Sex Offender 30-Day Review Form

IDAHO DEPARTMENT OF CORRECTION Reset Form
Sex Offender 30-Day Review Form (Page i of 2) Print Form
REVIEW DATE DISTRICT PPO NAME REVIEWER
OFFENDER NAME IDOC# ASSIGNED DATE SIGN UP DATE
Section I 30-DAY SEX OFFENDER MANAGEMENT STANDARDS REVIEW Does Not N/A or Comments/Feedback
Achieves Achieve Waived
Documented review of file/conducted assessments/assigned appropriate supv level or override r
Reviewed and signed court order/parole agreement/SO agreement of supervision with offender r
Confirmed sex offender registration/DNA submission and/or obtained DNA r
Caseplan entered in OMP and based on LSI domains(if applicable)and/or SO risk/need (-
Collateral contacts conducted first 3o days: treatment providers,court,family members,etc. r
Residence verification RESIDENCE VERIF.DATE (` (' r
Employment verification EMPLOYMENT VERIF.DATE (` (� r
Section II CASE PLANNING Does Not N/A or
Achieves Achieve Waived Comments/Feedback
Stable 2007 current and properly scored DATE F SCORE F C C r
Static 99R current and properly scored DATE SCORE F ( ( (-
LSI-R.current and properly scored DATE SCORE F C C r
Contacts/information(residence,employ,phone,vehicle,etc.)/staffings/polys/testing r
documented in appropriate module
Supervision Level 30 Day Review Percentage OF

Sex Offender 30-Day Review Form (Page 2 of 2)
Additional
Comments/
Feedback
Appendix M
701.04.02.006
(Appendix last updated 7/24/13