Index #: 118.

01 Page 1 of 18
ADMINISTRATIVE POLICIES
AND PROCEDURES Effective Date: February 15, 2014
State of Tennessee Distribution: A
Department of Correction Supersedes: 118.01 (1/1/11)
PCN 13-2 (2/1/13)
Approved by: Derrick D. Schofield
PCN 12-2 (1/1/12)
Subject: RELIGIOUS PROGRAMS

I. AUTHORITY: TCA 4-3-603, TCA 4-3-606, the Religious Land Use and Institutionalized Persons
Act, 42 U.S.C. 2000cc, et seq., the Omnibus Crime Control and Safe Streets Act of 1968, 42 U.S.C.
3789d, and the Prison Litigation Reform Act of 1995.

II. PURPOSE: To ensure access to religious resources for all inmates.

III. APPLICATION: To all Tennessee Department of Correction (TDOC) staff, volunteers who are
involved in the operation of religious programming, all inmates, and employees of privately managed
institutions.

IV. DEFINITIONS:

A. Chaplain : A staff member who is an ordained or endorsed minister in his/her faith group
and who remains in good standing and meets the requirements established by the
Department of Human Resources for employment as a chaplain. This individual is
responsible for providing pastoral care and religious leadership within an institution.

B. Director of Religious Services: Designated staff person who is an ordained or endorsed

minister in his/her faith group and who remains in good standing responsible for overseeing
and evaluating all religious activities within the Department.

C. Faith Group: A group whose sole purpose is to conduct a religious activity or religious
exercise.

D. Outside Clergy: Ordained clergypersons who come into TDOC institutions for the purpose
of ministering to inmates.

E. Religious Activity: An activity or program conducted by or under the supervision of the

chaplain or under the supervision of trained staff or approved volunteers. This activity is
designed specifically for worship, religious education, spiritual guidance, counseling or
other religious service.

F. Religious Activities Committee: A group established by the Director of Religious Services

with approval of the Commissioner responsible for review and approval of religious
accommodation requests.

G. Religious Exercise: Study, prayer, worship, and other liturgical activities, usually directed
toward a god or gods, to achie ve benefits in this life and/or eternity.

H. Religious Volunteer: A volunteer who participates in or leads religious services, religious

activities, and/or religious exercises.
Effective Date: February 15, 2014 Index # 118.01 Page 2 of 18

Subject: RELIGIOUS PROGRAMS

I. Security Threat Group (STG) : Any group, organization, or association of individuals who
possess common characteristics which serve to distinguish them from other individuals or
groups who have been determined to be acting in concert, so as to pose a threat or potential
threat to staff, other inmates, the institution, or the community.

J. Volunteer Chaplain : Religious or faith-based volunteer appointed by the Warden or

designee to assist the chaplain in performing his or her duties.

V. POLICY: The Department shall provide opportunities for inmates to voluntarily practice their
religion and receive appropriate pastoral care during incarceration.

VI. PROCEDURES:

A. Security Threat Groups (STG) : Inmate possession of STG type materials or symbols is
prohibited. First Amendment free exercise protection applies to religious ideas and symbols
by faith groups whose only purpose is religious but it does not extend to STG’s use of
religious ideas and symbols.

B. Religious Staff

1. Institutional Chaplains

a. The institutional chaplain shall be responsible for planning, leading,

administering, and coordinating religious activities and developing community
resources to meet the religious needs of inmates within the guidelines set by
policy with the approval of the Warden. The Warden may delegate approval
authority for specific actions to the chaplain or other designee.

b. In institutions without a chaplain, the Warden shall appoint one or more staff
members to perform the chaplain's duties.

c. Volunteers for religious assignments and religious program interns shall work
under the supervision of the chaplain or other designated staff member.

d. The chaplain shall be responsible for initiating programs, drafting budget

requests, and submitting reports. The chaplain shall attend appropriate staff
meetings and work with other staff for the well-being of the inmates and the
institution.

e. The chaplain shall have access to all areas of the institution, all staff, and all
inmates.

f. Chaplains shall be available to provide counseling to inmates in areas of religious

concerns, personal matters, crisis or high anxiety situations, and/or family
problems upon request from inmates. An appropriate private area should be made
available for the chaplain to counsel persons without interruption.

g. Inmates who are in segregation shall have the opportunity to see the chaplain or a
volunteer chaplain for crisis situations and at least weekly for routine matters.
Effective Date: February 15, 2014 Index # 118.01 Page 3 of 18

