Disciplinary Transmittal Form

Facility: Choose Facility.Date: Click here to enter a date.
To: Inmate Name: Enter name.IDOC Number: Enter number.
Institution, Housing Unit, & Cell: Enter text.
From: Enter name.☐ Appeal Coordinator☐ Other: Enter name.
The attached appeal form is being returned without action being taken because:
☐ You admitted to the disciplinary offense; therefore, you can only appeal the sanctions. You may resubmit if you have specific issues to appeal regarding the sanctions.
☐ You exceeded the allowable time limit (within 15 days of the date the infraction hearing officer confirmed the Infraction Report or the date the reviewing authority affirmed the Disciplinary
Offense Report (DOR). The due date was: Click here to enter a date.
☐ You did not state why you believe the Infraction Report or DOR finding and/or sanctions were inconsistent with the guidance provided in this SOP.
☐ Your description of the problem is not written within the appropriate area on one form.
☐ The form is typed. Forms must be handwritten.
☐ Your appeal form is not legible.
☐ You have already appealed this Infraction Report or DOR.
☐ You did not sign the form.
☐ This issue must be addressed using the grievance process.
Comments: Enter text.
IDAHO DEPARTMENT OF CORRECTION
Disciplinary Transmittal Form
318.02.01.001
(Last updated 05/18/2017)