Department Forms | Washington State Department of Corrections

Forms are official Department documents. Below is a list of available forms.

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01 Series Forms

DOC 01-002 Public Records Search (pdf) (Rev. 03/11/2022)
DOC 01-007 Furlough Application and Plan (pdf) (Rev. 08/05/2020)
DOC 01-008 Agency Denial/Exemption Log (pdf) (Rev. 03/11/2022)
DOC 01-009 Central File Archive Checklist (pdf) (Rev. 12/17/2021)
DOC 01-010 Audit Checklist - Central File (pdf) (Rev. 03/17/2022)
DOC 01-012 File Maintenance Checklist (pdf) (Rev. 01/06/2023)
DOC 01-013 Central File - Field Intake Audit Checklist (pdf) (Rev. 07/18/2019)
DOC 01-014 Field File Archive Checklist (pdf) (Rev. 12/17/2021)
DOC 01-015 Manifest - Archiving Files (pdf) (Rev. 01/06/2023)
DOC 01-018 Initial Sentence Structure Entry Checklist - Prison (pdf) (Rev. 05/15/2019)
DOC 01-019 Initial Sentence Structure Entry Checklist - Non Prison (pdf) (Rev. 06/30/2021)
DOC 01-020 Initial Sentence Structure Entry Checklist - Non Prison SOSSA (pdf) (Rev. 04/04/2019)
DOC 01-089 Records Destruction Request (pdf) (Rev. 01/26/2021)

02 Series Forms

DOC 02-001 Cell Phone Agreement (pdf) (Rev. 05/16/2022)
DOC 02-007 Aggravated Sexual Assault Checklist (pdf) (Rev. 03/03/2022)
DOC 02-011 PREA Response and Containment Checklist (pdf) (Rev. 03/21/2022)
DOC 02-014 PREA Investigation Checklist (pdf) (Rev. 07/14/2022)
DOC 02-015 PREA Triage Results Letter (pdf) (Rev. 04/19/2022)
- DOC 02-015ES Carta de Resultados del Triage PREA (pdf) (Rev. 04/19/2022)
DOC 02-021 Aggravated Sexual Assault Medical Follow-Up Checklist (pdf) (Rev. 10/08/2020)
DOC 02-022 Partial Confinement Mileage Log (pdf) (Rev. 11/16/2021)
DOC 02-024 Employer Vehicle Use Authorization (pdf) (Rev. 11/16/2021)
DOC 02-025 Sex Offender Treatment and Assessment Programs Limits of Confidentiality (pdf) (Rev. 07/22/2022)
- DOC 02-025ES Límites de Confidencialidad de Los Programas de Tratamiento y Evaluación de Delincuentes Sexuales (pdf) (Rev. 07/22/2022)
DOC 02-027 Virtual/Telephonic Hearing Request (pdf) (Rev. 10/06/2022)
DOC 02-028 Single Cell Screening and Assignment (pdf) (Rev. 10/21/2021)
DOC 02-029 Virtual Hearing Acknowledgement/Waiver (pdf) (Rev. 10/06/2022)
DOC 02-077 Investigation Report (pdf) (Rev. 08/26/2022)
DOC 02-175 Three Month (M3) Review Checklist (pdf) (Rev. 11/05/2020)
DOC 02-187 Individual Reentry Plan (pdf) (Rev. 09/23/2022)
DOC 02-195 Victim/Survivor Dialogue Meeting Application (pdf) (Rev. 07/20/2021)
DOC 02-203 Purchase Card Agreement (pdf) (Rev. 09/16/2019)
DOC 02-243 Notice of Continued Obligations/Restrictions (pdf) (Rev. 10/14/2021)
- DOC 02-243ES Aviso de Continuación de Obligaciones/Restricciones (pdf) (Rev. 10/14/2021)
DOC 02-247 Law Library Request for Priority Access (pdf) (Rev. 11/05/2020)
DOC 02-249 Request for Denial of Reentry Center Placement (pdf) (Rev. 10/21/2021)
DOC 02-301 Outgoing Transfer Checklist (pdf) (Rev. 07/01/2022)
DOC 02-303 Interstate Transfer Request Fee (pdf) (Rev. 12/20/2021)
DOC 02-322 Receipt of Handbook (pdf) (Rev. 12/27/2021)
- DOC 02-322ES Recepcion del Manual (pdf) (Rev. 12/27/2021)
DOC 02-323 Home Investigation Report (pdf) (Rev. 06/16/2022)
DOC 02-330 Sex Offender Treatment and Assessment Programs Informed Consent for Prison Treatment (pdf) (Rev. 07/22/2022)
- DOC 02-330ES Programas de Evaluación y Tratamiento de Delincuentes Sexuales Consentimiento Informado Para el Tratamiento en Prisión (pdf) (Rev. 07/22/2022)
DOC 02-335 Acknowledgment of Receipt of Identification/Social Security Card (pdf) (Rev. 03/04/2021)
DOC 02-337 Housing Payment Request (pdf) (Rev. 06/09/2022)
DOC 02-338 GPS Enrollment (pdf) (Rev. 06/10/2021)
DOC 02-339 Equipment Return (pdf) (Rev. 06/10/2021)
DOC 02-340 Radio Frequency (RF) Enrollment (pdf) (Rev. 06/10/2021)
DOC 02-353 Electronic Monitoring Contract (pdf) (Rev. 12/03/2021)
DOC 02-354 Care and Use of Radio Frequency Equipment (pdf) (Rev. 06/10/2021)
DOC 02-358 Employer Letter (pdf) (Rev. 01/12/2022))
DOC 02-361 Reentry Conditions (pdf) (Rev. 12/03/2021)
- DOC 02-361S Condiciones de Reingreso (pdf) (Rev. 12/03/2021)
DOC 02-363 DCYF – Authorization for Release of Information (pdf) (Rev. 08/27/2020)
DOC 02-364 Daily Itinerary – Community Parenting Alternative (pdf) (Rev. 09/18/2020)
DOC 02-365 Family and Offender Sentencing Alternative Job Search Log (pdf) (Rev. 01/12/2022)
DOC 02-366 Community Parenting Alternative Transfer Plan (pdf) (Rev. 11/20/2020)
DOC 02-368 Home Visitor Log (pdf) (Rev. 12/03/2021)
- DOC 02-368ES Registro de Visitas al Domicilio (pdf) (Rev. 12/03/2021)
DOC 02-369 Search Waiver (pdf) (Rev. 06/16/2022)
- DOC 02-369ES Renuncia a Los Derechos de Registro (pdf) (Rev. 06/16/2022)
DOC 02-371 Personal Vehicle Use Authorization (pdf) (Rev. 11/16/2021)
- DOC 02-371ES Autorizacion Para Uso de Un Vehiculo Personal (pdf) (Rev. 11/16/2021)
DOC 02-374 Personal Property Disposal (pdf) (Rev. 04/19/2022)
- DOC 02-374ES Disposición de Propiedad Personal (pdf) (Rev. 04/19/2022)
DOC 02-378 Investigative Finding Sheet (pdf) (Rev. 07/18/2022)
DOC 02-382 PREA Data Collection Checklist (pdf) (Rev. 04/15/2021)
DOC 02-383 Local PREA Investigation Review Checklist (pdf) (Rev. 04/19/2022)
DOC 02-384 Housing Protocol for Transgender, Intersex, and Non-binary Individuals (pdf) (Rev. 04/07/2022)
DOC 02-385 Housing Review for Transgender, Intersex, and Non-binary Individuals (pdf) (Rev. 04/07/2022)
DOC 02-391 Veterans Unit Application (pdf) (Rev. 09/30/2022)
DOC 02-394 Facilitator Dialogue Meeting Application (pdf) (Rev. 07/20/2021)
DOC 02-395 Accountability Letter Bank - Request to Participate (pdf) (Rev. 07/20/2021)
DOC 02-398 Transport Bag Inventory (pdf) (Rev. 12/06/2019)
DOC 02-399 Interstate Compact Notice of Probable Cause Hearing, Rights, and Waiver (pdf) (Rev. 12/20/2021)
DOC 02-400 Notice of PREA Investigation Findings (pdf) (Rev. 04/19/2022)
DOC 02-401 Juvenile Board Declaration of Intent (pdf) (Rev. 07/28/2020)
DOC 02-402 Sex Offender Treatment and Assessment Programs Informed Consent for Community Treatment (pdf) (Rev. 07/22/2022)
- DOC 02-402ES Consentimiento Informado Para el Tratamiento Comunitario de Los Programas de Tratamiento y Evaluación de Delincuentes Sexuales (pdf) (Rev. 07/22/2022)
DOC 02-406 Sex Offender Treatment and Assessment Programs Release of Confidential Information (pdf) (Rev. 07/22/2022)
- DOC 02-406ES Divulgación de Información Confidencial de Los Programas de Tratamiento y Evaluación de Delincuentes Sexuales (pdf) (Rev. 07/22/2022)
DOC 02-407 Statement to the Indeterminate Sentence Review Board (pdf) (Rev. 12/13/2019)
DOC 02-409 Reentry Goals - Community Parenting Alternative (pdf) (Rev. 11/20/2020)
DOC 02-410 Electronic Home Monitoring Screening - Community Parenting Alternative (pdf) (Rev. 11/20/2020)
DOC 02-413 Notice Future Supervision (pdf) (Rev. 10/14/2021)
- DOC 02-413ES Aviso de Futura Supervision (pdf) (Rev. 10/14/2021)
DOC 02-414 Memorandum of Involvement (pdf) (Rev. 07/23/2020)
DOC 02-416 Infants at Work Alternate Care Provider Application (pdf) (Rev. 06/01/2019)
DOC 02-417 Infants at Work Individual Care Plan Application (pdf) (Rev. 06/01/2019)
DOC 02-418 Infants at Work Liability Waiver and Release (pdf) (Rev. 06/01/2019)
DOC 02-419 Infants at Work Workspace Inspection (pdf) (Rev. 06/01/2019)
DOC 02-420 Preferences Request (pdf) (Rev. 03/09/2022)
- DOC 02-420ES Solicitud De Preferencias (pdf) (Rev. 03/09/2022)
DOC 02-421 Contract Staff Who Provide Services for Multiple Facilities Checklist (pdf) (Rev. 11/05/2021)
DOC 02-422 Transgender, Intersex, and Non-binary Housing Multi-Disciplinary Team (pdf) (Rev. 03/24/2022)

