ney —_ a > A0288 INCIDENT REPORT NA? J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Part ' = Incident Re port B_Insttuon MCC New York Sent Repo UME DAR ADSS a ate’s Name: . Register Number: 4. Date of incident: . Time: 9. Incident: Seif-Mutilation eee ane OP 258 11. Description of Incident (Date: 07/23/2019 Time: 1:27AM Staff became aware of incident): On July 23,2019 at approx. 1:27am While working in the Special Housing Unil elf and S/O ard noise coming from the M tier cell 124.Upo arrival /M's Epstein. Jeff ghone#785 14-054 )was UM Epstein Jefiery#76318-054 had attempted to ang self. | kept a visual e S/O orabbed the doo eys and called for assistance. After Sec: ing I/M Tartaglione#785 054 and removing om the cell, entered then placed I/M Epstein on his side and removed a orange homemade rope trom his neck./M was breathing al this ime But un . Addition staff and Ops Lt arrived I/M was then removed from SHU . yped N Empl ~ Date And Time: . medent Report e ie B D Inad Report Delivered 6. Time Incident Repo Del (Type Name/Sig art Il - Committee Action 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 * 8 [1 The Committee is referring the Charge(s) to the DHO for further Cc, The Committee advised the inmate of its finding and of the right 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): accurately reflecis the UDG sroSS6ORG)—————— (The UOC Chairmanes signature certifies who sat on the UDC and that the completed report airman lame/Signature, Member (Typed Namey. Wember (typed Ramee voided by staff. si = use only. Begin with the Work Up. Snot com Lg € Distribute: Original-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part | Preparation POF Prescribed by P5270 Replaces BP-A0288 of AUG 11 anaheim ST SE ERED V8 I es oe EFTA00104960

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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) 4. 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) oe vr @ POF Prescribed by P5270 Replaces BP-S288.052 Of MAY 94 EFTA00104961