aP-Ags08 ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE wen FEDERAL BUREAU OF PRISONS NEW YORK MCC Institution Date/Time: 07-29-2019 12:21 TO: Special Hopéing Unit Officer FROM ee (Name sTite) SUBJECT : Placement of, EPSTEIN, JEFFREY EOWARD Reg. No,____76318-054__ in Administrative Detention ¥___{(a) |s pending an investigation for a violation of Bureau regulations; (b) 1s pending an SIS investigation. ____(¢) Is pending investigation or trial for a criminal act; ___{@) Is to be admitted to Administrative Detention ___(1) Since the inmate has requested admission for protection; | hereby request placement in Administrative Detention for my own protection. Inmate Signature/Register No: Staff Witness Printed Name Signature; ___(2) Since a serious threat exists to individual's safety as perceived by staff, although person has not requested admission; referral of the necessary information will be forwarded for an appropriate hearing by the SRO. —__(e) 1s pending transfer or is in holdover status during transfer. ____ff) Is pending classification; or {9) 18 terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. itis this Correctional Supervsor’s decision based on all the circumstances that the above named inmate's continued presence in the general population poses a serious threat to life, property, self, staff, other inmates, or to the security or orderly running of the institution because” PENDING UDC FOR CODE 228 SELF-MUTILATION ec Therefore, the above named inmate is to be placed in Administrative Detention unti further notice. The inmate received a copy of this Order on (date / time) _———$$$—$ ovr’ Date StaffWitness Signature/Printed Name. Supervisor 24 hour review of placement: Signature/Printed name * In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an independent review and decision, which is documented here. Record Copy - inmate Concerned (not necessary if placement is a result of holdover status); Copy - Captain; Copy - Unit Manager, Copy - Operation Supervisor ~ Administrative Detention Unit; Copy — Psychology; Copy - Central File POF Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) EFTA00035216