03 Series Forms

DOC 03-011 Health Services Continuing Education Reimbursement Request (pdf) (Rev. 07/29/2021)
DOC 03-022 Overtime Request/Approval (pdf) (Rev. 05/12/2020)
DOC 03-026 Outside Employment/Volunteer Activity (pdf) (Rev. 06/23/2021)
DOC 03-031 Criminal Disclosure (pdf) (Rev. 03/04/2022))
DOC 03-051 Bona Fide Occupational Qualification Privacy Post Request (pdf) (Rev. 06/23/2021)
DOC 03-065 Internal Discrimination/Harassment Complaint (pdf) (Rev. 03/04/2022)
DOC 03-068 Applicant - Authorization to Release (pdf) (Rev. 03/04/2022)
DOC 03-085 Monthly/Quarterly Safety Committee Minutes (pdf) (Rev. 02/11/2022)
DOC 03-110 COVID-19 Screening Workplace Denial (pdf) (Rev. 02/24/2022)
DOC 03-112 High-Risk Employee Alternate Work Assignment, Telework, or Leave Request (pdf) (Rev. 09/09/2020)
DOC 03-114 Shared Leave Request (pdf) (Rev. 10/10/2022)
DOC 03-115 Shared Leave Donation (pdf) (Rev. 03/25/2021)
DOC 03-120 Specialized Unit Assignment Review (pdf) (Rev. 12/27/2021)
DOC 03-133 Accident/Injury Report (pdf) (Rev. 11/08/2021)
DOC 03-138 Alternate Work Schedule (pdf) (Rev. 08/24/2021)
DOC 03-151 Hazard Report (pdf) (Rev. 02/11/2022)
DOC 03-161 Volunteer Safety Orientation Information (pdf) (Rev. 02/11/2022)
DOC 03-172 Hepatitis B Vaccine Consent/Waiver and Vaccination Record (pdf) (Rev. 01/18/2023)
DOC 03-173 Coronavirus (COVID-19) Vaccination Screening and Consent (pdf) (Rev. 04/04/2022)
DOC 03-188 Application for Assault Benefits (pdf) (Rev. 04/22/2021)
DOC 03-201 Confined Space Entry Permit (pdf) (Rev. 02/03/2021)
DOC 03-202 Hot Work Permit (pdf) (Rev. 02/03/2021)
DOC 03-216 Tuberculin Screening (pdf) (Rev. 04/01/2022)
DOC 03-230 Employee Occupational Health Record (EOHR) Consent to Release/Disclosure Authorization (pdf) (Rev. 09/30/2020)
DOC 03-232 Employee Occupational Health Records Disclosure Log (pdf) (Rev. 09/30/2020)
DOC 03-240 Telework Agreement (pdf) (Rev. 07/28/2022)
DOC 03-241 Telework Safety Assessment (pdf) (Rev. 02/27/2023)
DOC 03-243 Respirator Fit Testing and Training Acknowledgement (pdf) (Rev. 09/16/2022)
DOC 03-247 Hazard Assessment Certification and Personal Protective Equipment (PPE) Selection Worksheet (pdf) (Rev. 03/11/2020)
DOC 03-248 Personal Protective Equipment (PPE) Training Record and Certification (pdf) (Rev. 03/11/2020)
DOC 03-271 Shared Leave Medical Certificate (pdf) (Rev. 03/25/2021)
DOC 03-303 Statewide Annual Agency Awards Nomination (Rev. 05/2021)
DOC 03-314 Licensed Health Care Provider Information and Response Sheet (pdf) (Rev. 10/10/2022)
DOC 03-327 Appointment Approval Request (pdf) (Rev. 03/15/2022)
DOC 03-315 Employee Separation Notice (pdf) (Rev. 02/01/2023)
DOC 03-346 Employee Training Request and Registration (pdf) (Rev. 10/24/2019)
DOC 03-373 Acknowledgement of Receipt of Policy and Related Educational Material (pdf) (Rev. 01/21/2022)
DOC 03-388 Chemical Request Application (pdf) (Rev. 07/10/2020)
DOC 03-391 Request for Accommodation (pdf) (Rev. 06/23/2021)
DOC 03-398 Authorization to Release Medical Information (pdf) (Rev. 06/23/2021)
DOC 03-405 Wellness Activity Liability Release (pdf) (Rev. 02/09/2022)
DOC 03-407 Leave Request (Rev. 01/24/2023)
DOC 03-416 Position Action Request (pdf) (Rev. 03/09/2023)
DOC 03-417 Position Review Request (pdf) (Rev. 10/20/2022)
DOC 03-417IT Position Review Request - Information Technology (pdf) (Rev. 10/20/2022)
DOC 03-421 Volunteer Confidentiality Agreement (pdf) (Rev. 03/22/2022)
DOC 03-430 Performance and Development Plan (PDP) Expectations and Evaluation (pdf) (Rev. 12/20/2022)
DOC 03-433 Approval for Employee Serving as a Department Volunteer (pdf) (Rev. 03/22/2022)
DOC 03-434 Record of Volunteer Services (pdf) (Rev. 03/22/2022)
DOC 03-435 Registered Volunteer Agreement (pdf) (Rev. 03/22/2022)
DOC 03-440 Volunteer Application and Registration (pdf) (Rev. 03/22/2022)
DOC 03-441 Volunteer Orientation Checklist (pdf) (Rev. 03/22/2022)
DOC 03-443 Non-Department Personnel Acknowledgment for Off-Site Work Crews (pdf) (Rev. 02/02/2022)
DOC 03-445 Position Description - Washington Management Service (WMS) (pdf) (Rev. 05/05/2022)
DOC 03-446 Position Description - Washington General Service (WGS) & Exempt Non-Management (pdf) (Rev. 10/31/2022)
DOC 03-450 Volunteer Policy Review Check Sheet (pdf) (Rev. 03/22/2022)
DOC 03-469 Pre-Employment Reference Check Applicant Previous Employment Check (pdf) (Rev. 09/14/2022)
DOC 03-472 Confined Space Entry Site-Specific Training - Employee (pdf) (Rev. 02/03/2021)
DOC 03-472A Confined Space Entry Site-Specific Training - Incarcerated Worker (pdf) (Rev. 02/03/2021)
DOC 03-473 Correctional Industries Safety Meeting Minutes (pdf) (Rev. 02/11/2022)
DOC 03-474 Safety Orientation Site Specific (pdf) (Rev. 01/20/2022)
DOC 03-475 Authorization for Release/Request of Health Information (employee use) (pdf) (Rev. 02/18/2020)
DOC 03-478 PREA Acknowledgement (pdf) (Rev. 04/19/2022)
DOC 03-484 Interview Acknowledgment (pdf) (Rev. 09/14/2022)
DOC 03-485 Biennial/Supplemental Budget Requests (pdf) (Rev. 04/29/2020)
DOC 03-494 Transitional Duty Assignment Attendance Report (pdf) (Rev. 07/17/2019)
DOC 03-497 Correctional Worker CORE Physician Statement for Participation (pdf) (Rev. 09/30/2020)
DOC 03-499 Instructor Agreement (pdf) (Rev. 10/20/2020)
DOC 03-503 PREA Monthly Retaliation Monitoring Report (pdf) (Rev. 08/11/2021)
DOC 03-504 Position Description - Exempt Management (pdf) (Rev. 05/09/2022)
DOC 03-505 Law Enforcement Referral of PREA Allegation (pdf) (Rev. 01/27/2022)
DOC 03-506 Sexual Misconduct and Institutional Employment/Service Disclosure (pdf) (Rev. 03/04/2022)
DOC 03-508 Authorization to Carry a Personal Firearm While Traveling (pdf) (Rev. 07/18/2019)
DOC 03-509 Peace Officer Identification (ID) Card Request and Authorization (pdf) (Rev. 07/19/2019)
DOC 03-510 Tuition Reimbursement Request (pdf) (Rev. 07/28/2022)
DOC 03-513 Family Council Meeting Minutes (Rev. 12/22/2022)
DOC 03-514 Family Council Action Items (Rev. 10/31/2022)
DOC 03-522 Specialty Team Assignment - Pay Roster (pdf) (Rev. 08/15/2019)
DOC 03-523 PREA Disclosure and Training Acknowledgement for Volunteers (pdf) (Rev. 04/19/2022)
DOC 03-525 Overtime Exempt Additional Compensation Request (pdf) (Rev. 10/14/2022)

