Form 583 Report of Incident Incident #: NYM-19- Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM 0076 Section 1: General Information Staff Aware Date: 7/23/2019 1:27 AM FBI Notified: No USMS Notified: No indicate Where Incident Occurred: Main Facility 4 Level 2: Housing Unit, Special (SHU) Level 3: 9 SOUTH SHU sa Institution Locked Down: No Modified Operations: No Cause Of Incident Known? No (Assault, Attempted On Staff — aie ond C Disruptive Behavior 7 (CO Escape From Non-secure Facility . bet Y (CO Escape From Secure Facility CU Disrespect issue C Escape, Attempted From Non-secure Facility (C0 Drugs CI Escape, Attempted From Secure Facility D Ethnic Conflict O Fight (C Food Issue CJ Inmate Death ( Geographical Conflict ( Institution Disturbance C2 Interfering with Staff duties (1 Introduction Of Contraband Some C Lethal Weapons Discharge = neo Equipment ( Self Mutilation oO . Religious Issue D Setting A Fire CD Security Threat Group Conflict CD Sexual Act, Non-consensual On Inmate CO Sexual Pressure 0 Sexual Assault On Staff C Sporting Events (1 Sexual Contact, Abusive On Inmate C Telephone C Sexual Harassment, Repetitive 0 Theft CO Staff Homicide Visiting CO Strike, Food DO Work Issue 0 Strike, Work @ Suicide Attempt Method: Hanging/Asphyxiation CO Use Of Force (CO Use Of Force/Applications Of Restraints | CO Use of Restraints, Pregnant/Postpartum | Section 2: Inmates Involved | UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unciassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the public or those without a “need to know.” It contains information that may be exempt from public release under the is Privacy Act (5 U.S.C. 552). 1 of 3 EFTA00104956

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Form 583 Report of Incident Incident #: NYM-19- Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM Reg #: 76318054 Name: EPSTEIN, JEFFREY Role: Victim Medical Attention Required: No Weapon (per inmate): No Use of Force (per inmate): No CIMS: No STG: Yes Restraints (per inmate): Escort Only Death (per inmate): No Reg #: 78514054 Name: TARTAGLIONE, NICHOLAS Role: Not Known Medical Attention Required: No Weapon (per inmate): No Use of Force (per inmate): No Injury Category: Minor Injuty Chemical Used (per inmate): No Injury Category: No Injury Chemical Used (per inmate): No CIMS: Yes STG: Yes Restraints (per inmate): No Death (per inmate): No Section 3: Others Involved Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Name: Medical Attention Required: No UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Uncilassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with attribution, to active Law Enforcement, DOD, or U.S. not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the ge’ public or those without a “need to know.” It contains information that may be exempt from public release under the i Privacy Act (5 U.S.C. 552). Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Agencies. This document, or any segmenv/attachment the: 2 of 3 EFTA00104957

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Form 583 Report of Incident Incident #: NYM-19- Submitted By: Date/Time Of Incident: 7/23/2019 1:27 AM 0076 Injury Category: No Injury Staff Injury by Inmate: No Sexual Assault: No Section 4: Lethal Weapon Discharge | No data found. Section 5: Use of Force No data found. DESCRIPTION OF INCIDENT (If Use Of Force, include details such as name of supervisor applying the ical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear al cause(s) of the incident in your description. On July 23, 2019 at approx. 1:27 a.m., a call for assistance on the Special Housing Unit was announced by the retrieve the stretcher. As inmate Epstein was being placed on the stretcher by responding staff, he would open oes and observe staff. When staff made eye contact with him, he would hurriedly shut his eyes. The inmate was HA-Unit, dressed in the suicide smock and placed on suicide watch. Upon the arrival of medical staff, inmate Epstein was examined and treated by, MLP Y. Joaquin for a circular line erythema at the base of the neck, one section on the front with marks of friction and a small erythema on his left Section 7: Attachments Co <2 original toreal 8g = No data found. Approved By: NOT COMPLETED UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the public or those without a “need to know.” It contains information that may be exempt from public release under the provisions of Privacy Act (5 U.S.C. 552). 3 of 3 EFTA00104958