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La County Grievance Procedures and Forms Rev2008

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5-12/000.00 INMATE COMPLAINT/SERVICE REQUESTS

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ti-12/000.0_QJNJ\l!AIE.C.QMPLAINT/SERVICE REQUESTS
Any inmate within Custody Operations and Correctional Services Divisions may submit a
complaint or request for service relating to any condition of confinement using the Inmate
Complaint/Service Request Form (SH-J-420 Rev. 5/07).
.
NOTE: For the purpose of this policy, the terms "grievance" and "complaint" are
synonymous.
Complaints or requests for service relating to a condition of confinement may include, but are
not limited to, medical/mental health services; complaints against staff; classification actions;
disciplinary actions; program participation; chaplain services; telephone; mail; visiting
procedures; food, clothing, and bedding; facility conditions; inmate money accounts; inmate
property issues; and commissary.
A complaint must be submitted by or on behalf of the inmate, whether in custody or not, within
15 calendar days after the event upon which the complaint is based, or the complaint will be
denied. In the event that custody personnel receive a complaint or request for service that is
not written on an Inmate Complaint/Service Request Form (SH-420), the employee is
responsible for returning the request to the inmate and providing the inmate with the proper
form, with the exception of "basic" inmate requests for service or information (see Inmate
"Basic Requests" for Service or Information). Use of the LASD Inmate Complaint/Service
Request Form is mandatory for all inmates in custody. Each housing area will have a locked
repository accessible to inmates to deposit their completed form without interference.
Complaints submitted after the 15 calendar day requirement will be accepted for statistical
purposes; however, the complaint will be denied and automatically issued the "50" - late
submiSSion, disposition code.
Administrative Process for Inmate Complaint/Service Requests
Assigned floor supervisors shall collect the Inmate Complaint/Service Request Form from the
locked repositories on each shift and ensure the inmate has taken their copy of the form. Floor
supervisors shall document in the Uniform Daily Activity Log (UDAL) indicating that the forms
were collected for the shift. All Inmate Complaint/Service Request Forms shall be immediately
reviewed by the collecting supervisor, and have a reference number assigned for all
complaints and services requests that will be handled by that particular facility. Any "basic"
inmate requests for service or information that are submitted on an Inmate Complaint/Service
Request Form shall be handled via the procedures listed under the section, Inmate "Basic
Requests" for Service or Information, and shall not require a reference number.
The supervisor shall separate all complaint/requests that can be investigated and resolved by
line personnel and place these complaint/requests into the Watch Sergeant's in-box. The
Watch Sergeant or his/her designee shall assign the
complaint/requests to personnel to investigate and resolve. If the complaint or request involves
conditions or personnel at another facility, the facility receiving the complaint shall faCSimile the

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5-12/000.00 INMATE COMPLAINT/SERVICE REQUESTS

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form to the concerned facility's unit commander and mail the original.
It shall be the handling unit's responsibility to obtain a reference number and process the
complaint or request.
If a form is submitted with more than one complaint or request involving the receiving unit and
another unit, the supervisor shall obtain a reference number for the complaint or request
involving his/her unit. The supervisor shall then facsimile the form to the unit commander of the
second unit, who will then obtain their own reference number and process the portion of the
complaint or request that involves their unit.