Subject: RELIGIOUS PROGRAMS

h. Chaplains shall remain in good standing with their faith group and retain their
endorsed or ordained status. Chaplains shall be permitted to attend events of their
faith group when participation is expected of all persons in their position. The
expense for attendance shall be paid by the chaplain, but he/she shall be granted
administrative leave for up to five days per year for such required attendance.

i. The chaplain may be asked to visit and/or counsel with staff or meet with staff's
families in hospitals or funeral homes, and he/she may be granted administrative
leave by the Warden for such visits and meetings.

j. The Department shall not impose upon the chaplain or any volunteer chaplain,
any duties that are in conflict with the chaplain's faith group, i.e., marriage,
baptism, communion. When a conflict exists, the chaplain shall make a
reasonable effort to assist inmates in locating another TDOC chaplain , outside
clergy or volunteer chaplain, or a community religious leader to fulfill the
request.

k. The chaplain shall avoid proselytizing for his/her particular faith.

l. The chaplain may, with the Warden’s approval, develop training opportunities
for clergy and theological students and/or supervise field training for theology
students where such programs can provide a valuable supplement to the religious
programming at the institution.

m. The Warden may appoint volunteer chaplains as needed.

n. The chaplain shall document inmates changing their religious preference on

eTOMIS (LCLA). The chaplain will also document this on eTOMIS contact
note screen (LCDG) using contact code “RECH” indicating a reason for the
change. Indic ation of religious preference by an inmate does not constitute
approval by TDOC of the accommodations requested by the indicated group. To
permit processing of records, inmates may change their religious preference no
more frequently than quarterly. The inmate’s religious property specific to
his/her former religious preference must be sent home or otherwise disposed of
within 30 days after changing religious preference.

o. Chaplains shall execute their duties relating to inmate marriages as described

within Policy #503.07. Neither Chaplains nor volunteer Chaplains in TDOC or
privately managed facilities shall receive a fee or solicit donations to charities in
exchange for performing marriages or premarital counseling services. Qualified
outside persons may receive such fees as negotiated and agreed to by the inmate.

2. Outside Clergy, Volunteer Chaplains, and Religious Volunteers

a. Inmates may receive visits from outside clergy, volunteer chaplains, and religious
volunteers. Their names and the names of inmates they are allowed to visit shall
be provided by the chaplain or designated religious leader and maintained at
checkpoint.

b. All volunteer chaplains and religious volunteers must comply with policies in the
#115 series (Volunteer Services).
Effective Date: February 15, 2014 Index # 118.01 Page 4 of 18

Subject: RELIGIOUS PROGRAMS

c. Outside clergy, volunteer chaplains, and religious volunteers should be recruited

to assist in meeting the religious needs of all represented faith groups in the
institution.

d. Individuals or groups aspiring to be volunteers have no First Amendment right to

minister in prison.

e. Religion may be a factor in selecting volunteers, either to maintain balance

between faith groups or to recruit a leader for a specific faith group.

f. Volunteer chaplains and religious volunteers may be required to be inclusive as

they lead groups and failure to do so may result in their dismissal.

g. Outside clergy, volunteer chaplains, and religious volunteers may speak

positively about their own faith but may not speak negatively about other faiths.

h. Volunteers shall not provide any personal contact information such as phone
numbers, e-mail address, or street address to inmates but volunteers may provide
contact information of their sponsoring organizations.

i. Volunteer chaplains are TDOC-certified volunteers who work either part-time or

full-time assisting the chaplain. Duties are assigned according to differing skill
levels, abilities, and time commitments to the institution. In the absence of the
chaplain, a volunteer chaplain may fill in and assume the chaplain’s
responsibilities, subject to approval by the Warden. Volunteer chaplains are
recommended by the chaplain , appointed by the Warden, and may be required to
attend training specific to their required duties.

j. Outside clergy need not be placed on the approved visitor’s list and do not need
to become certified volunteers in order to visit. However, inmates may elect to
place outside clergy on their visitor’s list and outside clergy may elect to become
certified volunteers. All outside clergy must complete an Outside Clergy
Application, CR-3347, and have the approval of the chaplain in consultation with
the Director of Religious Services. They must acquaint themselves with the rules
of the institution and agree to abide by them. Outside clergy visits are scheduled
by the chaplain. The chaplain shall also maintain a list of approved outside
clergy. The list shall contain the clergyperson’s name, address, telephone
number, and e-mail address (if there is one); the name of the faith group; and the
name of the inmate(s) the clergyperson is approved to visit. The chaplain shall
maintain a file evidencing the qualifications of all approved outside clergy.

