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Department of Corrections Forms Library

Title of Form
Applicable Directive(s)Numbers
Attachment NumberCurrent Creation/Revision Date
Duplication Instructions
CURRENT FORMS AS CREATED BY DIRECTIVE OR POLICY
Authorization to Disclose Protected Health Information DOC Authorization10-07-2015PDF
Home Detention Investigation Form431.011January 2014Word Document
Department Request for Review - Home Detention431.012January 2014Word Document
Notice to Court of Home Detention Revocation431.013January 2014Word Document
Request for Reimbursement - Electronic Monitoring431.014January 2014Word Document
Body Armor Request Form422.021October 2013Word Document
Residence Investigation371.141September 2013Word Document
Request to Seal or Expunge Records254.051June 2013Word Document
Financial Transaction Request254.052June 2013Word Document
Juvenile Probation Violation Complaint429.015May 2013Word Document
Arrest of Youthful Offender Form429.014May 2013Word Document
Media Release FormInterim Procedure Media Access1April 2013Online
Offender Responsibility Plan371.051June 2012Word Document
RSN Checklist371.281August 2012Online Smart form
Sample RSN Memo371.282August 2012Online Smart form
 Law Enforcement Notification: High Risk Sex Offender Release Form255.01, 371.28, 371.29 October 2014Word Document
 Law Enforcement Notification: Standard Sex Offender Release Form255.01, 371.28, 371.29, October 2014Word Document

Case Staffing Form

Community Notification Plan

Authorization for Release of Offender Information - Commissioner Waiver

371.29

371.29

371.28

2

1

5

October 2014

October 2014

August 2012

Word Document

Word Document

Online Smart form

Standardized Rules and Guidelines for Recommended Sanctions410.011 May 2012Online Smart form
Disciplinary Report410.012 May 2012

Online Smart form

Notice of Hearing/Waiver of 24 hour Notice

410.01

3

 May 2012

Online Smart form

Confidential Informant

410.01

4

 May 2012

Online Smart form

DR Waiver of Appearance/Hearing/Refusal to Appear

410.01

5

 May 2012

Online Smart form

Waiver Process410.016 May 2012Online Smart form
Inmate Disciplinary Appeal Form410.017 May 2012Online Smart form
Hearing Report

410.01

8

 May 2012

Online Smart form

Special Observation Form410.019 May 2012

Online Smart form

Notice of Supension410.021 May 2012

Online Smart form

Notice of Hearing/Waiver of 24 hour Notice

410.02

2

 May 2012

Online Smart form

Notice of Suspention Waiver of Appearance/Hearing/Refusal to Appear

410.02

3

 May 2012

Online Smart form

Confidential Informant

410.02

5

 May 2012

Online Smart form

Hearing Report

410.02

6

 May 2012

Online Smart form

Administrative Segregation Placement Report410.031 May 2012

Online Smart form

Notice of Hearing/Waiver of 24 hour Notice

410.03

2

 May 2012

Online Smart form

AD Seg Waiver of Appearance/Hearing/Refusal to Appear

410.03

4

 May 2012

Online Smart form

Confidential Informant

410.03

5

 May 2012

Online Smart form

Hearing Report

410.03

6

 May 2012

Online Smart form

 Payment Contract/Waiver Application 426.01 1 October 2012Online Smart form
Risk Management Monthly Audit Form430.101June 2012Online

Title of Form
Applicable Directive(s)Numbers
Attachment NumberCurrent Creation/Revision Date
Duplication Instructions
FORMS WAITING FOR THEIR EFFECTIVE DATE
Body Armor Request and Receipt Form422.021October 2013Word Document
PREA Inmate Orientation Form 409.09 1May 2013Word Document
Sexual Violence Screening Tool - Booking/Medical Staff409.092May 2013Online Smart Form
Sexual Violence Screening Tool - CSS409.092May 2013Online Smart Form
PREA Incident Protocols409.093May 2013Online Smart Form
PREA Incident Forms409.093May 2013Online Smart Form

Title of FormCurrent Creation/Revision DateDuplication Instructions
GENERAL USE FORMS
NCIC Entry Form for "Wanted Person"1/13Online Smart-Form
Individual Employee Acknowledgment Form09/051 page


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