For the purpose of this policy a group complaint is defined as any complaint submitted by three
(3) or more inmates confined in the same housing location, referencing the same or similar
complaints. All group complaints shall be collected and assigned only one reference number
as opposed to individual reference numbers. Group complaints shall be identified and entered
into the reference number log and the Facility Automated Statistical Tracking (FAS.T.)
System accordingly.
Inmate Requests fQLg_ervice
Requests for service or information received by a supervisor, may include, but are not limited
to, medical/mental health services; educational or vocational programs; inmate worker
classification; chaplain services; and commissary. These requests must be submitted on an
Inmate Complaint/Service Request Form (SH-J-420) and require a reference number.
Requests pertaining to a medical or mental health issue shall be handled without delay. If an
emergency medical condition exists with the inmate, the inmate shall be escorted immediately
to the clinic area.
The supervisor handling the request shall:
• Time stamp the form in the upper right corner;
• Make a photocopy of the form;
• Deliver the photocopy to the on-duty clinic supervisor;
• Retain the original complaint form and place it into the Inmate Complaint/Service Request
Coordinator's tray at their particular facility.
NOTE: Requests concerning mental health issues: The facility's clinic shift supervisor will
forward the complaint or request to Jail Mental Health Services.
Inmate "Basic Requests" for Service or Information
For the purpose of this policy, the term "Basic Requests" refers to simple requests that a
module or line officer can quickly obtain, such as, but not limited to: release date, next court
date, sentence status, inmate money accounts, and requests for supplies such as an inmate
admission kit.
Basic requests may be investigated and resolved by any Custody Assistant, Deputy Sheriff,
Senior Deputy, or Sergeant. These requests are not required to be written on an Inmate

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Complaint/Service Request Form (SH-J-420) and will not require a reference number. Basic
requests shall be completed in a reasonable amount of time and will not require further
process.

Complaints shall only be investigated by supervisors with the rank of Sergeant or above. The
assigned supervisor (rank of Sergeant or above) shall conduct a thorough investigation and
take all necessary steps to determine if the complaint is founded or unfounded. Complaints
should be investigated and resolved within 10 business days, or as soon as reasonably
possible.
Findings resulting from an investigation in response to an inmate complaint generally fall into
one of six categories:
• Founded - When the investigation establishes that the allegation is true and/or when the
action on the part of the Department member(s) is prohibited by law or by Department policy,
• Unfou[1ded - When the investigation clearly establishes the allegation is not true or when the
actions of the Department member, which formed the basis for the complaint, are not violations
of law or Department policy, and are otherwise not censurable,
• .Unresolved - When the investigation fails to resolve the complaint, and there is no
preponderance of evidence to either affirm or refute the inmate's allegation/complaint,
·Unit LevQllnvestigation - Allegations of misconduct are forwarded to the unit commander for
investigation and disposition,
• Internal Affairs Bureau Investigation (IAB)- Allegations of misconduct are forwarded to
Internal Affairs Bureau for investigation and disposition,
'inillfJl§lCrj[)1inaUnvestigations Bureau Investigation - Allegations of criminal misconduct are
forwarded to the Internal Criminal Investigations Bureau for investigation.
NOTE: Refer to Complaints Against Personnel below.
Resolution of the Complaint
Once the results of the complaint investigation have been determined, the assigned supervisor
shall complete the "Disposition" section on the Inmate Complaint/Service Request Form. A
written response shall be delivered to the inmate generally within 10 business days after the
submission of the complaint. A written response shall be provided for any approval or denial of
a complaint. This requirement shall be satisfied by providing the inmate a copy of the final
disposition of the Inmate Complaint/Service Request Form.
Inmates shall sign the original or facsimile copy (if forwarded from another unit) of the Inmate
Complaint/Service Request Form to document receipt of the written response as stated in Title
15 Section 1073, "Inmate Grievance Procedure." However, if the complaint was previously
addressed as the result of a court order or other governmental referral, it is not mandatory to
summon the inmate for his/her signature. If the inmate is released prior to the completion of