k. Religious volunteers work under the supervision of, and provide assistance to,
the chaplain. Each religious volunteer must comply with Policy #115.01 and
complete all required screening, training, orientation, and reference and
background checks.

l. All outside clergy (except those approved by the Warden for one-time emergency
visits) must receive an acceptable NCIC Criminal History Report which must be
updated at least every five years. If an outside clergy has been away from the
facility for more than 12 months, he/she shall be processed as a new outside
clergy.
Effective Date: February 15, 2014 Index # 118.01 Page 5 of 18

Subject: RELIGIOUS PROGRAMS

m. The chaplain or another staff member designated by the Warden shall submit a
NCIC Criminal History Request, CR-3552, within ten working days of receipt of
the application for all persons seeking to be approved as new outside clergy.
Results of the criminal history report shall be provided to the appropriate staff in
accordance with Policy #301.04. If the report discloses evidence of previously
undisclosed offenses, the Warden shall take appropriate action in the same
manner as provided in Policy #115.01.

n. Volunteers will be allowed to bring in outside food, paper goods, plastic utensils,
beverages, and necessary serving items at the discretion of the Warden for
special events such as but not limited to graduations, holidays, meetings and
family days. An itemized list of all requested items must be submitted to the
Chaplain and approved by the Warden 21 days prior to the event, such as
graduations, holidays, meetings and family days. All food, beverage(s) and
paper goods items will be cleared by security before being allowed entry into the
facility. Volunteers are responsible for providing all supplies necessary for the
serving of their food items and cleaning up after the event. All beverages must
be in sealed plastic containers. At the conclusion of the event, offenders will not
be allowed to return to their units with any food items.

C. Individual Religious Practices

1. Religious Diets: Inmates may request to participate in the Religious Diet Program per
Policy #116.08 and may contact the Chaplain to complete the Request for Religious
Diet Program Participation and Agreement, CR-3814.

2. Religious Literature: Inmates may receive religious literature, materials, books, CDs,
DVDs, video tapes and tape recordings about religion or religious teaching in
accordance with Policies #504.01 and #507.02. Chaplains will make donated religious
literature available to inmates. Reasonable access to CD players, DVD players, video
tape players and tape players will be made available to inmates in the chapel, the
library or another area designated by the Warden. Misuse or tampering with such
players may result in disciplinary action. Inmates may not possess such players in their
cells unless they are authorized to do so per Policy #504.01 and the #504.01 Personal
Property Memo.

3. Religious Objects: Inmates may possess objects of religious significance in accordance

with policy and the approved religious property memo. Religious objects are not
excluded from the volume limit. All objects are subject to security search and certain
objects may be prohibited if they are identified as security threat material under Policy
#506.25. Such objects may be donated to indigent inmates by volunteers, Outside
Clergy or outside organizations.
Effective Date: February 15, 2014 Index # 118.01 Page 6 of 18

Subject: RELIGIOUS PROGRAMS

4. Religious Property Memo: By July 1 of each year, the Commissioner shall publish a
list of religious property that inmates are permitted to have in their possession,
and/or in approved group religious gatherings. Items shown on the list shall not
count against the maximum number of packages an inmate may receive, and the
existence of a disciplinary package restriction shall not prohibit the receipt of such
property, unless the Warden determines on a case by case basis that receipt of such
property by the inmate will jeopardize institutional safety and security. The list may be
revised as frequently as needed and may include restrictions on such property. All
inmates and inmate groups are required to be in compliance with the list.

5. Any material, having a concentration of 1% or more of any ingredient for which a CAS
number is listed in section two of the Material Safety Data Sheet or specifically
identified as hazardous by the ACA or by the fire safety officer shall be controlled (i.e.,
prayer oils).

6. Inmates may wear headgear which is in keeping with the security practices of the
institution. All religious clothing or other accessories are subject to respectful search at
any time for security purposes. (See Policies #506.25 and #504.01)

7. Inmate Organizations: Religious preference or affiliation shall not be the basis for an
inmate organization, fund raising by sales or activities, or trust fund accounts. (See
Policy #503.01)

8. Inmates may use non-flammable, non-alcoholic sacramental oil in modest amounts for
religious purposes. Inmates may purchase three ounces of such oil from vendors
approved by the TDOC and in accordance with Policy #507.02; provided, however,
sacramental oil for religious use shall not count against the maximum number of
packages that an inmate may receive and the existence of a disciplinary package
restriction shall not prohibit the receipt of sacramental oil for religious use. Inmates
may keep such oil in their cells in its original container in an amount not to exceed
three ounces. Any use of such oil for non-religious purposes shall result in a
disciplinary action.

