EFTA00035605.pdf

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pdf

Source set

data-set-8

Original source

Extracted text

BP-80203 
FEDERAL PRISON SYSTEM PRETRIAL INMATE WORK 
C:Drati 
JUN 10 
WAIVER/NOTICE OF SEPARATION 
U.S. DEPARTMENT OF JUSTICE 
FEDERAL BUREAU OF PRISONS 
I. INSTRUCTIONS 
The staff member conducting intake screening shall advise the pretrial inmate, depending upon the design, 
structure, and operation of the individual institution, that the inmate may have contact with convicted 
inmates. The inmate is to be asked to sign the appropriate portion in Section II of this Pretrial Inmate 
Work Waiver/Notice of Separation. If the inmate refuses to sign this segment of the form, staff shall 
document this refusal on the form. 
A pretrial inmate who wishes to waive the exemption from work must sign the appropriate portion in 
Section IV of this Pretrial Inmate Work Waiver/Notice of Separation. This form must be completed prior 
to the issuance of a work assignment. If the inmate's behavior suggests an inability to comprehend the 
waiver, or if the inmate has been admitted to a mental health referral for evaluation or treatment, the 
inmate must be referred to a mental health professional for an assessment as to competency to sign the 
waiver. The waiver may be rescinded at the inmate's request and reasons for the rescission should be 
documented in Section V of this form and signed by a staff member. The waiver shall be maintained in the 
inmate's unit file or record office file and will remain in the file as a permanent document. The inmate may 
be given a copy of this form if the inmate so requests. 
II. NOTICE OF SEPARATION 
A. I unde 
d that it is possible that I will have contact with inmates already convicted of a crime. I 
(circle one) aware of any reason why my having contact with convicted prisoners 
w ul pose a thre 
my safety or the safety of others. 
B 
to Signature 
B. Inmate Refuses to Sign 
Date 
REASONS STATED (IF ANY ): 
ex031%-osi 
72,41
Reg. No. 
Date 
Staff Signature/Tide 
Staff Signature/Title 
EFTA00035605


III. POLICY 
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