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¶