PRETRIAL HOUSE ARREST PROGRAM PROGRAM VIOLATION REPORT STATE OF GEORGIA vs. _______________________________________________ Warrant Nos: _______________________________ Defendant Inmate No: _______________________________ VIOLATION CHECKLIST CHECK ALL APPLICABLE Unapproved Address Change Alcoholic Use/ Beverages on premises Drugs on person/premises Telephone difficulty contacting; failure to maintain approved phone line; Failure to Report as directed by House Arrest New violation of criminal laws Provider/GCSD Failure keep $15.00 on person Refusal to consent to search Failure to attend AA, NA, counseling Curfew Violation Impermissible contact with victim Motor vehicle improper use/unapproved use Employment Failure to maintain or report. Damage to monitoring equipment Monies Owed Failure to timely pay program fees. Other: Brief Description of incident: Reporting Officer Date Action Taken by Reporting Officer: Reported to GCSD to this supervisor: Recommendation: [ ] Verbal Warning; [ ] Written Warning; [ ] Termination from program; [ ] New Arrest Warrant; [ ] Lock down period for _________________; [ ] Other W:\Magforms\MAG 95-07 Violation Checklist