05 Series Forms

DOC 05-047 Project Request Application (Rev. 09/2020)
DOC 05-062 Offender Property (pdf) (Rev. 08/01/2019)

DOC 05-062S Propiedad Del Interno/Interna (pdf) (Rev. 08/01/2019)

DOC 05-066 Public Records Request (pdf) (Rev. 03/11/2022)

DOC 05-066ES Solicitud de Registros Publicos (Rev. 03/11/2022)

DOC 05-091 Daily Segregation Report (pdf) (Rev. 03/06/2020)
- DOC 05-091 Daily Segregation Report (Continued) (pdf) (Rev. 03/06/2020)
DOC 05-092 Administrative Segregation Review (pdf) (Rev. 03/06/2020)
DOC 05-093 Disciplinary Hearing Notice/Appearance Waiver (pdf) (Rev.02/22/2023)

DOC 05-093ES Aviso De Audiencia Disciplinaria/Renuncia De Comparecencia (pdf) (Rev. 02/22/2023)

DOC 05-094 Witness Statement (pdf) (Rev. 02/22/2023)
- DOC 05-094ES Declaracion De Testigo (Rev. 02/22/2023)
DOC 05-100 Tort Claim Log (pdf) (Rev. 11/15/2022)
DOC 05-101 Administrative Segregation Referral (pdf) (Rev. 07/22/2022)
- DOC 05-101S Remisión A Segregación Administrativa (Rev. 03/06/2020)
DOC 05-113ES Request for Interpreter - E/S (Solicitud Para Servicio De Intérprete) (pdf) (Rev. 03/06/2020)
DOC 05-121ES Request for Department Advisor - E/S (Solicitud Para Un Asesor Del Departamento) (pdf) (Rev. 03/06/2020)
DOC 05-165 Resolution Request (pdf) (Rev. 10/12/2022)
- DOC 05-165S Solicitud de Resolución (pdf) (Rev. 10/24/2022)
DOC 05-166 Level I Resolution Response (pdf) (Rev. 07/26/2022)
- DOC 05-166S Respuesta de Resolución de Nivel I (pdf) (Rev. 07/26/2022)
DOC 05-168 Level II Resolution Response (pdf) (Rev. 07/26/2022)
- DOC 05-168S Respuesta de Resolución de Nivel II (pdf) (Rev. 07/26/2022)
DOC 05-169 Level III Resolution Response (pdf) (Rev. 07/26/2022)
- DOC 05-169S Respuesta de Resolución de Nivel III (pdf) (Rev. 07/26/2022)
DOC 05-171ES Notification of Time Extension/Notificación de Extensión de Tiempo - E/S (pdf) (Rev. 03/31/2021)
DOC 05-280 Acknowledgment of Receipt of Badge (pdf) (Rev. 08/26/2022)
DOC 05-311 Resolution Review Report (pdf) (Rev. 12/15/2022)
DOC 05-363 Restitution Review (pdf) (Rev. 02/22/2023)
- DOC 05-363S Evaluacion de Restitucion (pdf) (Rev. 02/22/2023)
DOC 05-370 Request for Criminal History Record Information WASIS/NCIC III Check NCIC/WACIC Check (pdf) (Rev. 03/04/2022)
DOC 05-384 Search Report (pdf) (Rev. 01/12/2022)
DOC 05-411 End of Sentence Review Referral (pdf) (Rev. 03/17/2022)
DOC 05-507 Indigency Approval for Polygraphs (pdf) (Rev. 05/26/2022)
DOC 05-512 Partial Confinement Orientation Checklist (pdf) (Rev. 06/16/2022)
- DOC 05-512S Lista de Comprobación de Orientación en Confinamiento Parcial (pdf) (Rev. 06/16/2022)
DOC 05-525 Rejection Notice (pdf) (Rev. 01/20/2020)
- DOC 05-525S Notificacion De Rechazo (pdf) (Rev. 01/20/2020)
DOC 05-530 Notice of Payroll Deduction (pdf) (Rev. 07/01/2022)
DOC 05-531 Termination of Notice of Payroll Deduction (pdf) (Rev. 07/01/2022)
DOC 05-532 Answer to Notice of Payroll Deduction (pdf) (Rev. 02/22/2023)
DOC 05-533 Order to Withhold and Deliver - Entity (pdf) (Rev. 02/22/2023)
DOC 05-534 Order to Withhold and Deliver - Employer (pdf) (Rev. 02/22/2023)
DOC 05-535 Answer to Order to Withhold and Deliver (pdf) (Rev. 02/22/2023)
DOC 05-536 Additional Answer to Order to Withhold and Deliver (pdf) (Rev. 02/22/2023)
DOC 05-537 Notice of Debt (pdf) (Rev. 07/01/2022)
DOC 05-538 Notice of Right to Petition for Judicial Review (pdf) (Rev. 07/01/2022)
DOC 05-539 Notice of Potential Withholding and Right to File Petition (pdf) (Rev. 07/01/2022)
DOC 05-554A Electronic Monitoring Schedule (pdf) (Rev. 06/10/2021)
DOC 05-587 In-State Transfer Checklist (pdf) (Rev. 07/01/2022)
DOC 05-666ES Request for Interpretation/Translation by an Incarcerated Individual - E/S (Solicitud de Interpretacion/Traduccion de Un Individual Encarcelado) (pdf) (Rev. 08/04/2020)
DOC 05-673 Escorted Leave Reimbursement Request (pdf) (Rev. 08/05/2020)
DOC 05-685 Rules for Contact with Victims or Minors (pdf) (Rev. 02/20/2020)
- DOC 05-685ES Reglas Para El Contacto Con Victimas O Menores De Edad (pdf) (Rev. 02/20/2020)
DOC 05-686 Chaperone/Supervisor of Contact Agreement of Responsibilities (pdf) (Rev. 11/04/2020)
- DOC 05-686ES Chaperon/Supervisor De Contacto Acuerdo De Responsabilidades (pdf) (Rev. 11/04/2020)
DOC 05-688 Chaperone/Supervisor of Contact Requirements (pdf) (Rev. 02/20/2020)
- DOC 05-688S Requisitos Del Acompañante/Supervisor De Contacto (pdf) (Rev. 03/02/2021)
DOC 05-698 Affidavit for Disposition of Personal Property (pdf) (Rev. 04/05/2022)
DOC 05-702 Contact/Safety Plan (pdf) (Rev. 02/20/2020)
- DOC 05-702ES Plan de Contacto/Seguridad (pdf) (Rev. 03/02/2021)
DOC 05-703 Termination of Contact with Minors Appeal (pdf) (Rev. 02/20/2020)
DOC 05-753 Polygraph Examination - Authorization for Release of Information (pdf) (Rev. 01/25/2021)
- DOC 05-753ES Prueba de Polígrafo - Autorización Para Divulgación de Información (pdf) (Rev. 02/01/2021)
DOC 05-754 Polygraph Letter (pdf) (Rev. 01/25/2021)
DOC 05-764 Work Crew Expectations Declaration (pdf) (Rev. 05/24/2019)
- DOC 05-764ES Declaracion De Expectativas De Cuadrilla (pdf) (Rev. 05/24/2019)
DOC 05-774 Foreign Language Mail and Review (pdf) (Rev. 01/20/2020)
- DOC 05-774ES Lengua Extranjera y Revisión de Correo (pdf) (Rev. 03/11/2021)
DOC 05-780 Global Positioning System Rules (pdf) (Rev. 12/03/2021)
DOC 05-781 Internet Access Rules (pdf) (Rev. 11/03/2022)
DOC 05-785 Personal Property Claim Investigation Report (pdf) (Rev. 11/15/2022)
DOC 05-793 Funeral Trip/Deathbed Visit Worksheet and Checklist (pdf) (Rev. 08/05/2020)
DOC 05-797 Ad Seg Review Notice/Appearance Waiver (pdf) (Rev. 03/09/2020)
- DOC 05-797ES Aviso/Renuncia De Comparecencia A Audiencia De Ad Seg (pdf) (Rev. 03/09/2020)
DOC 05-808 Supply Inventory Transaction Report (pdf) (Rev. 02/06/2020)
DOC 05-814 Electronic Monitoring Agreement (pdf) (Rev. 06/10/2021)
DOC 05-818 Indeterminate Sentence Review Board Interpreter Request/Refusal (pdf) (Rev. 08/04/2020)
DOC 05-824 Assessment Tool to Determine English Proficiency (pdf) (Rev. 08/04/2020)
DOC 05-826 Reentry Center Mail Rejection Notice (pdf) (Rev. 01/12/2022)
DOC 05-827 Contract Language Interpreter Appointment Record (pdf) (Rev. 08/04/2020)
DOC 05-831 Attorney Representation - Consent for Release of Information (pdf) (Rev. 08/16/2021)
DOC 05-596 Contraband/Evidence Log (pdf) (Rev. 08/01/2019)

