Form 583 Report of Incident Type Of Incident ❑ Assault On Inmate ❑ Assault On Staff ❑ Assault, Attempted On Inmate ❑ Assault, Attempted On Staff ❑ Disruptive Behavior ❑ Escape From Non-secure Facility ❑ Escape From Secure Facility ❑ Escape, Attempted From Non-secure Facility ❑ Escape, Attempted From Secure Facility ❑ Fight ❑ Inmate Death ❑ Institution Disturbance ❑ Introduction Of Contraband ❑ Lethal Weapons Discharge ❑ Self Mutilation ❑ Setting A Fire ❑ Sexual Act, Non-consensual On Inmate ❑ Sexual Assault On Staff ❑ Sexual Contact, Abusive On Inmate ❑ Sexual Harassment, Repetitive ❑ Staff Homicide ❑ Strike, Food ❑ Strike, Work ❑✓ Suicide Attempt ❑ Use Of Force ❑ Use Of Force/Applications Of Restraints ❑ Use of Restraints, Pregnant/Postpartum Method: Hanging/Asphyxiation Incident #: NYM-19- Submitted By: 0082 Date/Time Of Incident: 8/10/2019 6:33 AM Section 1: General Information Staff Aware Date: 8/10/2019 6:33 AM FBI Notified: Yes USMS Notified: Yes Indicate Where Incident Occurred: Main Facility Location Level 1: SHU Level 2: Housing Unit, Special (SHU) Level 3: 9 SOUTH SHU Institution Locked Down: Yes Modified Operations: No Cause Of Incident Known? No Cause Of Incident ❑ Alcohol ❑ Commissary ❑ Debts ❑ Disrespect Issue ❑ Drugs ❑ Ethnic Conflict ❑ Food Issue ❑ Geographical Conflict ❑ Interfering with Staff duties ❑ Property Issue ❑ Racial Conflict ❑ Recreation Equipment ❑ Religious Issue ❑ Security Threat Group Conflict ❑ Sexual Pressure ❑ Sporting Events ❑ Telephone ❑ Theft ❑ Visiting ❑ Work Issue Section 2: Inmates Involved UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD. or U.S. Intelligence Agencies. This document, or any segmenUattachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a -need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 1 of 3 SDNY_00013430 EFTA00123089 Form 583 Report of Incident Incident #: NYM-19- Submitted By: 0082 Date/Time Of Incident: 8/10/2019 6:33 AM Reg #: 76318054 Name: EPSTEIN, JEFFREY Role: Not Known Medical Attention Required: Outside Injury Category: Fatal Injury Weapon (per inmate): No Use of Force (per inmate): No Chemical Used (per inmate): No CIMS: No STG: Yes Restraints (per inmate): Escort Only Death (per inmate): No Section 3: Others Involved Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Noel, Tova Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD. or U.S. Intelligence Agencies. This document, or any segmenUattachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a -need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 2 of 3 SONC00013431 EFTA00123090 Incident #: NYM-19- 0082 Form 583 Report of Incident Submitted By: Date/Time Of Incident: 8/10/2019 6:33 AM Name: Thomas, Michael Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Person Type: Staff Death: No Staff Injury by Inmate: No Section 4: Lethal Weapon Discharge No data found. Section 5: Use of Force No data found. Section 6: Description of Incident DESCRIPTION OF INCIDENT (If Use Of Force, include details such as name of supervisor applying the chemical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear about cause(s) of the incident in your description. On August 10, 2019, at approximately 6:33 a.m., while serving the breakfast meal inmate Epstein, Jeffrey, Reg. No. 76318-054 was found unresponsive in his cell. Staff called for assistance and began life saving measures. He was escorted to Health Services at approximately 6:39 a.m., and EMS arrived at 6:43 a.m. He was transported to the local hospital at approximately 7:10 a.m. Inmate Epstein was pronounced deceased at 7:36 am. Section 7: Attachments File Date File Name Original Entered By Original Lac. Code 8/10/2019 Operation Memorandum.pdf TF18990 NYM 8/10/2019 Unit Roster.pdf TF18990 NYM 8/10/2019 Staff Roster.pdf TF18990 NYM 8/10/2019 Medical Assessment.pdf TF18990 NYM 8/10/2019 Staff Memorandum.pdf TF18990 NYM Approved By: SUBMITTED UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD. or U.S. Intelligence Agencies. This document, or any segmenUattachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a -need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 3 of 3 SONC00013432 EFTA00123091