9. Inmates may engage in prayer as an individual religious exercise during periods of

recreation (while in their cell or bed assignment and during non-work or programming
times). Corporate or group prayer shall be reserved for scheduled religious activities.

10. In Catholic worship services, the priest (but no inmates) may consume small amounts
of consecrated wine, subject to the following restrictions: No more than one half ounce
may be brought into the institution by the priest per service, provided the empty
container and any unused wine shall be taken out by the priest after each visit. An
accurate record of all wine which comes in and out shall be maintained at checkpoint.
No staff member, chaplain, volunteer chaplain, or religious volunteer shall be permitted
to bring wine into the institution.

11. Abuse or misuse of religious rights and privileges (for example, an inmate using a
religious item for non-religious purposes or an inmate with permission to be excused
from a job or program assignment to attend a religious gathering failing to attend
without a valid excuse such as illness), may result in appropriate disciplinary action.
Effective Date: February 15, 2014 Index # 118.01 Page 7 of 18

Subject: RELIGIOUS PROGRAMS

D. Group Worship and Study:

1. The chaplain shall schedule appropriate group worship and study opportunities to meet
the needs of inmates. The groups shall be inclusive and be led by the chaplain, outside
clergy, or religious volunteers. The leaders must agree to teach the central and
inclus ive doctrines common to the major faith group without degrading or impacting
upon the tradition of others in a negative way. Individual inmate needs or traditions
specific to a particular faith group may be met by individual visits with outside clergy
of each inmate’s denomination.

2. Except as stated in this paragraph, inmates will not be placed in a position of religious
leadership or authority over other inmates. Group religious activities shall be video
taped and/or monitored by staff. If the chaplain or a volunteer is not available to lead a
group, the following may occur:

a. CDs, DVDs, video tapes, or tape recordings of sermons or religious lessons

which comply with policy, including but not limited to Policy #507.02, may be
made available to the group.

b. An inmate may be authorized by the Warden to lead the service. Inmates may
ONLY lead religious services in the presence of staff.

3. The chaplain shall develop and maintain an up to date religious activity schedule and
shall ensure that information about various opportunities for religious activities shall be
available to all inmates. Group worship and study shall be conducted only in the
designated places and times.

4. The chaplain shall conduct an annual religious and pastoral care needs review or survey
and adjusts religious programming accordingly. The survey may be included as part of
the annual social services survey. The completed review or survey shall be submitted
to the Warden and a copy sent to the Director of Religious Services by the due date of
the annual social services survey.

5. Religious worship and study groups shall be open to all inmates unless such
participation is limited to maintain the order and security of the institution. Inmate
attendance shall be voluntary.

6. The integrity of worship space shall be maintained at all times. The chapel has been
designated as a place of worship and should not be used for searching or detaining
inmates except in emergency situations. Inmates who attend religious services shall
show proper respect to that particular faith group. Loud talking and disturbing others
will result in a disciplinary action, (See Policy #502.05). Any act, whether spoken,
visual, or written, which would tend to degrade a particular person, group, or ideology
will not be tolerated and will result in a disciplinary action.

7. Outside clergy and volunteer chaplains may wear their religious vestments and/or
insignia, except in those cases where potential danger may be present to the safety
and/or security of the participants or institution.

8. Inmates may carry their personal property rugs to religious services for use as prayer
rugs.
Effective Date: February 15, 2014 Index # 118.01 Page 8 of 18

Subject: RELIGIOUS PROGRAMS

9. With the approval of the Warden memorial services may be conducted for deceased
inmates or staff and shall be coordinated by the chaplain.

10. Extra worship services and group gatherings may be scheduled to accent special
observances, religious holidays, and feasts. These activities may be conducted by the
chaplain or volunteers. These activities must be requested in writing at least 15 days
prior to the event and conducted in accordance with guidelines approved by the
Assistant Commissioner of Rehabilitative Services.

11. Inmates in administrative or punitive segregation may not participate in religious group
worship and study group activities. Compatible inmates in protective custody may
participate in religious worship and study groups with other protective custody inmates
if approved by the Warden/designee. (See Policy #506.16) All segregated inmates may
receive visits from the chaplain, outside clergy, and religious volunteers. Segregated
inmates may possess religious literature and objects in accordance with this policy.