06 Series Forms

DOC 06-003 Lodging and Transportation Assistance Program - Application for Reimbursement (pdf) (Rev. 10/27/2022)
DOC 06-004 Purchasing Approval/Signature Authority Request (pdf) (Rev. 12/24/2021)
DOC 06-028 Transition Resources Request (pdf) (Rev. 05/14/2020)
DOC 06-070 Mandatory Savings Account Exemption (pdf) (Rev. 03/03/2020)
DOC 06-071 Mandatory Savings Account Access (pdf) (Rev. 03/03/2020)
- DOC 06-071ES Acceso Obligatorio A La Cuenta De Ahorros (pdf) (Rev. 03/03/2020)
DOC 06-072 Work/Training Release Transmittal of Trust Funds (pdf) (Rev. 02/10/2022)
DOC 06-073 Request for Advance and Promissory Note (pdf) (Rev. 02/11/2022)
- DOC 06-073ES Solicitud De Anticipo Y Pagaré (pdf) (Rev. 02/10/2022)
DOC 06-074 Check Request (pdf) (Rev. 03/12/2020)
- DOC 06-074H Check Request (half sheet) (pdf) (Rev. 03/12/2020)
DOC 06-075ES Request to Transfer Funds - E/S (Peticion Para Transferencia De Fondos) (pdf) (Rev. 10/06/2022)
DOC 06-076 Education Subaccount Withdrawal Request (pdf) (Rev. 03/03/2020)
DOC 06-077 Request to Reissue Check (pdf) (Rev. 03/03/2020)
DOC 06-080 Electronic Deposit Rejection Notice (pdf) (Rev. 02/10/2022)
DOC 06-081 Compassion Transfer Expense (pdf) (Rev. 02/07/2022)

07 Series Forms

DOC 07-011 Request for Information Regarding Tribal Deposits (pdf) (Rev. 06/09/2020)
DOC 07-024 Conditions, Requirements, and Instructions (pdf) (Rev. 02/22/2023)

DOC 07-024ES Conditions, Requirements, and Instructions - E/S (Condiciones, Requisitos, E Instrucciones) (pdf) (Rev. 02/22/2023)

DOC 07-025 Chaperone Orientation Certificate (pdf) (Rev. 11/04/2020)
DOC 07-026 Formal Headquarters Community Screening Committee (HCSC)/Life without Parole Decision (pdf) (Rev. 06/16/2022)
DOC 07-028 Victim Services Referral (pdf) (Rev. 12/13/2019)
DOC 07-029 Prison Transfer Packet Checklist (pdf) (Rev. 02/11/2022)
DOC 07-031 End of Sentence Review Committee Decisions (pdf) (Rev. 03/17/2022)
DOC 07-033 Prohibited Contact Definitions (pdf) (Rev. 11/04/2020)
DOC 07-035 Drug Offender Sentencing Alternative Compliance Review (pdf) (Rev. 01/14/2022)
DOC 07-037 Classification Appeal (pdf) (Rev. 10/21/2021)

DOC 07-037ES Apelacion De Clasificacion (pdf) (Rev. 10/21/2021)

DOC 07-038 Drug Offender Sentencing Alternative (DOSA) Compliance Review (Rev. 01/14/2022)
DOC 07-040 Application for Advance Notification and Victim Services (Rev. 07/2019)
DOC 07-042 Weekly Planner (pdf) (Rev. 11/04/2020)
DOC 07-043 Trip Proposal (pdf) (Rev. 11/04/2020)
DOC 07-044 Travel Schedule (pdf) (Rev. 11/04/2020)
DOC 07-046 Community Contact/Chaperone Proposal (pdf) (Rev. 11/04/2020)
- DOC 07-046ES Propuesta de Contacto Comunitario/Acompañante (pdf) (Rev. 03/02/2021)
DOC 07-047 Inactive Banked Caseload Transfer/Review Checklist (pdf) (Rev. 01/06/2023)
DOC 07-053 Release/Transfer Needs Survey (pdf) (Rev. 09/23/2022)

08 Series Forms

DOC 08-076 Information Technology Security Data Request (pdf) (Rev. 05/21/2021)

09 Series Forms

DOC 09-012ES Request for Unclaimed Property - E/S (Solicitud De Propiedad No Reclamada) (pdf) (Rev. 03/03/2020)
DOC 09-042 Petition for Mandatory Wage Assignment (pdf) (Rev. 07/01/2022)
DOC 09-043 Wage Assignment Order (pdf) (Rev. 07/01/2022)
DOC 09-044 Answer to Wage Assignment (pdf) (Rev. 07/01/2022)
DOC 09-052 Miranda Warning Waiver (pdf) (Rev. 09/26/2019)

DOC 09-052ES Renuncia a La Advertencia Miranda (pdf) (Rev. 09/26/2019)

DOC 09-065ES Notice of Significant Legal Document - E/S (Notificacion de un Documento Significativo Legal) (pdf) (Rev. 08/04/2020)
DOC 09-071 Order of Furlough (pdf) (Rev. 08/05/2020)
DOC 09-129 Pre-Sentence Investigation (pdf) (Rev. 02/23/2022)

DOC 09-129A Pre-Sentence Investigation Mental Health Sentencing Alternative Addendum (pdf) (Rev. 02/23/2022)

DOC 09-113 PSI - Judgment & Sentence (Felony) - Appendix H Community Placement/Custody (pdf) (Rev. 07/01/2022)
DOC 09-164 Responsibilities of Furlough Sponsors (pdf) (Rev. 08/05/2020)
DOC 09-173 Risk Assessment Report (pdf) (Rev. 10/10/2022)
DOC 09-174 Parenting Sentencing Alternative - Risk Assessment Report (pdf) (Rev. 12/07/2022)
DOC 09-191 Board - Order for Arrest and Detention (pdf) (Rev. 01/24/2022)
DOC 09-197 Disciplinary Hearing Appeal Decision (pdf) (Rev. 02/22/2023)

DOC 09-197ES Decision Sobre La Apelacion de La Audiencia Disciplinaria (pdf) (Rev. 02/22/2023)

DOC 09-223 Clemency - Special (pdf) (Rev. 07/21/2021)
DOC 09-224 Conditional Commutation Hearing Report (pdf) (Rev. 12/20/2021)
DOC 09-227 Deferred Decision Waiver (pdf) (Rev. 08/03/2021)
DOC 09-230 Partial Confinement Notice of Allegations, Hearing, Rights, and Waiver (pdf) (Rev. 01/09/2020)
- DOC 09-230ES Confinamiento Parcial Notificacion de Alegaciones, Audiencia, Derechos y Renuncia (pdf) (Rev. 01/10/2020)
DOC 09-231 Notice of Allegations, Hearing, Rights, and Waiver (pdf) (Rev. 08/03/2021)

DOC 09-231ES Notificacion de Alegaciones, Audiencia, Derechos y Renuncia (pdf) (Rev. 08/03/2021)

DOC 09-235 Appeals Panel Decision (pdf) (Rev. 08/03/2021)
DOC 09-242 General Authorization for Release of Information (pdf) (Rev. 02/20/2020)
DOC 09-248 Prison DOSA Deportation/Removal Order Hearing Disposition Report (pdf) (Rev. 11/05/2020)
DOC 09-260 Court Special - Drug Offender Sentencing Alternative (pdf) (Rev. 11/05/2020)
DOC 09-271 Less Restrictive Alternative Court - Notice of Violation (pdf) (Rev. 11/04/2020)
DOC 09-272 Less Restrictive Alternative Court - Special (pdf) (Rev. 11/04/2020)
DOC 09-274 Notification of Department Violation Process (pdf) (Rev. 09/28/2021)