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the complaint, it shall be noted in lieu of the inmate's signature.
For complaints relating to inmates that have been released, after the submission of a
complaint, the assigned supervisor shall note in the "Disposition" section that the inmate has
been released. A copy of the disposition should be forwarded to the released inmate's listed
mailing address. Once the complaint has been resolved and signed by the inmate (if
applicable), the Inmate Complaint/Service Request Form shall be placed into the facility's
Inmate Complaint/Service Request Coordinator's in-box for further processing.
NOTE: The Inmate Complaint/Service Request Coordinator shall ensure that the receipt of the
written response is properly entered in the FAS.T. system. The Inmate Complaint Disposition
Data Form, SHJ-438, shall no longer be used, with the exception of Referred Inmate
Complaints. The SHJ-438 is information now is captured on the back of the Inmate
Complaint/Service Request Form. Additionally, all Inmate Complaint/Service Request Forms,
SH-J-420, dated prior to May 2007, shall not be used and must be discarded.
Complaints From Released Inmates
Inmate complaints received from persons that have been released from custody shall be
processed on an Inmate Complaint/Service Request Form (not a Watch Commander Service
Comment Report form) pursuant to Manual of Policy and Procedures, section 3-04/010.05,
"Procedures for Department Service Review." Complaints submitted from former inmates shall
be subject to the same guidelines, requirements and procedures as a complaint submitted by
an inmate in custody.
Referred Inmate Complaints
In the event an inmate is unable to submit a complaint, a complaint may be submitted by a
non-involved or non-aggrieved party; i.e., an inmate's friend, relative, etc. on behalf of an
inmate. Referred inmate complaints shall be processed pursuant to Custody Division Manual
section, (2,J2IQ£O.l)Q, "Referred Inmate Complaints." Referred inmate complaints shall be
subject to the same guidelines, requirements and procedures as a complaint submitted by an
inmate in custody.
Complaints Against Personnel
The results of an investigation pertaining to an inmate complaint, that involves the conduct of
personnel, shall not be disclosed in any form, including written responses to inmate
complaints. The reviewing supervisor shall advise the inmate, in writing, of the disposition of a
complaint against any personnel or any results of inquiries pertaining to personnel conduct.
The information disclosed to the inmate shall be limited to the following information:
• Acknowledgment of the complaint,
• Statement that the investigation was completed,
• Assurance that the appropriate administrative action has been taken.
Note: For unfounded or unresolved complaints against staff, the disclosure shall be limited to
the following response: "Your complaint has been thoroughly investigated; however, we were
unable to substantiate that (employee's name) violated any of our Department policies and
procedures."

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5-12/000.00 INMATE COMPLAINT/SERVICE REQUESTS

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When an inquiry into the conduct of any personnel results in the initiation of a unit level or lAB
investigation, the supervisor conducting the inquiry into the inmate complaint shall complete
the "Disposition" section of the Inmate Complaint/Service Request Form, indicating the
disposition as "Unit Level Investigation" or "Internal Affairs Bureau Investigation."
Jurisdiction of Complaints
Any question of complaint jurisdiction within a jail facility shall be determined by the unit
commander. Any question of jurisdiction within the Custody Operations Division shall be
determined by the Division Chief.
Retention of Original If1!ll ate C9JIlP1.?ints
Pursuant to Custody Division Manual section 4-13/Q_00.00, Custody facilities shall retain all
inmate complaints for five (5) years. Additionally, all inmate requests requiring a reference
number shall be retained for five (5) years.
6PJ)ealj"rocess for Complaints
Inmates must submit an appeal from a denied complaint within five (5) calendar days of
receiving the written disposition regarding their complaint, or they will be denied. Appeals shall
be submitted on the Inmate Complaint Appeal Form (SH-J-446). The appropriate supervisor
(watch commander, medical supervisor, mental health supervisor, or food production
supervisor) shall make the final determination of the resolution for the appeal.
Inmates shall be advised, in writing, of the disposition of their appeal within 10 business days
after the submission of the appeal. The unit commander or his designee, shall review all
inmate complaint appeals to ensure a thorough investigation has been conducted and the
appropriate disposition has been rendered.
Extensions
The Unit Commander, or their designee, may extend time deadlines for the submission or
disposition of a complaint or appeal in the event of an emergency situation or when there is an
extended disruption of normal facility operation.

Revised 04/01/08
Revised 08/16/07
12/10/01 CDM

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COUNTY OF LOS ANGELES SHERIFF'S DEPARTMENT

INMATE COMPLAINT / SERVICES REQUEST FORM
Instructions:
FlU out the portion below as completely as possible. -Place" an f'X'" in the appropriate box. Once completed,
tear ofl the last copy lor yourself and then place the original and the second copy into the "Request / Complaint
Form" box. Some of the choices mayor may not apply to you or your facility,

Only one request per form.