12. A non-smoking, group religious pipe ceremony for Native Americans shall be
permitted and shall not constitute a violation of Policy #112.11, provided:

a. The pipe may only be used in group gatherings at times and places approved by
the Warden.

b. No material whatever will be placed in the bowl of the pipe and the pipe will not
be lighted.

c. The pipe must be used for religious purposes only, and any other use may result
in disciplinary action.

d. The pipe must be brought in by volunteers or Outside Clergy and taken out each
time, OR stored in a designated area in or near the chapel, as determined by the
Warden.

e. The pipe must not be a risk to the safety and security of the institution, as
determined by the Warden.

f. The pipe must not contain STG or STG-related markings or insignia .

g. The pipe is subject to inspection and search at all times.

E. Requests for Religious Accommodations

1. Individual Requests: Accommodations for individual requests pertaining to religious

matters shall be submitted in writing using the Inmate Inquiry Information Request,
CR-3118.

a. The inmate shall submit the form to the Chaplain for consideration. Within ten
days of receipt, the Chaplain shall send a copy of the request (with his/her
recommendations) to the Warden for his/her approval or disapproval.
Effective Date: February 15, 2014 Index # 118.01 Page 9 of 18

Subject: RELIGIOUS PROGRAMS

b. If the Warden approves the request, the Director of Religious Services shall be
informed of the decision. If the disapproval(s) is based on a policy or prior
decision of the Religious Activities Committee the request does not have to be
sent to the Director of Religious Services or Religious Activities Committee. If
the decision of the request is not based on policy or prior decision of Religious
Activities Committee, then within 60 days the Warden and the Director of
Religious Services shall work together to agree on the approval or disapproval of
the request.

c. If the Warden and the Director of Religious Services do not agree on the
disposition of the request, the Director of Religious Services shall submit the
request to the Religious Activities Committee to be approved or disapproved in
the same manner as a request for group religious accommodations. The chaplain
shall notify the inmate of the decision regarding the request.

2. Group Requests: Accommodations for group worship services and other group
activities will only be made for faith groups which comply with the following
procedure:

a. Inmates may request accommodation by submitting a written request to the

Chaplain on Request for Group Religious Accommodations, CR-3735. Pages
one and two shall be completed by the inmate(s). Inmates shall be advised that
an incomplete request can cause the request to be returned.

b. The request must include:

(1) The name and TDOC number of the inmate(s) submitting the request and
an estimate of the number of inmates in the group.

(2) The official name of the group, including names and contact information
of the group’s leaders.

(3) Information on the group’s teachings, beliefs, and practices including

titles of the group’s basic texts and other information helpful in
researching the group.

(4) Names of outside clergy or volunteers available to visit the institution.

(5) A detailed description of the accommodation requested.

c. Within 30 days of receipt, the Chaplain will consult with the Warden and
complete page three of the Request for Group Religious Accommodations,
CR-3735. The entire request will then be sent to the Director of Religious
Services with recommendations from the Warden and Chaplain.

d. Within 60 days after receipt of the request, the Director of Religious Services,
will send the request to the Religious Activities Committee.
Effective Date: February 15, 2014 Index # 118.01 Page 10 of 18

Subject: RELIGIOUS PROGRAMS

e. The Religious Activities Committee will meet in person on a quarterly basis to

consider requests received by the Director of Religious Services. At the
discretion of the Director of Religious Services, the Committee may consider
requests via e-mail at any time.

f. By majority vote, the Religious Activities Committee will recommend that the
Commissioner disapprove the request, if it is determined that any of the
following conditions have been met:

(1) The group is an STG

(2) The group is a bona fide faith group with beliefs and practices adequately
represented by an existing faith group for which similar accommodations
have been made

(3) The accommodation will jeopardize the security and safety of the
institution

g. The Director of Religious Services will send the recommendations of the

Religious Activities Committee to the Commissioner. The Commissioner will
subsequently approve or disapprove the request.

h. The Director of Religious Services will notify the inmate, the Warden, and the
Chaplain of the decision by the Commissioner.

i. Inmates who disagree with the determination of the Commissioner will have the
right to appeal in accordance with Section VI.(H) below.

j. Groups which are currently being accommodated as of the effective date of this
policy will be exempt from the procedure outlined above. However, failure to
comply with the any provision of this policy may result in revocation of their
accommodation in the manner set out above.

k. After a group religious accommodation has been approved at one institution, the
Director of Religious Services shall have the authority to approve the same
request for group accommodatio ns at another institution, unless the Warden at
the other institution recommends against such accommodation, in which case the
request shall be processed in the manner set out above and the Warden shall be
invited to attend the meeting of the Religious Activities Committee.