DOC 09-274ES Notificación de Proceso de Infracción del Departamento (pdf) (Rev. 09/28/2021)

DOC 09-275 Appeal of Department Violation Process (pdf) (Rev. 10/14/2021)

DOC 09-275ES Apelacion al Proceso de Infraccion del Departamento (pdf) (Rev. 10/14/2021)

DOC 09-286 Board - Court Special - Interstate Compact Transfer Request (pdf) (Rev. 07/01/2022)
DOC 09-288 Board - Petition for Review (pdf) (Rev. 07/28/2020)
DOC 09-289 Hearing Continuance (pdf) (Rev. 08/03/2021)
DOC 09-295 Less Restrictive Alternative – Stipulated Agreement (pdf) (Rev. 11/04/2020)
DOC 09-298 Affirmative Conditions and Crime-Related Prohibitions (pdf) (Rev. 07/01/2022)
DOC 09-302 Final Discharge Request (Rev. 08/2018)
DOC 09-304 Board - Rights and Privileges for Parole/Community Custody Violation/Revocation Hearings (Rev. 10/20/2021)
DOC 09-306 Board - Violations Specified (Rev. 01/27/2021)
DOC 09-307 Board - Request for Appointment of Attorney (Rev. 10/20/2021)
DOC 09-308 Board - Supplement (Rev. 10/20/2021)
DOC 09-314 Mental Health Sentencing Alterative Report (Rev. 09/13/2022)
DOC 09-315 Mental Health Sentencing Alternative Progress/Termination Review (Rev. 02/23/2022)
DOC 09-485 Authorization for Release of Custodial Information (pdf) (Rev. 10/31/2022)

10 Series Forms

DOC 10-031 Correctional Industries Application for Work Programs (pdf) (Rev. 05/24/2019)
DOC 10-102 Correctional Industries Work Program Position Description (pdf) (Rev. 05/24/2019)
DOC 10-113 Correctional Industries Interview Results (pdf) (Rev. 05/24/2019)
DOC 10-114 Correctional Industries Work Program Recommendation Referral (pdf) (Rev. 03/03/2022)
DOC 10-116 Job Specialty Training Record (pdf) (Rev. 02/11/2022)
DOC 10-117 Safety Orientation Worksheet (pdf) (Rev. 02/11/2022)
DOC 10-118 Shop Rules and Requirements (pdf) (Rev. 02/11/2022)
DOC 10-120 Incident Camp Summary Report (pdf) (Rev. 05/29/2019)
DOC 10-121 Performance Evaluation (pdf) (Rev. 08/25/2021)
DOC 10-122 Tool/Equipment/Process Specialty Training Outline (pdf) (Rev. 02/11/2022)

11 Series Forms

DOC 11-011 In-State Transfer Referral for Individuals on Community Supervision (pdf) (Rev. 04/02/2021)
DOC 11-012 Release/Transfer Sponsor Orientation Checklist (pdf) (Rev. 06/16/2022)

DOC 11-012S Liberación/Transferencia Lista de Control de Orientación Del Patrocinador (pdf) (Rev. 06/16/2022)

DOC 11-013 Sponsor Letter (pdf) (Rev. 04/24/2020)
- DOC 11-013S Carta Del Patrocinador (pdf) (Rev. 04/24/2020)
DOC 11-024 Daily Itinerary - Graduated Reentry (pdf) (Rev. 11/20/2020)
- DOC 11-024ES Itinerario Diario - Reingreso Graduado (pdf) (Rev. 11/20/2020)
DOC 11-025 Graduated Reentry Job Search Log (pdf) (Rev. 11/20/2020)
- DOC 11-025S Reingreso Graduado Registro de Busqueda de Empleo (pdf) (Rev. 11/20/2020)
DOC 11-039 Graduated Reentry Criteria (pdf) (Rev. 06/29/2022)
DOC 11-042 Request for Denial of Graduated Reentry (pdf) (Rev. 06/24/2022)
DOC 11-045 Special Sex Offender Sentencing Alternative Informed Consent (pdf) (Rev. 09/21/2021)
DOC 11-046 Mental Health Sentencing Alternative Agreement (pdf) (Rev. 02/23/2022)
DOC 11-050 Emergency Caregiver Agreement (pdf) (Rev. 11/20/2020)
- DOC 11-050ES Acuerdo De Guardian De Emergencia (pdf) (Rev. 11/20/2020)
DOC 11-065 Graduated Reentry Participant Agreement (pdf) (Rev. 06/16/2022)
- DOC 11-065S Reingreso Graduado Acuerdo Del Participante (pdf) (Rev. 06/16/2022)
DOC 11-080 Social Media and Electronic Device Monitoring Agreement (pdf) (Rev. 03/04/2022)
- DOC 11-080S Acuerdo De Monitoreo De Redes Sociales Y Dispositivos Electronicos (pdf) (Rev. 03/04/2022)

13 Series Forms

DOC 13-013FP Infirmary/Extended Observation Unit Progress Record (pdf) (Rev. 08/29/2019)
DOC 13-024 Intersystem Intake Screening (pdf) (Rev. 04/13/2022)
- DOC 13-024S Toma de Datos Iniciales Entre Sistemas (pdf) (Rev. 04/13/2022)
DOC 13-035 Authorization for Disclosure of Health Information (pdf) (Rev. 03/13/2023)

DOC 13-035S Autorizacion Para Revelar Informacion Sobre La Salud (pdf) (Rev. 03/13/2023)

DOC 13-048 Refusal of Medical, Dental, Mental Health, and/or Surgical Treatment (pdf) (Rev. 04/22/2022)
DOC 13-069 Individual Behavior Management Plan (pdf) (Rev. 10/12/2022)
DOC 13-070 Infirmary/Extended Observation Unit Discharge/Transfer Summary (pdf) (Rev. 06/13/2019)
DOC 13-084 Mission Housing/Skills Building Unit Transition Plan (pdf) (Rev. 05/10/2022)
DOC 13-109 Seriously Ill Notification (pdf) (Rev. 10/13/2022)
DOC 13-159 Request for Health Information (pdf) (Rev. 11/07/2022)
DOC 13-203 Health Information Disclosure (pdf) (Rev. 04/13/2020)
DOC 13-236 Psychiatric Assessment (pdf) (Rev. 06/14/2019)
DOC 13-303 History and Physical (pdf) (Rev. 07/27/2022)

DOC 13-303ES Historia Clínica y Examen Médico (pdf) (Rev. 07/27/2022)

DOC 13-326 Request for Continuance of Involuntary Antipsychotic Hearing (pdf) (Rev. 06/11/2019)
DOC 13-327ES Decision of Involuntary Antipsychotic Hearing Committee - E/S (Decisión Del Comité De Audiencia Para La Administración Involuntaria De Medicamentos Antipsicóticos) (pdf) (Rev. 06/11/2019)
DOC 13-328 Receipt of Minutes of Involuntary Antipsychotic Hearing Committee and Appeal Procedures (pdf) (Rev. 06/10/2019)

DOC 13-328S Recibo De Las Actas Del Comite De La Audiencia Para Medicamentos Involuntarios Antipsicoticos y Procedimentos De Apelacion (pdf) (Rev. 06/13/2019)

DOC 13-329 Involuntary Antipsychotic Report (pdf) (Rev. 06/11/2019)
DOC 13-330 Notice of Involuntary Antipsychotic Hearing (24 Hour) (pdf) (Rev. 06/11/2019)

DOC 13-330S Notificacion De Audiencia Para La Administrion Involuntaria De Medicamentos (24 Horas) (pdf) (Rev. 06/13/2019)

DOC 13-349 Intersystem/Restricted Housing Mental Health Screening (pdf) (Rev. 11/23/2022)
- DOC 13-349S Evaluacion de Salud Mental Entre Sistemas/Viviendas Aseguradas (pdf) (Rev. 11/23/2022)
DOC 13-357 Hepatitis C Treatment Consent (pdf) (Rev. 08/11/2021)
- DOC 13-357S Consentimiento Para El Tratamiento Contra La Hepatitis C (pdf) (Rev. 08/11/2021)
DOC 13-371 Suicide Risk Assessment (pdf) (Rev. 05/07/2021)
DOC 13-380 Release of Incarcerated Individual (pdf) (Rev. 06/03/2022)
DOC 13-386 Consent for Evaluation and Initiation of Mental Health Treatment (pdf) (Rev. 11/21/2019)

DOC 13-386ES Consentimiento Para Evaluacion Y Comienzo Del Tratamiento De Salud Mental (pdf) (Rev. 11/21/2019)

