EFTA00119513.pdf

BP-A0288 INCIDENT REPORT CDFRM JUN 10 U.S . DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Part I - Incident Report 1. Institution:NCC New York 2. Inmate's Name 1. Register Number 4. Date of Incident 5. Time Epstein , Jeffery 76318-054 07/23/2019 1:30 am 6. Place of Incident 7. Assignment 8. Unit SIR( M-Tier Cell 124 Unassigned ZA 9. Incident 10. Prohibited Act Code(s) Self-Mutilation 228 11. Description Of Incident (Date: 07/23/2019 Time: 1:27 am Staff became aware of ' cidentl On July 23,2019 at approx. 1:27am While working in the Special Housing Unit Myself and /0 AIM heard noise coming from the M tier Cell 124.Upon arrival inmate Epstein's cell mete (I/ Tartaglione 878514-054) was at the door stating I/M Epstein 876318-054 had attempted to hang himself. I kept a visual while Officer alnigrabbed door keys and called for assistant -After securing I/M Tartaglione and removing him from the cell, I entered then placed I/M Epstein on his side and removed an orange homemade rope from his neck. I/M was breathing at this time,But unresponsive.Addition staff and Ops Lt arrived I/M was then removed from the SHU. 12. Typed Name/Signature of Reporting Employee 13.Date And Time , I 7/23/2019 1:30 am 14. Incident Report Delivered to Above Inmate By 15. Date incident 16. Time ncident (Type Name/Signature) Report Delivered Repor Delivered Part II - 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 Committed the Prohibited Act as charged. Hearing. Did not Commit a Prohibited Act. The Committee advised the inmate of Committed Prohibited Act Code(s) its finding and of the right to file an appeal within 20 calendar days. 19. Committee Decision is Based on Specific Evidence as Follows: 20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO findi g inmate committed prohibited act) 21. Date And Time Of Action (The UDC Chairman's signature cart Lies who sat on the UDC and that the completed report accurately reflects the UDC proceedings.) Chairman (Typed Name/Signature) Member (Typed Name) Member (Typed Has e) INSTRUCTIONS: All items outside heavy rule we for staff me only. Begin entries with the number I and wort up. Entries not completed will be voided sy stiff DISTRIBUTE: ORIGINAL-Cement Pile weed; COP Y.I - DUO: COPY-2-tomato After UDC Action; COPY.). Winne within 24 bows of Pen I Promreties PDF Prescribed by P6270 Replaces Eillpfaillik0114311V061101MAY 94 EFTA00119513