Suicide Watch Chronological Log Inmate Companions Log © Name of inmate on watch: = .. - c Epsiew Stem oO 6 Zz Ss $8 = Register #: 2 a eo) = 2 q Wrest 3 Bowe z — =a x5 5 F [oe omar) ¢ Institution: 4 ov % ae =-£ 2 ao 4's wi SCHRHReE S ¢ iy (ss) & E Sv o wv oY SeTBSSSaal$ Date Watch Began/Ended 73 SBBSawES Pad S535 7 OG ¢ 1/23 |14 ORAAAGAFY To be completed by Chief Psychologist at conclusion of watch: Booklet of SWCL - INMATE CONFIDENTIAL soNY_00000575. EFTA00033886

--=PAGE_BREAK=--

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: ia) 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. CONFIDENTIAL SDNY_00009576 EFTA00033887

--=PAGE_BREAK=--

Suicide Watch Observation Log auth EBSCO Regt: 14515. 5 | _time | __ observations: Bretly note your observations. initial allentries. | initia == Osa Ym Freie vt Deer o Surci&e cet Ff MS, — jive ra an Cul! 4c 4 Tene Th. le he matt 12d r(f AA __ bb | lm iMag om be) ured — What Happen ——_— 4) wu i (n'a 36 — rv * wa _| Ton iHytq em Bed ——— 2 4 Sou 7 Andes takes pictues cf ilu |B Mme | fm Gi thing yn EO AS Sted Ses fn [Ye Sey en Bed pet a a Note to all observers: Legibly print and sign your name at the beginning of your shift. SDNY_00009577 CONFIDENTIAL EFTA00033888

--=PAGE_BREAK=--

Suicide Watch ono! OG.) Staff Suicide Watch « ’ Observers only. Be eh SS: Rae yr at a fmt . “Institution: "A igen" Date’ Watch Began | Ended . uly 23,2014 = July 24, oq To be completed by Chief Psychologist at conclusion of watch: _ Booklet of SWCL - STAFF CONFIDENTIAL SDNY_00009578 EFTA00033889

--=PAGE_BREAK=--

STAPLE LOCAL PROCEDURES HERE Check one of the following: aw: * This is the initial log book for this suicide watch... Enter date and time watch began: Suly 23,2010 a} 40am O° Thisa continuation log book for this watch. aw Enter date and time this watch book was initiated: ere ee + a 4 % \ Instructions to Observer: “3 Document your observations every AG minutes. Legibly print and sign your name at the beginning of your shift. CONFIDENTIAL SDNY_00009579 EFTA00033890

--=PAGE_BREAK=--

COSsIeIN Suicide Watch Observation Log Observations: Briefly note your observations. Initial all entries. iN thy “inmate slonding at dane RY ee ee Note to all observers: Legibly print and sign your name at the beginning of your shift. CONFIDENTIAL SDNY_00009580 EFTA00033891