DOC 13-393 Close Observation Conditions of Confinement (pdf) (Rev. 10/20/2021)
DOC 13-418 Restrained Patient Assessment (pdf) (Rev. 07/23/2021)
DOC 13-420 Request for Mental Health Assessment (pdf) (Rev. 03/13/2023)
DOC 13-423 Health Services Kite (pdf) (Rev. 01/13/2022)
- DOC 13-423S “Kite” Para Servicios De Salud (pdf) (Rev. 01/13/2022)
DOC 13-435 Primary Encounter Report (pdf) (Rev. 07/27/2022)
DOC 13-437ES Consejos Previos a Las Visitas Familiares (pdf) (Rev. 07/27/2022)
DOC 13-440 Emergency Response Record (pdf) (Rev. 05/25/2021)
DOC 13-450 Behavioral Health Discharge Summary (pdf) (Rev. 12/13/2019)
DOC 13-455 Transfer Summary for Work Release (pdf) (Rev. 06/03/2022)
DOC 13-457 Intellectual Disability Review (pdf) (Rev. 01/20/2022)
DOC 13-465 Mental Health Transfer Screening (pdf) (Rev. 10/12/2022)
DOC 13-468 Infirmary/Extended Observation Unit Admission Orders (pdf) (Rev. 03/01/2023)
DOC 13-471 Self-Wellness Check (pdf) (Rev. 03/10/2020)
- DOC 13-471 ES Autoevaluación de Bienestar (pdf) (Rev. 03/10/2020)
DOC 13-472 Offender-Paid Durable Medical Equipment (DME) (pdf) (Rev. 4/18/2019)
DOC 13-473 Medical Risk Evaluation for OC, CS and ECD Use (pdf) (Rev. 02/19/2021)
DOC 13-476 Mental Health Residential Treatment Update (pdf) (Rev. 03/13/2023)
DOC 13-480 TB/Immunization Record (pdf) (Rev. 10/11/2021)
DOC 13-502 Involuntary Antipsychotic Hearing Minutes (pdf) (Rev. 11/20/2019)
DOC 13-503 Involuntary Antipsychotic Hearing Minutes Statement (pdf) (Rev. 11/21/2019)
DOC 13-505 Violator Intake Screening (pdf) (Rev. 11/17/2021)
- DOC 13-505S Evaluacion de Admision de Internos (pdf) (Rev. 11/17/2021)
DOC 13-507 Health Records Request Continuity of Care (pdf) (Rev. 03/27/2019)
DOC 13-508 Accommodation Status Report (pdf) (Rev. 11/24/2021)
DOC 13-509 PREA Mental Health Notification (pdf) (Rev. 07/26/2022)
DOC 13-510 Accommodation Review Committee - Decision Notification (pdf) (Rev. 07/06/2021)
- DOC 13-510ES Comité de Revisión de Alojamiento - Notificación de Decisión (pdf) (Rev. 07/06/2021)
DOC 13-521 Consent for Hormone Treatment for Gender Dysphoria and/or Transgender Identification (pdf) (Rev. 01/11/2021)
- DOC 13-521S Consentimiento para Tratamiento Hormonal para Disforia de Género y/o Identificación Transgénero (pdf) (Rev. 01/11/2021)
DOC 13-538 Mental Health Encounter Report (pdf) (Rev. 01/03/2022)
DOC 13-556FP Close Observation Orders (pdf) (Rev. 09/04/2019)
DOC 13-557 Close Observation Nursing Assessment (pdf) (Rev. 10/08/2021)
DOC 13-558 Close Observation Suicide Risk Assessment (pdf) (Rev. 09/29/2022)
DOC 13-576 Skill Building Unit Individualized Plan (pdf) (Rev. 01/03/2022)
- DOC 13-576ES Plan Individualizado de la Unidad de Fomento de Habilidades (pdf) (Rev. 01/03/2022)
DOC 13-584 Patient Appeal of Accomodation Review Committee Decision (pdf) (Rev. 06/23/2021)
- DOC 13-584S Apelación del el Paciente a la Decisión del Comité de Revisión de Alojamiento (pdf) (Rev. 06/23/2021)
DOC 13-585 HQ ARC Appeals Committee Response to Patient Appeal (pdf) (Rev. 10/27/2021)
DOC 13-589 COVID-19 Vaccination (pdf) (Rev. 09/27/2022)
- DOC 13-589S Vacuna Contra COVID-19 (pdf) (Rev. 09/27/2022)
DOC 13-594 Close Observation Dry Cell Watch Assessment (pdf) (Rev. 09/09/2021)

DOC 13-600 Mental Health Update and Treatment Plan (pdf) (Rev. 03/18/2022)

14 Series Forms

DOC 14-002ES Acknowledgment of Drug/Alcohol Testing - Total/Partial Confinement (pdf) (Rev. 07/20/2021)
- DOC 14-002ES Reconocimiento de Pruebas de Drogas/Alcohol en Confinamiento Total/Parcial (pdf) (Rev. 07/20/2021)
DOC 14-003 Confidentiality Statement (pdf) (Rev. 11/20/2020)
DOC 14-021 Drug/Alcohol Use Admission (pdf) (Rev. 07/20/2021)
DOC 14-030 Reentry Community Service Program Referral (pdf) (Rev. 08/20/2021)
DOC 14-031 Partial Confinement Health Services Screening (pdf) (Rev. 02/02/2022)
DOC 14-035 Acknowledgment of Drug/Alcohol Testing – Field (pdf) (Rev. 10/14/2021)
- DOC 14-035ES Reconocimiento de Pruebas de Drogas/Alcohol en la Comunidad (pdf) (Rev. 10/14/2021)
DOC 14-035A Less Restrictive Alternative Drug/Alcohol Testing Acknowledgment (pdf) (Rev. 07/11/2022)
DOC 14-038 Drug/Alcohol Test Chain of Custody Log (pdf) (Rev. 07/20/2021)
DOC 14-039 Substance Use Disorder Treatment Participation Requirements (pdf) (Rev. 10/25/2022)
- DOC 14-039ES Requisitos de Participacion en el Tratamiento de Trastorno por Uso de Sustancias (pdf) (Rev. 10/25/2022)
DOC 14-042 Prison Drug Offender Sentencing Alternative Agreement (pdf) (Rev. 11/05/2020)
DOC 14-044 Substance Use Disorder Discharge Summary and Continued Care Plan (pdf) (Rev. 10/17/2022)
DOC 14-047 Medication Log - Reentry Center (pdf) (Rev. 03/17/2022)
DOC 14-049 Boarder Health History Screening (pdf) (Rev. 10/14/2020)
DOC 14-053 Use of Medical Cannabis Verification (pdf) (Rev. 02/24/2023)
DOC 14-055 Suitability for Medical Cannabis Use (pdf) (Rev. 02/24/2023)
DOC 14-148 Extraordinary Medical Placement Referral (pdf) (Rev. 04/14/2021)
DOC 14-172 Substance Abuse Recovery Unit Compound Release of Confidential Information (pdf) (Rev. 11/05/2020)
- DOC 14-172ES Complejo de La Unidad de Recuperación de Abuso de Sustancias Divulgacion de Informacion Confidencial (pdf) (Rev. 11/05/2020)
DOC 14-173 Substance Use Disorder Individual Service Plan (pdf) (Rev. 08/07/2019)
DOC 14-174ES Acknowledgment of Urine Testing Time Requirements (pdf) (Rev. 07/20/2021)
- DOC 14-174ES Reconocimiento de Requisitos de Tiempo Para Pruebas de Orina (pdf) (Rev. 07/20/2021)
DOC 14-179 Residential Drug Offender Sentencing Alternative Examination Report (pdf) (Rev. 03/04/2022)
DOC 14-182 Drug Offender Sentencing Alternative Non-Eligibility Finding Report (pdf) (Rev. 11/05/2020)
DOC 14-188 Substance Abuse Recovery Unit Treatment Termination Notice/Appeal Request (pdf) (Rev. 11/22/2019)
DOC 14-196 Reentry Community Services Program Summary and Committee Decision (pdf) (Rev. 08/20/2021)
DOC 14-197 Drug Offender Sentencing Alternative (DOSA) Treatment Termination Report (pdf) (Rev. 11/05/2020)
DOC 14-198 Substance Abuse Recovery Unit Treatment Termination Decision (pdf) (Rev. 11/22/2019)
DOC 14-204 Request for Laboratory Confirmation (pdf) (Rev. 03/25/2020)
DOC 14-311 Breathalyzer Accuracy/Calibration Record (pdf) (Rev. 07/20/2021)

