DOJ-OGR-00027335.jpg

a ‘os t f BP-,,028g~ , / INCIDENT REPORT JANA? U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS art | — Incident Report ncident Report Number: NSHUBON: WICC New York nmate’s Name: . Register Number: ate of Incident: Epstein , Jeffery 76318-054 07/23/2019 5. Place of Incide 7. Assignment: SHU M-Tier Cell 124 Unassigned 3. Incident: seit Mutilation A 11. Description of ncident (Date: 97/23/2019 Time: 1:27AM Staff became aware of incident): b}(6); (DFC) 4. Incident Rep - ime Incident Report Delivered: (Type Name/Skgadt re):|°" B, _ The Committee is referring the Charge(s) to the DHO for further He: Cc. The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days. 18. A. Itis the finding of the committee that you: Committed the Prohibited Act as charged: Did not Commit a Prohibited Act. Committed Prohibited Act Code (s). 19. Committee Decision is Based on Specific Evidence as Follows: WC Nhe US TT a SS OE mi EE ©: Vala: A OY. Sr Zz CTY Ren A 11 Gia ww, Win SAS SUS © 6174 wos 4 in ember (Typed Name): lems ou of heavy rule are for use only. Begin entries wi ne number 7 and work up. ies not compile will De voided by staff. Distribute: Original-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part | Preparation Prescribed by P5270 Replaces BP-A0288 of AUG 11 PDF DOJ-OGR-00027335