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Page 241 -_ (im 4 i Form 583 Report of Incident Incident #: NYM-19- Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM 0076 Injury Category: No Injury Staff injury by Inmate: No Sexual Assault: No Section 4: Lethal Weapon Discharge No data found. Section 5: Use of Force No data found. Section 6: Description of Incident DESCRIPTION OF INCIDENT (If Use Of Force, include details such as name of supervisor applying the chemical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear about cause(s) of the incident in your description. Section 7: Attachments FileDate “FileName Original Entered By No data found. Approved By: NOT COMPLETED 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). 3 of 3 DOJ-OGR-00024805