15 Series Forms

DOC 15-019 Vehicle Safety Inspection Checklist (pdf) (Rev. 08/25/2020)
DOC 15-024 Certificate of Lockout/Tagout Annual Review (pdf) (Rev. 01/08/2020)
DOC 15-025 Exception for Removal of Lockout/Tagout Device (pdf) (Rev. 01/08/2020)
DOC 15-026 Lockout/Tagout Procedures (pdf) (Rev. 03/10/2020)
DOC 15-030 Capacity Modification Request (pdf) (Rev. 11/05/2020)
DOC 15-032 Weekly Generator Inspection (pdf) (Rev. 05/04/2021)
DOC 15-033 Quarterly Load Test (pdf) (Rev. 05/04/2021)
DOC 15-034 Generator Activity Log (pdf) (Rev. 05/04/2021)
DOC 15-035 Weekly UPS Inspection (pdf) (Rev. 05/04/2021)
DOC 15-036 Semi-Annual UPS Inspection (pdf) (Rev. 05/04/2021)

16 Series Forms

DOC 16-043 Reentry Center Employee Letter (pdf) (Rev. 06/28/2022)
DOC 16-172 Victim/Offender Facilitated Dialogue Meeting Letter (pdf) (Rev. 07/20/2021)
DOC 16-340 Prison Rape Elimination Act (PREA) Language Log (pdf) (Rev. 08/04/2020)
DOC 16-342 Monthly Report for DOC-Certified Interpreter/Translator (pdf) (Rev. 03/21/2023)
DOC 16-347 Monthly Safety and Sanitation Inspection (pdf) (Rev. 02/11/2022)
DOC 16-348 Quarterly Safety and Sanitation Inspection (pdf) (Rev. 02/11/2022)
DOC 16-348HQ Headquarters Quarterly Safety and Sanitation Inspection (pdf) (Rev. 02/11/2022)
DOC 16-352 Outdoor Heat Exposure Awareness Training (pdf) (Rev. 11/18/2019)
- DOC 16-352ES Exposicion al Calor al Aire Libre Curso de Capacitacion (pdf) (Rev. 11/18/2019)
DOC 16-357 Crime Scene Containment/Preservation/Processing Checklist (pdf) (Rev. 04/19/2021)
DOC 16-358 Crime Scene Security Log (pdf) (Rev. 04/19/2021)
DOC 16-364 Pre-Maintenance Work Asbestos Assessment Tool (pdf) (Rev. 01/08/2020)

17 Series Forms

DOC 17-069 Infraction Review Checklist (pdf) (Rev. 02/22/2023)
DOC 17-070 General Infraction Report (pdf) (Rev. 02/22/2023)
- DOC 17-070ES Reporte de Infraccion General (pdf) (Rev. 02/22/2023)
DOC 17-071 Disciplinary Hearing Refusal/Waiver of Attendance (pdf) (Rev. 02/22/2023)
- DOC 17-071ES Audiencia Disciplinaria Renuncia a la Asistencia (pdf) (Rev. 02/22/2023)
DOC 17-073 General Infraction Hearing Extension (pdf) (Rev. 02/22/2023)
- DOC 17-073ES Prorroga de Audiencia Para Infraccion General (pdf) (Rev. 02/22/2023)
DOC 17-074 Disciplinary Hearing Appeal (pdf) (Rev. 07/22/2022)
- DOC 17-074ES Apelacion de Audiencia Disciplinaria (pdf) (Rev. 07/22/2022)
DOC 17-075 Segregation Authorization (pdf) (Rev. 10/12/2022)
- DOC 17-075ES Autorizacion Para Segregacion (pdf) (Rev. 10/12/2022)
DOC 17-076 Initial Serious Infraction Report (pdf) (Rev. 02/22/2023)
- DOC 17-076ES Informe Inicial de Infraccion Grave (pdf) (Rev. 02/22/2023)
DOC 17-077 Appeal Receipt (pdf) (Rev. 02/22/2023)
- DOC 17-077ES Recibo de Apelacion (pdf) (Rev. 02/22/2023)
DOC 17-084 General Infraction Appeal Decision (pdf) (Rev. 02/22/2023)
- DOC 17-084ES Decision Sobre Apelacion de Infraccion General (pdf) (Rev. 02/22/2023)
DOC 17-085 Sanction Notification (pdf) (Rev. 02/22/2023)
- DOC 17-085ES Notificacion de Sanciones (pdf) (Rev. 02/22/2023)
DOC 17-086 Department Interpreter Authorization for General Infraction Hearings/Stipulated Agreement (pdf) (Rev. 08/04/2020)
DOC 17-087 Separation/Prohibition Addition/Removal (pdf) (Rev. 03/10/2021)
DOC 17-088 Disciplinary Hearing Audio Request Log (pdf) (Rev. 07/22/2022)

18 Series Forms

DOC 18-022 Incident Review Report (pdf) (Rev. 09/24/2020)
DOC 18-024 Critical Incident Review Action Plan (pdf) (Rev. 09/24/2020)

19 Series Forms

DOC 19-003 Equipment Transfer/Loan (pdf) (Rev. 03/26/2020)
DOC 19-058 Release of Funds (pdf) (Rev. 02/27/2023)
DOC 19-080 Receipt of Legal Media Materials (pdf) (Rev. 11/05/2020)
DOC 19-082 Vehicle/Machinery Disposal Request (pdf) (Rev. 07/24/2019)
DOC 19-083 Equipment Disposal Request Surplus/Donate/Scrap/Lost/Stolen (pdf) (Rev. 03/26/2020)
DOC 19-084 Legal Copy/Indigent Postage/Scanning Request (pdf) (Rev. 10/06/2022)

20 Series Forms

DOC 20-051 Serious Infraction Report (pdf) (Rev. 02/22/2023)
- DOC 20-051ES Informe de Infraccion Grave (pdf) (Rev. 02/22/2023)
DOC 20-060 Visitor Application (Rev. 09/2022)
DOC 20-073 Standard Rules (pdf) (Rev. 03/17/2022)
- DOC 20-073ES Reglas Estándar (pdf) (Rev. 03/17/2022)
DOC 20-084 Social Outing Request and Responsibilities (pdf) (Rev. 11/15/2021)
- DOC 20-084S Peticion Y Responsabilidades De Una Excursion Social (pdf) (Rev. 11/15/2021)
DOC 20-102 Schedule/Plan (pdf) (Rev. 01/09/2020)
DOC 20-155 Intake/Pre-Sentence Report Personal Information Sheet (pdf) (Rev. 03/09/2022)
- DOC 20-155ES Ingreso/Informe Precondenatorio Hoja De Informacion (pdf) (Rev. 03/09/2022)
DOC 20-167ES Continuance/Postponement of Decision of Disciplinary Hearing (pdf) (Rev. 02/22/2023)
DOC 20-169 Reentry Center Sponsor Application (pdf) (Rev. 11/15/2021)

DOC 20-169ES Reclusorio Nocturno Solicitud para Visitantes y Patrocinadore (pdf) (Rev. 11/15/2021)

DOC 20-171 Reentry Center Sponsor Interview/Orientation (pdf) (Rev. 11/15/2021)
DOC 20-181 Minor Visitor Application (Rev. 04/2021)
DOC 20-182 Government Designated Escort Application (Rev. 12/2020)
DOC 20-213 Marriage/State Registered Domestic Partnership Application for Intended Spouse/State Registered Domestic Partner Use (pdf) (Rev. 08/13/2020)

DOC 20-213ES Solicitud de Matrimonio/Union Civil de Pareja Domestica Registrada en el Estado. Uso del Pretendido Cónyuge/Pareja Domestica Registrado en el Estado (pdf) (Rev. 08/13/2020)

DOC 20-214 Marriage/State Registered Domestic Partnership Application (pdf) (Rev. 08/13/2020)

DOC 20-214ES Solicitud de Matrimonio/Union Civil de Pareja Domestica Registrada en el Estado. Uso del Pretendido Cónyuge/Pareja Domestica Registrado en el Estado (pdf) (Rev. 08/13/2020)

DOC 20-215 Marriage/State Registered Domestic Partnership Approval Release of Information (pdf) (Rev. 02/11/2021)

DOC 20-215ES Matrimonio/Union Civil de Pareja Domestica Inscrita Aprobacion para la Revelacion de Informacion (pdf) (Rev. 02/11/2021)

DOC 20-218 Marriage/State Registered Domestic Partnership Approval Routing (pdf) (Rev. 08/13/2020)
DOC 20-219 Acknowledgment of DOC 590.200 Marriages and State Registered Domestic Partnerships (pdf) (Rev. 08/13/2020)

DOC 20-219ES Matrimonio/Pareja Domestica Registrada en el Estado Aprobación de Divulgación de Información (pdf) (Rev. 08/13/2020)

DOC 20-230 Record of Volunteer Services for Incarcerated Individual (pdf) (Rev. 12/28/2020)
DOC 20-235 Work Program Assignment/Change/Termination (pdf) (Rev. 03/02/2022)
DOC 20-305 Correspondence Study Request (pdf) (Rev. 12/04/2020)

