Texas Department of Criminal Justice
Texas Department of Criminal JusticeEmployee Offense and PreHearing Investigation ReportPurpose: This form is used to record alleged violations of rules or regulations by employees. It also serves as a prehearing investigation report. If additional space is needed for any portion of this report, a continuation sheet may be attached.I. To be completed by the Charging Official:Employee Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Payee ID: FORMTEXT ?????LastFirstMIPayrollJob Title: FORMTEXT ?????Date ofIncident: FORMTEXT ?????(mm/dd/yyyy)Description of employee’s specific conduct. Do not reference rule number or describe the rule: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????The employee’s conduct may be a violation of rule number: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Charging Official Name and Title (Print)SignatureDateII. Employee’s Statement: The prehearing investigator shall obtain an employee’s statement even when a Use of Force Fact Finding Inquiry, Risk Management Incident Review Board, or Office of the Inspector General investigation has been conducted. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employee’s Signature:Date: FORMTEXT ?????Note to Employee: With few exceptions, you are entitled upon request: (1) to be informed about the information the TDCJ collects about you; and (2) under Texas Government Code §§?552.021 and 552.023, to receive and review the collected information. Under Texas Government Code §?559.004, you are also entitled to request, in accordance with TDCJ procedures, that incorrect information the TDCJ has collected about you be corrected.III. Witnesses: See attached.IV. Prehearing Investigator’s Review and Recommendation:Employee Hearing: FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, alleged rule violation number(s): FORMTEXT ?????Comments: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investigator’s Name and TitleSignatureDate(Print)V. Reprimanding Authority’s Action:427291529591000 FORMCHECKBOX Proceed to employee hearing. Alleged rule violation number: FORMTEXT ????? FORMCHECKBOX No employee hearing and no action taken. FORMCHECKBOX No employee hearing and other action taken, such as dispute resolution or training. Attach explanation of action taken. FORMTEXT ?????Reprimanding Authority’s Name and Title(Print)SignatureDate ................
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