Suicide Watch Chronological Log Inmate Companions Log Name of inmate on watch: Eps 41 Register #: a a 1 ea iN Institution: Date Watch Began / Ended To be completed by Chief Psychologist at conclusion of watch: Booklet ___ of SWCL - INMATE

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STAPLE LOCAL PROCEDURES HERE Check one of the following: o This is the initial log book for this suicide watch. Enter date and time watch began: This is a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: Document your observations every minutes. Legibly print and sign your name at the beginning of your shift.

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Suicide Watch Observation Log Name of Inmate on watch: Bsiein Reg #: 1USI5. oS Observations: Briefly note your observations. Initial all entries. | initiats | Ow | Yu Breught don do Surcibe ceil Fd | WS aw agit owt Be “en lw Gill ‘ uy 4 Spllewe Ti [fu Sf bs) his Cellmek Arird fe Fit | “An 7 y nF i NG mn be) 4 wz, Vf wen — hi hat Hayy fY ———_ a “ = i ths Be —— 7 _ * aw AU BeS —— 3 nF An Deion isk dictueS cA lu [we te ee ee Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00106355

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Suicide Watch Observation Log Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00106356

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Suicide Watch Chronological Log Staff Suicide Watch Observers Only Name of inmate on watch: Epstein, J. Register #: 4312-054 Institution: Mec, New Yer« Date Watch Began / Ended July 23,2014 - July 24, A014 To be completed by Chief Psychologist at conclusion of watch: Booklet _____ of

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STAPLE LOCAL PROCEDURES HERE Check one of the following: 2 This is the initial log book for this suicide watch. Enter date and time watch began: This a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: Document your observations every So aia minutes. Legibly print and sign your name at the beginning of your shift.

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HO a Suicide Watch Observation Log . 14) Date: } 5:00 Himalayan bed 1 \y 5SiNSA mate and doo (tks, VX ‘amar 1% WAY rahe inmate londin? at dew TRY ee S527 Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00106359

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Suicide Watch Observation Log Name of Inmate ‘on watch: Reg #: Date: Observations: Briefly note your observations. Initial all entries. Note to all observers: Legibly print and sign your name at the beginning of your shift. 2 EFTA00106360