f ——___, -_~ ie »> A0296 INCIDENT REPORT NAT J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Part | - Incident Rep : —— 1. Tnsblution’ waco New York | Incident Report Number — 2 > = Timate’s Name: Reg 4g LS naan seffery SHU M-Tier Con 124 11. Description of incident (Date: 07/23/2019 Time: 1:27AM ___ staff became aware of incident): 23,2019 at pprox. 1:27am While working in the Special Housing Unit ond (0 Siva heard nose coming from the M tier cell 124.Upo val M's Epstein. VATESTG-O54 col mate (UN Tari lagilone#t 78: : : 8-054 had attempted to ang himself. {kept a visual while S/O Silva grabbed the door keys and called for assistance. Afler at laglione# 765 14-054 d remo hi ti lered then placed I/M Epsiein on his side and oved a orange ho de rope from his neck. /M was Breathing at this i But unresponsive. Addition staff and Ops Lt Anderson arrived I/M was then removed from SHU ~ q an Signathred ffs ale Masullo, ii maident R Report Delivere: "Tae Sigheiel ‘ime Incid Report Delivered: 17. Comments of inmate to Committee Regarding Above Incident: 18. A. Itis the finding of the committee that you: Committed the Prohibited Act as charged: Did not Commit a Prohibited Act. Committed Prohibited Act Code (s). 19. Committee Decision is Based on Specific Evidence as Follows: * c. The Committee advised the the inmate of its finding and of the right a The Committee is referring the Charge(s) to the DHO for further a to file an appeal within 20 calendar days. 20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act): 21. Date and ee of Action: (The UDC Chairmanes signature certifies who sat on the UDC and that the completed report reflects ‘UDC proceedings) Distribute: Original-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part | Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG 1t EFTA00040960

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22. Date And Time Investigation Began Part III - Investigation 23. Inmate Advised Of Right To Remain Silent: You are advised of your right to remain silent at all stages of the discipline process. Your silence may be used to draw an adverse inference against you at any stage of the discipline process. Your silence alone may not be used to support a finding that you have committed a prohibited act. The Inmate Was Advised Of The Above Right By At (Date/time) 24, Inmate statement and attitude 25. Other facts about the incident, statements of those persons present at scene, disposition of evidence, etc. 26. Investigator’s comments and conclusions 27. Action taken Date and Time Investigation Completed Printed Name/Signature Of Investigator Title A) 7 vr @ PDF Prescribed by P5270 Replaces BP-S288.052 Of MAY 94 EFTA00040961