F. Religious Activities Committee:

1. The Religious Activities Committee shall be composed of:

a. The Director of Religious Services (Chair)

b. One representative from the General Counsel’s office
c. One representative from the Deputy Commissioner of Operations
d. One representative from the Deputy Commissioner of Administrative Services
e. One Warden selected by the Director of Religious Services
f. Two Institutional Chaplains selected by the Director of Religious Services
Effective Date: February 15, 2014 Index # 118.01 Page 11 of 18

Subject: RELIGIOUS PROGRAMS

2. The Religious Activities Committee shall be responsible for the following:

a. Review and approval of all requests for accommodations for religious practices
filed under Section VI. (E)(2) above.

b. To perform such other duties as the Assistant Commissioner of Rehabilitative

Services may require.

G. The Director of Religious Services shall:

1. Be responsible for policy develo pment regarding religious activities on a department-

wide basis.

2. Develop and deliver training for line staff regarding religious policy and procedure.

3. Monitor religious services within various institutions to ensure policy compliance.

4. Develop knowledge of STG issues as it relates to religious functions within the TDOC.

5. Develop a working relationship with the Office of Investigations and Compliance

(OIC) and TDOC STG coordinator regarding religious activities within TDOC.

6. Serve as the central point of contact for all religious activity and practice within the
TDOC.

7. Work closely with internal TDOC security regarding religious activities.

8. Stays informed through research about religious issues (both legally and operationally)
and advise senior management accordingly. Subject to the supervision of the Assistant
Commissioner of Rehabilitative Services, the Director of Religious Services may serve
as a resource to the Department’s General Counsel and to the Attorney General as
needed.

9. Have a working knowledge of comparative religions and utilize such in the

administration of religious policy and procedure.

10. Send copies of all final decisions on Requests for Group Religious Accommodations to
all wardens and chaplains.

H. Inmate Grievance Procedures and Review

1. Inmates shall utilize the inmate grievance procedures set forth in Policy #501.01 for
review of issues affecting the inmate regarding religious activity or religious exercise.

2. Grievances must be filed utilizing Inmate Grievance, CR-1394, and must provide
sufficient information regarding and describing the inmate’s specific religious activity
or religious exercise which the inmate is grieving. The grievance must also set forth
and describe how the inmate’s religious exercise has been substantially burdened by the
action(s) of the institution.
Effective Date: February 15, 2014 Index # 118.01 Page 12 of 18

Subject: RELIGIOUS PROGRAMS

3. The review of the grievance (See Policy #501.01) shall examine and document whether
the burden on the inmate’s specific religious exercise furthers a compelling
governmental interest.

4. If it is determined, upon review, that the burden on the inmate’s specific religious
exercise furthers a compelling governmental interest, the review must determine and
document if the burden on the inmate’s religious exercise is the least restrictive means
of achieving the compelling government interest.

VII. ACA STANDARDS: 4-4319 and 4-4512 through 4-4521.

VIII. EXPIRATION DATE: February 15, 2017.

 STATE OF TENNESSEE
DEPRARMENT OF CORRECTION
OUTSIDE CLERGY APPLICATION

INSTITUTION

DATE

Dear Clergy Person:

Thank you for your interest in visiting an inmate at ___________________________________ as an

Outside Clergy person in accordance with TDOC Policy # 118.01. Each inmate is entitled to receive
visits from one outside clergyperson without the visit counting against his/her other visiting privileges.

Please answer all questions below and return this Application with evidence of your ordination to:

All information provided is confidential.

We will conduct an NCIC Background check as required by Policy #118.01.

Only approved Outside Clergy may schedule a visit, and they must call us at least (7) days prior to an
intended visit, except in cases of emergency. Visits generally last about 1 hour.

Name: ________________________________________________ D.O.B. ____________________

Drivers License # and State: _____________________ / _____ SSN: _________________________
Other States you have lived/resided/worked in: ____, ____, ____, ____, ____, ____, ____, ____, ___
Aliases: ___________________, ____________________, __________________, ______________
Home Address: ___________________________________ State: ________ ZIP: _______________
Home P hone: (______) ______________
E-mail: ________________________________
Race: _________________________________

Denomination/Church/Mosque/Temple: _________________________________________________
Street Address: ____________________________________________________________________
Mail Address: __________________________ City: _____________________ State: ____________
Phone Number: (_____) _____________________

Cr-3347 (Rev. 07-10) DUPLICATE AS NEEDED RDA

Please give two references (Name, Address, and Phone) of individuals who can confirm your status
as an ordained clergy person:

“Clergy / Pastoral Visit” privileges are extended to ordained clergy only. Others are encouraged to ask
the inmate that they be placed on the normal visiting list of family and friends.

