John E. Rodarte, Sr. v. Ralph Lopez ( 2015 )

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OFFICE USE ONLY
Texas Department of Criminal Justice
Grievance #:.
OFFENDER
Date Received;.
STEPl GRIEVANCE FORM
"^ateDiie: r
Grievance Code: .
Offender Name: S.-7. ^ TDCJ # investigator ID
Unit: Housing Assipnment:"^/g^'t>?'^' ^ /"2 3~^ Extension Date:
Unit where incident occurred: A') /T. Date Retd to OiTender;.
You must try to resolve your problem with a staff member before you submit a formal complaint. The onlyexception is when
appealing the results of a disciplinary hearing.
\Vhodi(itwwtdV<1bA0iifi:,title)? lA/n f 'M When? //^/ 'Zy-^/^C'JC
What was their response? A<
What action was taken? AJtJJr'. Of>. Tr-"* • A -NOV n ? 2015
State your grievance in the space provided. Please state who, what, when, where and the disciplinary ease number if appropriate
On
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1-127 Front (Revised 11-2010) YOUR SIGNATURt IS REQUIRED ON BACK OK THIS FORM HOVER)
Appendix F
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Ndv 0 2 2015
Action Requested to resolve your Complaint.
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•^u^y^y^T'—y^/yy A/^y.-p • y'C'./ny^ yttUf
Offender Signature:^ Date: /' C-/
Grievance Response:
Signature Authority: Date:
Ifvuu arcdi«sativlicd »iththc.Slcp I response.)you may submit 8Slep 2(1-128) (o the Unit Grievance Investigator nithin 15 days from the dale ofthe Step I response.
Stale the reason for appeal on the Step 2 Form.]
Returned because: *Resubmit this foym when the corrections arc made.
• l Grievable time period has expired.
n 2. Submission in excess of I every 7 days. OFFICE ^SE ON
liiilini :>tibtnission luGI Iniiials
f~l 3. Originals not submitted. •
Grievance #:
• 4. Inappropriate/Excessive ultachments.
Screening Criteria Used:
r~l .5. No docuinenled attempt at infcnnal res:ilution. wmrrn
Dale Reed from Offender;
• 6. No requested relief is slated. *
Date Returned lo Offender:
-NOV 0 2 2015
• 7 Malicious use ofvulgar, indecent, or piVsically threatening language.
Z'^&MlUBiSSimi -UCI Initials:.
n 8. jrhgiinHie'prdSehte'J'is not ^evable Grievance #:
iyi 9. Redundant, Referiogrievance Screening Criteria Used:
si Dale Reed from Offender:
Q 11! Inappropfiaie. ^ Date Returned to Offender:
ij\ UGI Printed Name/Signature: au-aiUunihSM uci initials:.
Grievance S:
Application of tlie screening criteria for this grievance is not expected to.adversely
Screening Criteria Used:.
Affect the offender's health.
Date Reed from Offender:
Mcdicai Signature Authority:. Dale Returned lo Offender:
1-127 Back (Revised 11-2010)
Appendix F
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TDCJ - INSTITUTIONOL DIVISION
OFFICIAL LAYIN PASS
RDMINISTROTIVE
EFFECTIVE DATE: ll/04/e0i5
FRDM-TO TIME: 03:45--05:A5
START DATE: 11/'M/£015 END DATE: 11/0A/S015 i
ADMIT: 01£&3£70 RCDARTE,JOHN SR
REASON: LAW LIBRARY 1ST HOUSE-<,^135-1 £1
JOB: UNASSN MEDICAL 00:00-00:00!
EDUC: ^
I
COUNTROOM: GRANT
TITLE: ADMIN