EFTA00105445.pdf

/ INCIDENT REPORT littr d / J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Part I — Incident Report 1. Institution. incident-Report Numbets5_3ip MCC New York 2. Inmate's Name: 3. Register Number 4. Date of Indent: ?TimB Epstein Jeffery 76318-054 07123/2019 1:27am 6. Place oftnadent —T. Assignment: S. una SHU M-Tier Cell 124 Unassigned ZA 9. Incident Self-Mutilation 10. Prohibited Act Code (s): 228 11. Description of Incident (Date: 07/23/2019 rime: 1:27AM Staff became aware of incident): On July 23.2019 at approx. 1:27am White working in the Special Housing Unit Myself an heard noise coming from the M tier cell 124.Upon arrival I/M's Epstein,Jefferyn6318-054 cell mate (UM Tartaglionea78514-054)was at the door stating I/M Epstein.Jefferytl76316-054 had attempted to hang himself. I kept a visual while grabbed the door keys and called for assistance. After Secunng I/M Tartaglioned/8514•054 and removing him from the colli entered then Epstein on his side and removed a orange homemade rope from his neck.1/M was breathing at this time But unresponsive. Addition strna IIMMarrived I/M was then removed from SHU SI Name/ g Employee: 13. Date And Time: 07/23/2019 3:30am 14. Incident Rep Inmate By L 15. Date Incident Report Delivered: 16. Time Indent Report Delivered: (Type Name/ art H — Committee Action 17. Comments of Inmate to Committee Regarding Above Incident: 18 A It is the finding of the committee that you: The Committee is referring the Charge(s) to the DHO for further B Heagna.„ Ii4 Committed the Prohibited Ad as charged: Did not Commit a Prohibited Act. Committed Prohibited Act Code (s). 19. Committee Decision is Based on Specific Evidence as Follows: C. l I The Committee advised the inmate of its finding arsd of the right to file an appeal within 20 calendar days. 20. Committee action and/or recommendation if referred to DHO (Contingent upon DUO finding inmate committed prohibited act): 21. Date and Time of Action: (The UDC Chainnan=s signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings). airman (typed Nameibignature). Member (Typed Name): Member (Typed Name): INS1RUCTIONS: All items outside ofheavy rule are for staff—use only. Begin entries with the number I and voided by staff. work up. Entries not completed will be Distribute: Original-Central File Record: COPY-1.0HO: COPY -2-Inmate after UDC Action. COPY 3-Inmate within 24 hours of Part I Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG EFTA00105445