Are you the Pastor / Leader of your church/mosque/temple? Yes: ___________ No: _____________

If “No” to the above,

1) What is your religious office/ordination?____________________________________________

2) What is your religious relationship to this inmate? ___________________________________
3) Are you trained and authorized to perform all of the duties of the pastor / leader? Yes
________, with the exception / restriction of ________________________________________

Name of Inmate: _______________________________________ TDOC # ____________________

How long have you known this inmate? _________________________________________________

Have you ever been convicted of a felony? Yes _____ No _____

If so, please provide details: _________________________________________________________

I agree that I am familiar with all policies and procedures governing visitation with inmates and that I
will abide by the same, as they may be amended from time to time.

Your Signature: _____________________________________ Date: _________________________

Please attach evidence of your ordination

Cr-3347 (Rev. 07-10) DUPLICATE AS NEEDED RDA

 TENNESSEE DEPARTMENT OF CORRECTION
NATIONAL CRIME INFORMATION CENTER (NCIC)
CRIMINAL HISTORY REQUEST

Date:

SECTION I - To be completed by volunteer/employee. (PLEASE P RINT CLEARLY)

Name:
Last First Middle

DOB: SSN: - -
SEX: RACE:
DRIVER LICENSE #: ISSUE DATE:

List All Other States Where Person Has Resided or Worked:

1) 2) 3) 4) 5) 6) 7) 8)

List All Aliases/Maiden/Legal Names Used:

1)
2)
3)
4)
5)
6)
7)
8)

*******************************************************************************************

SECTION II - To be completed by Volunteer Coordinator and signed by Warden or Designee

Purpose: New Volunteer/New Employee

Site: Contact Person:

Telephone ( ) - Ext. Fax Number: ( ) -

Authorizing Signature: Title: Warden/Designee

*******************************************************************************************

SECTION III - To be completed by Volunteer Coordinator. (Warden/Designee for employee)

Synopsis of Information Obtained:

FBI# (if known): SID# (if known)

CR-3552 (Rev. 06-12) Duplicate as Needed RDA S470-2

 TENNESSEE DEPARTMENT OF CORRECTION
REQUEST FOR RELIGIOUS DIET PROGRAM PARTICIPATION AND AGREEMENT

INSTITUTION
I, , ,
INMATE NAME (PLEASE PRINT) INMATE NUMBER
would like to participate in the Religious Diet Program. I understand that in order for me to be served a religious diet, special foods
may have to be procured for me, and special preparation practices must be used. Therefore, I agree to abide by the following
conditions:

1. I understand that if l voluntarily request that my religious diet be cancelled, I must do s o in writing (Religious Diet
Canc ellation R equest – CR 3813) and I must wait for a period of thirty (3 0) days before requesting that my diet be
reinstated or requesting a new reli gious diet.
2. I understand that repeated requests for withdrawals or changes may result in a waiting period of up to ninety (90)
days.
3. During meals I will eat and possess on my food tray only those food items served as a part of the Religious Diet
Program.
4. I will not purchase, possess, or consume any food items that are not permitted under my religious diet.
5. I will not eat foods from the general facility diet that are in conflict with my religious diet.
6. I will follow all facility policies for dining in my facility.
7. I will not provide any portions of my specially -prepared meal to other inmates.
8. I will not collect religious food items (or unauthorized amounts of Commissary items) in my cell/room.
9. If I am found in violation of this agreement I understand that I am subject to suspension and/or termination.
10. I understand that if I am suspended from the program it is my responsibility to notify the Chaplain of my desire to be
reinstated.
11. If I am terminated for any violation of this agreement, I understand I may not reapply for the program for ninety (90)
days.
12. I understand that failure to pick up my religious diet meal may result in the cost being deducted from my inmate trust
account. Repeated failures to pick up my religious diet may result in suspension and/or
termination from the program.
By my signature below, I acknowledge that I have read and/or discussed, with a staff person, the contents of this agreement. I further
agree that if permitted to participate in the Religious Diet Program I will abide by the conditions of participation set forth above in
this agreement.

