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Section 3: Others Involved Form 583 Report of Incident Incident #: NYM-19- Submitted By: Skipper-Sott, S. 0076 Date/Time Of Incident: 7/23/2019 1:27 AM (biG); (oF HC) Name: Medical Attention Required: Injury Category: No Injury Sexual Assault: No Name: [exer wivic) Medical Attention Required: Injury Category: No Injury Sexual Assault: No Name: [byes iburc) Medical Attention Required: Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: Injury Category: No Injury Sexual Assault: No (OMG): (bF MC} Name: Medical Attention Required: UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE No No No No No No Person Type: Staff Death: No Staff Injury by Inmate: Person Type: Staff Death: No Staff Injury by Inmate: Person Type: Staff Death: No Staff Injury by Inmate: Person Type: Staff Death: No Staff Injury by Inmate: Person Type: Staff Death: No Staff Injury by Inmate: Person Type: Staff Death: No No No No No No 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 4 DOJ-OGR-00027317