EFTA00104960.pdf

A02:8 .N :S J.S. DEPARTMENT OF JUSTICE INCIDENT REPORT FEDERAL BUREAU OF PRISONS Part I - Incident Report 1. Institution: MCC New York Incident Report Numbs • ••;s a , c25 2. Inmates Name: Epstein . Jeffery 3. Register Number: 76318-054 4. Date of Incident: 07/2312019 1:27am 6. Place ofinadont: SHU Miler Cell 124 7. Assignment: Unassigned 8. unit: ZA 9. Incident: Self-Mutilation . 10. Prohibited Ad Code (s): 228 11. Description of Incident (Dale: 07/23/2019 Time: 1:27AM Staff became aware of incident): On July 23.2019 al approx. 127am Whale working in the Special Housing Unit Myself and S/0 =heard noise coning from the M tier cell 124.Upon arrival UM's Epstoin.Jelfery/t76318-054 cell mate ((UM Tartagrionea78514.054)was at the door stating UM Epstein.Jeffery/t76318-054 had attempted to hang himself. I kept a visual Mule S/0 Mgrabbed the door keys and called for assistance. After Secunng I/M Tartaghone#78514-054 and removing him from the colt, entered then placed UM Epstein on his side and removed a orange homemade rope from his neek.UM was tirealhng at this time But unresponsive. Addition staff and Ops It arrived UM was then removed from SHU 12. Typed NamoiSil . Incident Report (Type Name/Sic mg Employee: 13. Dale And-Time: ye Inmate by i 15. Dale In ent Report Dekvered. 07/23/2019 3:30am 6. Time Inodent Repot Delivered: Part It - Committee Action 17. Comments of Inmate to Committee Regarding Above Incident: 18. A. It is the finding of the committee that you: Committed the Prohibited Act as charged: 1 --1 Did not Commit a Prohibited Act Committed Prohibited Act Code (s). 19. Committee Decision is Based on Specific Evidence es Follows: B. In The Committee is referring the Charges) to the C. at a l The Committee advised the inmate of its fmdirry to Be an appeal within 20 calendar days. OHO for further and of the right 20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act): 21. Date and Time of Action: (The UDC Chairman=s signature certifies who sal on the UDC and that the completed report accurately reflects the UDC proceedings). Chairman (TypedName/Signature): ember (Typed Name): Member (Typed Name): INS I RUC IONS: All deals outside of heavy rule are for staff use only. Begin entries with the number 1 and work up. Entnes not completed will be voided by staff. Distribute: Onginal.Cenual File Record. COPY-1-DHO: COPY-2-Inmate after UDC Acton: COPY 3-Inmate within 24 hours of Part I Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG 11 EFTA00104960 Part III - Investigation 22. Date And Time Investig ation Began 23. Inmate Advised Of Right To Remain Silent: You are advised of your right to remain silent at all stages of the discipline process. Your silence may be used to draw an adverse inference against you at any stage of the discipline process. Your silence alone may not be used to support a finding that you have committed a prohibited act. The Inmate Was Advised Of The Above Right By At (Date/time) 24. Inmate statement and attitude 25. Other facts about the incident, statements of those persons present at scene, disposition of evidence, etc. 26. Investigator's comments and conclusions 27. Action taken Date and Time Investigation Completed Printed Name/Signature Of Investigator Title POF Prescribed by P5270 Replaces BP-5288.052 Of MAY 94 EFTA00104961