INMATE SIGNATURE DATE

APPROVED: DISAPPROVED: TYPE OF DIET:

CHAPLAIN PRINTED NAME

CHAPLAIN SIGNATURE DATE

APPROVED: DISAPPROVED:

WARDEN SIGNATURE DATE

REASON FOR DISAPPROVAL INMATE SIGNATURE

Original: Inmate File Copy: Food Service Manager Warden Chaplain

CR-3814 (Rev 12-14) Duplicate as Needed RDA 1458

 TENNESSEE DEPARTMENT OF CORRECTION
GROUP RELIGIOUS ACCOMMODATIONS REQUEST

(COMPLETE pages 1 & 2; submit to Chaplain; See Policy # 118.01)

Date Submitted to Chaplain:

Inmate Name TDOC#

Estimated Number of Inmates in the Group:

1. Official name of the group:

2. Names and contact information of the group’s leaders:

3. The group’s teachings, beliefs, and practices:

4. Titles of the group’s basic text(s):

5. Other information helpful in researching the group:

CR-3735 (Rev. 06-10) Duplicate as Needed 1

 6. Names of outside clergy or volunteers available to visit the institution:

7. DETAILED description of the accommodation(s) requested:

a. First Accommodation

b. Second Accommodation

c. Third Accommodation

d. Fourth Accommodation

e. Fifth Accommodation

If more than five accommodations are requested, please add additional pages showing Sixth
Accommodation, Seventh Accommodation, etc.

CR-3735 (Rev. 06-10) Duplicate as Needed 2

 8. Recommendations by the Warden and the Chaplain

Date Sent to the Religious Activities Committee:

a. First Accommodation -- Recommendation: Approval Disapproval

Reason:

b. Second Accommodation -- Recommendation: Approval Disapproval

Reason:

c. Third Accommodation -- Recommendation: Approval Disapproval

Reason:

d. Fourth Accommodation -- Recommendation: Approval Disapproval

Reason:

e. Fifth Accommodation -- Recommendation: Approval Disapproval

Reason:

CR-3735 (Rev. 06-10) Duplicate as Needed 3

 9. Approval or Disapproval by the Religious Activities Committee

Date of Approval or Disapproval:

a. First Accommodation: Disapproved Approved

b. Second Accommodation: Disapproved Approved – subject to conditions:

c. Third Accommodation: Disapproved Approved

d. Fourth Accommodation: Disapproved Approved

e. Fifth Accommodation: Disapproved Approved

CR-3735 (Rev. 06-10) Duplicate as Needed 4

 TENNESSEE DEPARTMENT OF CORRECTION
INMATE GRIEVANCE

NAME NUMBER INSTITUTION & UNIT

DESCRIPTION OF PROBLEM:

REQUESTED SOLUTION:

Signature of Grievant Date

TO BE COMPLETED BY GRIEVANCE CLERK

Grievance Number Date Received Signature Of Grievance Clerk

INMATE GRIEVANCE COMMITTEE’S RESPONSE DUE DATE:

AUTHORIZED EXTENSION:
New Due Date Signature of Grievant

INMATE GRIEVANCE RESPONSE

Summary of Supervisor’s Response/Evidence:

Chairperson’s Response and Reason(s):

DATE: CHAIRPERSON:

Do you wish to appeal this response? YES NO

If yes: Sign, date, and return to chairman for processing within five (5) days of receipt of first-level response.

GRIEVANT DATE WITNESS

Distribution Upon Final Resolution:

White - Inmate Grievant Canary – Warden Pink – Grievance Committee Goldenrod – Commissioner (if applicable)

CR-1394 (Rev. 3-00) Page 1 of 2 RDA 2244

 TENNESSEE DEPARTMENT OF CORRECTION
INMATE GRIEVANCE (continuation sheet)

DESCRIPTION OF PROBLEM:

Distribution Upon Final Resolution:

White - Inmate Grievant Canary – Warden Pink – Grievance Committee Goldenrod – Commissioner (if applicable)
CR-1394 (Rev. 3-00) Page 2 of 2 RDA 2244
 TENNESSEE DEPARTMENT OF CORRECTION
INMATE INQUIRY – INFORMATION REQUEST

INSTITUTION

INMATE NAME (Please Print) INMATE NUMBER

UNIT: ROOM / BED: DATE:

ROUTED TO: Unit Manager Inmate Relations Coordinator (IRC)

Counselor Inmate Job Coordinator (IJC)

1. Inmate Inquiry/Request:

2. Action by Counselor/IRC/Inmate Job Coordinator:

Counselor / IRC / Inmate Job Coordinator SIGNATURE DATE

3. Action by Record Office

RECORD’S OFFICE STAFF SIGNATURE DATE

4. Sentence Management Services (SMS) Response:

SMS STAFF SIGNATURE DATE

CR-3118 (Rev. 12-06) White - Inmate Canary - Record Office Pink - Counselor/IRC/IJC RDA 1167