ponsible officer designated by Warden: O yes: O No Has received prescribed weekly exorcise: K Yot O No Proper documentation and justification in the Central File (Incident Report. OHO Radon, copies of Special Housing Review Form): O Yes: O No if no, why not? Is there a written psychiatric or psychological assessment on ale

ible officer designated by Warden: ~ Yes; O No Has received prescribed weekly exercise: ~ Yes; D No Proper documentation and justification in the Central File (Incident Report, OHO Report, copies of Sp~ial Housing Review Form): if no, why not? I Is there a written psychiatric or psychological assessment on the inmate who

ible officer designated by Warden: ~ Yes; O No Has received prescribed weekly exercise: ~ Yes; D No Proper documentation and justification in the Central File (Incident Report, OHO Report, copies of Sp~ial Housing Review Form): if no, why not? I Is there a written psychiatric or psychological assessment on the inmate who

Mseestbs olllo& designated by Wanien: Yes: K No Has received pniscrlbed wacky exerdea: III Yes; 0 No Proper dccurnentailon and lasliffltdon in the Central File (Incident Report, DHO Repel. copies of Societal /boatel Ftevkair Farm)* yes: 0 No d no, wily man Ls them a wragen gibe/4Mo cc psych/Nogg' esaemment on the Crenate

ponsible officer designated by Warden: O Yes D No Has received prescribed weekly exercise: D Yes: K No Proper documentation and justification in the Central File (Incident Report, DHO Report, copes of Special Housing Review Form): O Yes; O No if no. why not? Is there a written psychiatric or psychological assessment on the