Suicide Watch Chronological Log Inmate Companions Log © Name of inmate on watch: = .. wv c Epsiem Siem oO 6 Zz Ss $8 = Register #: 2 a eo) = 2 q Wrest 3 Bwy z — =a x5 5 F [oe omar =) ¢ Institution: “4 ov % ae =-£ 2 ao 4's wi SARE S ¢ i oO & E S vo wv oY SeTBSSGal$ Date Watch Began/Ended 73 SBBSawES Fad S535 79 OG ¢ 1/23 }'4 ORAAAGAKY To be completed by Chief Psychologist at conclusion of watch: Booklet of SWCL - INMATE CONFIDENTIAL SDNY_00008269 EFTA00033775

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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: 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_00009270 EFTA00033776

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rere CBstenn Regt: 1U315. 5 }| time | __ Observations: Brietly note your observations. initial allentries. | initia _| Wry | Yn Grcagh+ o Surcike cont Fe WA iw {/ “Si Bed 4c Iplte,i o ~~ Cell made 4 cir Le cae | Uy Tw S Mina ne i VA a be) ig wen Tac | un Steg wd Be —— BE Th Bed —_— ie = od le —_—_ Note to all observers: Legibly print and sign your name at the beginning of your shift. CONFIDENTIAL SDNY_00009271 EFTA00033777

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Suicide Watch ono! he OG:,! Staff Suicide Watch « “Observers Only. — . zs ‘Pogister# | | Moaecosd | “Institution: ade ei ast Date’ Watch Began | Ended . uly 23,2014 = July 2 24, oq To be completed by Chief Psychologist at conclusion of watch: _ Booklet of SWCL - STAFF CONFIDENTIAL SDNY_00009272 EFTA00033778

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STAPLE LOCAL PROCEDURES HERE Check one of the following: ve ' This is the initial log book for this suicide watch... Enter date and time watch began: Suly 23,2010 at 40am O° Thisa continuation log book for this watch. aw Enter date and time this watch book was initiated: ope ee Het a % \ Instructions to Observer: “3 Document your observations every AG minutes. Legibly print and sign your name at the beginning of your shift. CONFIDENTIAL SDNY_00009273 EFTA00033779

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EO: a Suicide Watch Observation Log Reg # AG % - ()52} Date: 7) 11Q | Name of Inmate on watch: : Observations: Briefly note your observations. Initial all entries. | initiats | mo |. AD Aw 2: DO AM 2:15AM 2.30AM 3.QD/ Note to all observers: Legibly print and sign your name at the beginning of your shift. SDNY_00009274 CONFIDENTIAL EFTA00033780