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Incident #: NYM-19- Form 583 Report of Incident Submitted By: Skipper-Sott, S. 0076 Date/Time Of Incident: 7/23/2019 1:27 AM Section 1: General Information Staff Aware Date: 7/23/2019 1:27 AM FBI Notified: No Location Level 1: SHU USMS Notified: No Type Of Incident L] OOONODOOOOOOONOOOOOOOOOOOOO Assault On Inmate Assault On Staff Assault, Attempted On Inmate Assault, Attempted On Staff Disruptive Behavior Escape From Non-secure Facility Escape From Secure Facility Escape, Attempted From Non-secure Facility Escape, Attempted From Secure Facility Fight Inmate Death Institution Disturbance Introduction Of Contraband Lethal Weapons Discharge Self Mutilation Setting A Fire Sexual Act, Non-consensual On Inmate Sexual Assault On Staff Sexual Contact, Abusive On Inmate Sexual Harassment, Repetitive Staff Homicide Strike, Food Strike, Work Suicide Attempt Use Of Force Use Of Force/Applications Of Restraints Use of Restraints, Pregnant/Postpartum Method: Laceration Method: Hanging/Asphyxiation Indicate Where Incident Occurred: Main Facility Level 2: Housing Unit, Special (SHU) Level 3: 9 SOUTH SHU Institution Locked Down: No Modified Operations: No Cause Of Incident Known? No Cause Of Incident ILI OOOUOOO JOO OOO Alcohol Commissary Debts Disrespect Issue Drugs Ethnic Conflict Food Issue Geographical Conflict Interfering with Staff duties Property Issue Racial Conflict Recreation Equipment Religious Issue Security Threat Group Conflict Sexual Pressure Sporting Events Telephone Theft Visiting Work Issue 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). 1 of 4 DOJ-OGR- 00027316