I WOULD LIKE TO SPEAK WITH A:

o

Inmate Services

o

Other:

Chaplain:
Religious Preference

Language _ _ _ _ _ _ __

o

Education Representative

0

V.A. Representative

~_--1-~

_ __

Release Planner from the Community Transition Unit (CirCle all that apply).
Information all any courl ordered classes (domestic vlolonce, parenting, subslanCQ abuse assistance), education programs, Job training, housing,
medical health, mentaillealth, transpoT1ation to a shelter or drug rehab programs, social security benefits, or religious services,

REQUEST TO SPEAK WITH THE APPROPRIATE PERSON REGARDING:
ITa~;;~';~g an-~~ale worker.

o

Becoming an inmate station worker.

o

When is m release date?

o
o

o

Attending school while in custody.
Attonding substance abuse treatment while in cuslody.

REQUEST FOR INFORMATION:

0

When Is m next court date?

D What is m

account balance?

0

Other:

I WOULD LIKE TO RECEIVE:
Ha'lf('llt (Indigent I No Funds)

0

Wrlting materials (lndigenll No Funds)

Library time (Mayor may not appty to your facility)

0

Law Library time

0 Commissary 0
0 Legal torms

ShaGS

OOlher:"

S

Specify

ci

I HAVE THE FOLLOWING REQUEST / COMPLAINT:
(11 Ihis Is a cOnlpluinl, inclUde dales, limes, and names 01 palsons involvod, Attach Mdllionsl pages if needed.)

·••·····•··••••·•.. ••••••• .. ·•.. ············FOR DEPARTMENT USE ONLY ~OO NOT WRITE BELOW THIS LINE·........•.. •••.. ··-·· ..•......•••• ..•

DISPOSITION

Yellow - hllnme coPy i,l lime or disposillOIl

[link -- inmale copy at lillie of sllbmissi()1\

·

... ,..

··llOl'JSI~G·TYFil"(G".P': Olst'ipllnaJ Adlnili S.~.\l ,'PIO rbI, t;l.au9,·MQdief"E~C),

I

00 NOT VlRltEQNTHISSIO.E.
DATE,T1ME, DAY OF i:)CCUflANCE

LAST NAME

I

FACll"lty.OF OCGURANC. E··I

. I.

roCATION OF .oCCUAANCE·

.

.(

J'

IRST NAME

RESIDENTIAl. ADDRESS

FINDINGS:

-----~--------------------------.

-~~---~~-~-------

...-~~---.-~~.-- .. ---'--~.

- . - -..-------.-----.~.'-'-'-'-'-'------

-----.~-.---

NOTE: For unidentified

complainants,useaboo~ing

II of 0000000.

..........

.

COUNTY OF LOS ANGELES SHERIFF'S DEPARTMENT

INMATE COMPLAINT APPEAL FORM

Instructions:
Fill out the portion below as completely as possible, Provide as much detail as possible why you are appealing
the Judgment on your complaint. Once completed, place both copies into the "Request I Complaint Form" box,
Only one appeal per form, As an inmate within the Los Angeles County Jail system, you have only Q calendar
days from the time you received the results of your complaint to submit an appeal.

•••••••••• ••• ••••·•• ••••• •• ................·FOR DEPARTMENT USE ONLY - DO NOT WRITE BELOW THIS LINE················· ••••••••••• ·•••••••••

DISPOSITION

--""'---'--"-------------------------

-

THIS APPEAL HAS BEEN DISCUSSED WITH ME AND I HAVE BEEN ADVISED OF ,T'"H"'E"-F'''''ND''''N'''G'''S'-___- - . - - - ;

f~~~,_,,_

Nan_10 or Person Handlinq Appeal

[

"

$~IJ·446

'

'"

Inmate Signature

----

I'BO()kin g .# '

Date

Name______-+E-=Ecc.mxP-"lo:.<y'-"e"'e"",#-+-=D"'a""te"-'-~____R_E"F_E,..cR_EN_"C_E_N-'U-'M_'B_E__R===-'-"'-'---1J

 

 

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