INCIDENT REPORT /
INCIDENT REPORT /
littrd
/ J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS
Part I — Incident Report 1. Institution. MCC New York incident-Report Numbets5_3ip
4. Date of Indent: ?TimB
07123/2019 1:27am 2. Inmate's Name:
Epstein Jeffery 3. Register Number
76318-054
6. Place oftnadent
SHU M-Tier Cell 124 —T. Assignment:
Unassigned S. una
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/
14. Incident Rep
(Type Name/ g Employee: 13. Date And Time:
07/23/2019 3:30am
Inmate By L 15. Date Incident Report Delivered:
art H — Committee Action 16. Time Indent Report Delivered:
17. Comments of Inmate to Committee Regarding Above Incident:
18 A It is the finding of the committee that you:
Ii4Committed the Prohibited Ad as charged:
Did not Commit a Prohibited Act.
Committed Prohibited Act Code (s). B The Committee is referring the Charge(s) to the DHO for further Heagna.„
C. l I The Committee advised the inmate of its finding arsd 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 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 work up. Entries not completed will be voided by staff.
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