EFTA00140247.pdf

BP-AZ-3C9 ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE JAN 1, FEDERAL BUREAU OF PRISONS NEW YORK MCC Inaction Date/Time- 07-29.2019 12-.21 TO: Sp FROM: (Ramerite) EPSTEIN, JEFFREY EDWARD Reg. No. 76318-054 in Administrative Detention SUBJECT Placement of (a) Is pending an investigation for a %otation of Bureau regulations: (b) Is pending an SIS investigation. (c) Is pending investigation or trial for a cnminal act: (d) Is to be admitted to Administrative Detention (1) Since the inmate has requested admission for protection; I hereby request placement in Administrative Detention for my own protection. Inmate SignaturelRegister No.: Staff Witness Printed Name Signature: admission; referral of (2) Since a serious threat exists to individual's safety as perceived by staff, although person has not requested the necessary information wit be forwarded for an appropriate healing by the SRO. (e) Is pending transfer or is in holdover status during transfer. (f) Is pending classificabon; or (9) Is terminating confinement In Discipimary Segregation and has been ordered Into Administrative Detention by the Warden's designee. presence In the general It is this Coffectonal Supewlsor's decision based on all the circumstances that the above named Inmate's continued institution because' population poses a serious threat lo lee. property, self, staff. other Inmates. or to the security or orderly running of the PENDING UDC FOR CODE 228 SELF-MUTILATION received a copy of this Order on Therefore. the above named inmate is to be placed In Admmistratwe Detention unti further notice. The Inmate (date/ lime) Date Staff Witness Signature/Printed Name Supervisor 24 hour review of placement: Signature/Printed name independent review and dectslen, which is ' In the case of DHO action, reference to that order Is sufficient. In other cases, the Correctional supervisor will make an documented here. Manager, Copy • Operation Supervisor Record Copy - Inmate Concerned (not necessary if placement is a result of holdover status); Copy - Captain: Copy - Unit - Administrative Detention Unit Copy — Psychology. Copy Central File PDF Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) EFTA00140247