DOC 20-305ES Solicitud Para Tomar Cursos Por Correspondencia (pdf) (Rev. 12/04/2020)

DOC 20-309 Correspondence Education College Provider/Student Agreement (pdf) (Rev. 12/04/2020)
DOC 20-314 From Out-of-State (FOS) Face Sheet (pdf) (Rev. 12/20/2021)
DOC 20-329 Residential Parenting Program Community Visit Authorization (pdf) (Rev. 07/17/2020)
DOC 20-332 Residential Parenting Program Participant Application (pdf) (Rev. 07/17/2020)
DOC 20-333 Residential Parenting Program Case Plan (pdf) (Rev. 07/17/2020)
DOC 20-335 Residential Parenting Program Child Property Release (pdf) (Rev. 07/17/2020)
DOC 20-336 Residential Parenting Program Emergency Caregiver Application (pdf) (Rev. 07/17/2020)
DOC 20-414 Intake Questionnaire (pdf) (Rev. 09/01/2022)
- DOC 20-414ES Cuestionario de Ingreso (pdf) (Rev. 09/01/2022)
DOC 20-430 Kitchen Equipment Purchase Request (pdf) (Rev. 05/23/2019)
DOC 20-431ES Food Services Training Record - E/S (Registro De Entrenamiento De Servicios De Comida) (pdf) (Rev. 05/23/2019)
DOC 20-437 Partial Confinement Serious Infraction Report (pdf) (Rev. 01/09/2020)
DOC 20-438 Approval for Visits with Multiple Incarcerated Individuals (pdf) (Rev. 11/30/2021)

DOC 20-440 Native American Heritage Questionnaire (pdf) (Rev. 02/02/2022)
DOC 20-441 Parent/Guardian Consent for Minor Visit and/or Escort (pdf) (Rev. 11/16/2020)

DOC 20-441ES Permiso del Padre/Guardian Legal para Visita de Un Menor y/o Acompañante (pdf) (Rev. 11/16/2020)

DOC 20-443 Marriage/State Registered Domestic Partnership Process Checklist (pdf) (Rev. 10/11/2022)
DOC 20-450 Approval for Visits by Current/Former Employee, Contract Staff, or Volunteer (pdf) (Rev. 01/04/2023)

21 Series Forms

DOC 21-043 Evidence Card (pdf) (Rev. 01/08/2020)
DOC 21-139ES 90 Day Property Disposition - E/S (Disposicion De Propieded De 90 Dias) (pdf) (Rev. 08/01/2019)
DOC 21-148 Extended Family Visit Property Waiver (pdf) (Rev. 10/01/2020)
DOC 21-312 Disciplinary Hearing Minutes and Findings (pdf) (Rev. 02/22/2023)
- DOC 21-312ES Actas y Determinaciones de Audiencia Disciplinaria (pdf) (Rev. 02/22/2023)
DOC 21-312 Disciplinary Hearing Minutes and Findings (Continuation Sheet) (pdf) (Rev. 02/22/2023)

DOC 21-312AES Actas y Determinaciones de Audiencia Disciplinaria (Segunda hoja) (pdf) (Rev. 02/22/2023)

DOC 21-329 Property - ID Label (pdf) (Rev. 08/01/2019)
DOC 21-357 Emergency Notification Information Card (pdf) (Rev. 07/18/2019)
DOC 21-379ES Informe de Una Alegacion a Una Agencia Externa Ley Para la Eliminacion de Violaciones en Prison (PREA) (pdf) (Rev. 04/19/2022)
DOC 21-408 Dry Cell Watch Authorization (pdf) (Rev. 09/09/2021)
- DOC 21-408ES Autorizacion Para Registro/Vigilancia de Celda Seca (pdf) (Rev. 09/09/2021)
DOC 21-415 Extended Family Visiting Visitor Acknowledgment (pdf) (Rev. 10/01/2020)
- DOC 21-415ES Visita Familiar Extendida Solicitud/Reconocimiento (pdf) (Rev. 10/05/2020)
DOC 21-417 Extended Family Visit Facility Action (pdf) (Rev. 12/20/2022)
- DOC 21-417ES Accion de la Visita Familiar Extendida (pdf) (Rev. 12/20/2022)
DOC 21-421ES Aceptacion del Uso del Telefono en La Prisión (pdf) (Rev. 05/16/2022)
DOC 21-425 Shift Commander/Unit Supervisor Use of Force Report (pdf) (Rev. 08/30/2019)
DOC 21-470 Extended Family Visit (EFV) Review Decision/Recommendation (pdf) (Rev. 2/17/2022)
DOC 21-472 Behavior and Programming Plan (BPP) (pdf) (Rev. 08/04/2021)
DOC 21-473ES Kite - E/S (Kite) (pdf) (Rev. 08/04/2020)
DOC 21-489 Facility Guest Access (pdf) (Rev. 10/25/2021)
DOC 21-503 Special Escorted Leave Reimbursement Request (pdf) (Rev. 01/06/2023)
DOC 21-506 Special Escorted Leave Worksheet and Checklist (pdf) (Rev. 01/06/2023)
DOC 21-507 Temporary Transfer of Custody Between Washington State Department of Corrections and Tribal Executive Leadership (pdf) (Rev. 01/06/2023)
DOC 21-548 Notification of Restrictions (pdf) (Rev. 11/07/2022)
DOC 21-563 PREA Vulnerability Assessment (pdf) (Rev. 04/19/2022)
DOC 21-565 Hazard Communication Label and Safety Data Sheet Training (pdf) (Rev. 07/10/2020)
- DOC 21-565S Etiqueta de Comunicación de riesgos y Entrenamiento de Ficha de Datos de Seguridad (pdf) (Rev. 07/10/2020)
DOC 21-566 Security Concerns/Suggestions (pdf) (Rev. 06/26/2019)
DOC 21-572 Request for Inter-Facility Telephone Communication (pdf) (Rev. 03/01/2023)
DOC 21-574 Control Card (pdf) (Rev. 02/06/2023)
- DOC 21-574S Tarjeta de Control (pdf) (Rev. 08/05/2020)
DOC 21-575ES Acknowledgment of Visitor Search Requirements - E/S (Reconocimiento De Los Requisitos Para El Registro De Visitantes) (pdf) (Rev. 11/30/2021)
DOC 21-583 Fall Protection Work Plan (pdf) (Rev. 12/17/2020)
DOC 21-611 Associate List (pdf) (Rev. 08/13/2021)
DOC 21-616 Close Associate Recommendation (pdf) (Rev. 08/13/2021)
DOC 21-632 Restrictive/Secured Housing Unit Conditions of Confinement Modification Approval (pdf) (Rev. 06/03/2022)
DOC 21-660 Off-Site Work Crew Security Audit (pdf) (Rev. 02/02/2022)
DOC 21-662 PREA Database Access Confidentiality Agreement (pdf) (Rev. 01/27/2022)
DOC 21-665 Extended Family Visit (EFV) Orientation (pdf) (Rev. 06/03/2022)
DOC 21-666 Off-Site Work Crew Daily Log (pdf) (Rev. 02/02/2022)
DOC 21-720 After Hours Escape Information (pdf) (Rev. 12/13/2019)
DOC 21-734 Emergency Preparedness and Fire Drill Report (pdf) (Rev. 01/20/2022)
DOC 21-754ES Accion Telefonica (pdf) (Rev. 05/16/2022)
DOC 21-757 Publication Rejection Appeal (pdf) (Rev. 01/20/2020)
- DOC 21-757ES Apelación De Una Publicación Rechazada (pdf) (Rev. 01/20/2020)
DOC 21-761 Prohibited Contact Review (pdf) (Rev. 04/25/2022)
DOC 21-764 Flammable, Toxic, and Caustic Material (FTCM) Log (pdf) (Rev. 07/10/2020)
DOC 21-787 Special Visit Request (pdf) (Rev. 11/30/2021)
- DOC 21-787ES Peticion Para Una Visita Especial (pdf) (Rev. 11/30/2021)
DOC 21-916 Presumptive Drug Testing Agreement (pdf) (Rev. 09/03/2019)
DOC 21-917 Incident Report (pdf) (Rev. 12/20/2021)
DOC 21-964 Reentry Community Services Program Transition Plan (pdf) (Rev. 08/20/2021)
DOC 21-966 Donation Approval Request (pdf) (Rev. 06/22/2022)
DOC 21-992 Prison Orientation Checklist (pdf) (Rev. 12/27/2021)
- DOC 21-992ES Lista de Temas de la Orientacion en Prisión (pdf) (Rev. 12/27/2021)

Miscellaneous

Indeterminate Sentence Review Board Victim Confidentiality Request (pdf)
Report Tips and Leads (Rev. 08/2018)
Subscription Request (Rev. 09/2019)