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Page 240 Form 583 Report of Incident Incident #: NYM-19- Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM 0076 Section 3: Others Involved Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No : Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Person Type: Staff : E Death: No Injury alate: No iegury Staff Injury by Inmate: No Sexual Assault: No Person Type: Staff Medical Attention Required: No Death: No Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Name: |" Person Type: Staff Medical Attention Required: No Death: No UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a “need to know.” It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 2 of 3 DOJ-OGR-00024804