Transcription of DD Form 509, Inspection Record of Prisoner in Segregation ...
1 Inspection Record OF Prisoner INSEGREGATION1. TYPE OF Segregation (X one)ADMINISTRATIVEDISCIPLINARY2. CORRECTIONAL FACILITY/INSTALLATION3. Prisoner NAME (Last, First, Middle)4. REGISTRATION NUMBER6. REASON FOR Segregation (Cite offense for disciplinary Segregation )5. DATE Segregation IMPOSED (YYYYMMDD)7. DATE OF ACTUAL RELEASE FROM Segregation (YYYYMMDD)PART I - SPECIAL INSTRUCTIONS/REMARKS (Enter comments relative to the Prisoner 's custody, control and security measures, diet, behavior, etc.)PART II - DAILY Inspection Record (Signed daily by the below named positions)DATEHOURCONDUCTSIGNATURE OF CONFINEMENT OFFICERHOURSIGNATURE OF DUTY OFFICERHOURCONDITIONSIGNATURE OF MEDICAL OFFICERHOUROTHER (Chaplain, Duty Officer, etc.)
2 AMPMAMPMAMPMAMPMAMPMAMPMAMPMDD FORM 509, MAR 2013 PREVIOUS EDITION IS OBSOLETE. Adobe Professional XPage 1 of 2 Pages PART III - INSTRUCTIONS AND EXAMPLES (Page 2): Checks are made at irregular intervals within the hour and according to annotated special instruction above. The below illustrations show 30 minute and 15 minute MINUTES: Initial the upper left block within the first 30 minutes of the hour and the lower right block for the second 30 minutes as follows:15 MINUTES: 1. Initial the upper left block during the first quarter after hour within 15 Initial the upper right block during the 2nd quarter after the hour (between 15 - 30 minutes).
3 4. Initial the lower right block during the last quarter of the hour (between 45-59 minutes). 3. Initial the lower left block during the 3rd quarter after the hour (between 30 - 45 minutes).Upon completion, this form will be maintained in the Prisoner 's Correctional Treatment file (CTF).JD 0014JD 0043JD 0028JD 0058JD 0014 JD 00582400 - 01000100 - 02000200 - 03000300 - 04000400 - 05000500 - 06000600 - 07000700 - 08000800 - 09000900 - 10001000 - 11001100 - 12001200 - 13001300 - 14001400 - 15001500 - 16001600 - 17001700 - 18001800 - 19001900 - 20002000 - 21002100 - 22002200 - 23002300 - 2400DD FORM 509, MAR 2013 PART III - CORRECTIONAL OFFICER Inspection Record (Inspections will be made at irregular intervals.)
4 Supervisors or Correctional Officers will initial and enter time completed in hour columns.)Page 2 of 2 PagesTIME: AM:/DATE:TIME: PM:/DATE.
