Suicide Watch Chronological Log Inmate Companions Log < Name of inmate on watch: = - a © Epsikm = gg Z a oO > me 5 ES 3 a YD wo ¥ a Mili © <:: < oa. 5 . Institution: s ° $ vn es wgnn 3 c ec EsovoaY Oo 4 > SBeGa Si Date Watch Began/Ended 23 x ‘S SS oaaeEe Z2seas55 5006 ¢ 7 12314 ONAHDAQUHEY To be completed by Chief Psychologist at conclusion of watch: Booklet ___ of SWCL - INMATE ¥ EFTA00035257

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STAPLE LOCAL PROCEDURES HERE Check one of the following: o This is the initial log book for this suicide watch. Enter date and time watch began: Oo This is a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: Document your observations every —______-_— minutes. Legibly print and sign your name at the beginning of your shift. EFTA00035258

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Suicide Watch Observation Log Name of Inmate — Date: 1|23| G on watch: PS en Reg #: _ Time Observations: Briefly note your observations. Initial all entries. y wm Brcagut dan do Surccike ceil Fi in Sal fw yey ow Bed Mm | tw Ci theg oy Se te lieng ae lS iS Cellmate 4rizd fe (ill a De | Yu Sifhisn ww BES ——_ * WA hs iH ew be —— Sha IE Y tates Pictuns oF Ju | ; ou ‘tua Si Via ya L<O — EFTA00035259

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Suicide Watch Chronological Staff Suicide Watch | Observers Only — “SAnstitution: | 007 8 Date’ Watch Badan / Ended . 22,2010 = July 24; an To be completed by Chief Psychologist at conclusion of watch: _ Booklet of SWCL - STAFF EFTA00035260

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STAPLE LOCAL PROCEDURES HERE Check one of the following: @° This is the initial log book for this suicide watch. Enter date and time watch began: July 23:2010 ot roa es nay : A "ox, This a continuation log book for this watch. ‘Enter date and time this watch book was ‘initiate = Ee “| iy “, ‘ fy i ard | Instructions to Observer: : “ee 4s ee ! " Document your observations every |e YeKnearee minutes.’ Legibly print and sign your name at the beginning of your shift. . EFTA00035261

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Suicide Watch Observation Log Observations: Briefly note your observations. Initial all entries. Or C Lv, A 5:00am Inmate sittie? on bed Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00035262