(1) If the parole officer believes that the parolee has violated his/her terms of parole, he shall serve the parolee with a report of violation and statement of charges. (Form A.) This form shall apprise the parolee of the following information:

(a) A description of the alleged violation(s) of the conditions of parole with which the parolee is charged.

(b) Parolee is entitled to a preliminary on-site hearing to determine whether there is probable cause to believe that these alleged violations occurred.

(c) Parolee may appear and speak on own behalf at the hearing and may bring documents and individuals that can give relevant information to the hearing officer.

(d) Upon parolee's request, persons who have given adverse information, upon which revocation may be based, will be made available for questioning in parolee's presence, unless the hearing officer determines that the informant would be subject to risk of harm if his identity were disclosed.

(e) Parolee is entitled to legal counsel at the hearing, however, counsel and witnesses must be notified by the parolee and secured at own expense.

(f) Preliminary hearing may be waived by parolee, however, parolee will still be entitled to a revocation hearing before the parole board after return to the institution.

(2) At the time the statement of charges is served, the parolee shall indicate on the form whether he desires a preliminary hearing or wishes to waive the hearing.