGATION/ THREAT ASSESSMENT | | |
| I. Subject: (2 or 3 Days) 3 Day Review | Date Reviewed 07-19-2019 | | |

Action Taken on the Above Date:
Continue in Special Housing Unit

Printed Name/Signature:

II. RECORD REVIEW.
(To be done weekly in the absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.)

| DATE | ACTION TAKEN | REMARKS | SIGNATURE |
| :--- | :--- | :--- | :--- |
| | | | |
| | | | |
| | | | |

III. Subject: (7 or 30 Days) Review By (SRO): Reviewing Authority:

Date inmate appeared for a Special Housing Review: Or Date inmate waived right to appear:

Has been seen daily by Medical Staff: □ Yes; □ No

Has been seen daily by responsible officer designated by Warden: □ Yes; □ No

Has received prescribed weekly exercise: □ Yes; □ No

Proper documentation and justification in the Central File (Incident Report, DHO Report, copies of Special Housing Review Form): □ Yes; □ No if no, why not?

Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? □ Yes; □ No

Is there an additional assessment for every one month interval thereafter? □ Yes; □ No if no, why not?

Action taken on the above date by the Segregation Review Official or the Reviewing Authority:
□ Released from Special Housing: □ Continue in Special Housing

Did inmate in Administrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? □ Yes; □ No if no, why not (Should be given provided institutional security not compromised)?

Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of this form):

Date of Next Review:
07-23-2019

Printed Name and Signature of Segregation Review Official or the Reviewing Authority and Date Signed:

Record Copy - Central File

This form replaces BP-295(52) dated January 1988





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7/19/2019