t NAME:_— O S44) | e REGISTRATION#: _ 13} y- O54 WIZ ~~ + f OBSERVATION STARTED:._// y19 (2 @} M OBSERVATION ENDED: Iho/ q / Am PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. THANK YOU. Regular Clothes Safety Toothbrush Newspaper/Magazine Books (softcover only) ____ Safety Pen and Paper Toilet Paper Legal Mail Other SW Blanket & SW Mattress must be used even on Psych Observations. If nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket are allowed. EFTA00106339

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+ Gag "irate ates tein is sitting on the bed’ }7/ G15 "Tote Eysteip is pacing, tine toom ——————— am” ip inte tine Showerand GED “A Ye tll ann tis set oF cleties E> tamat elting de: ee, Nisit —— um rary be €in has entered a ceou ont ; es we chict Mbed MODuf Rie +: ina” ~ EFTA00106350

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Name of Inmate On Suicide Watch or Psych Observation: Geaes E pSit j /\ Registration #: me EATING/SHOWER CHART | DATE BREAKFAST | LUNCH | DINNER | LiQuips fannie a RECEIVED 7 He ies) al 4 SHOWER _| SHOWER Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if he just received it, but did not eat it. Place a check in the “Liquids” box each time the person drinks. Thank you. EFTA00106352