Suicide Watch Chronological Log Inmate Companions Log ra Name of inmate on watch: = . .. - c Epst« Lis Oo §¢ 2 Ss £8 = Register #: = % { 2 Boe : \f- oS = OY Wy Welt a Eee : wn ooh ~ £ Institution: Ov % 0: wi SHH S ce Y Oo - Suu oY >+>TSTEBSBSZEaHL$ Date Watch Began/Ended 23 =~ ‘OS ‘O ‘O Oomcetr Zesasa 509 OG 7124414 ONnNNNNAYNE U To be completed by Chief Psychologist at conclusion of watch: Booklet ___ of SWCL - INMATE ¥ EFTA00110502

--=PAGE_BREAK=--

STAPLE LOCAL PROCEDURES HERE Check one of the following: Oo This is the initial log book for this suicide watch. Enter date and time watch began: ia) 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. EFTA00110503

--=PAGE_BREAK=--

Suicide Watch Observation Log onwatch EPSIELO Regt: 14515. 5 | _rime | ___ observations: sretly note your observations. initia allentries. | initiate : On S rans 1 ff Ya Becaght ws o Surci&ke Cel oon fan 1K0 ca fe mot “Ted ke er (t Th tn | | 4 BULL a be) “g (Cw cul eth ei Bed ——— ra lakes Dic tue of tl _| . oie m Si ia ‘ Ye Sted on Be) Se eee EFTA00110504

--=PAGE_BREAK=--

Suicide Watch Chronological Staff Suicide Watch a Observers $ Only ia? “Register #: ; "Institution: cootneat gs SSE Date’ Watch Began | Ended . 2, a To be completed by Chief Psychologist at conclusion of watch: _ Booklet of SWCL - STAFF EFTA00110505

--=PAGE_BREAK=--

STAPLE LOCAL PROCEDURES HERE Check one of the following: @° This is the initial log book for this suicide watch. Enter date and time watch began: July 23:2010 ot roa es nay : A "ox, This a continuation log book for this watch. ‘Enter date and time this watch book was ‘initiate = Ee “| iy “, ‘ fy i ard | Instructions to Observer: : “ee 4s ee ! " Document your observations every |e YeKnearee minutes.’ Legibly print and sign your name at the beginning of your shift. . EFTA00110506

--=PAGE_BREAK=--

Suicide Watch Observation Log VAM mo 6 Hemae Win pad née 3 5au 5. A aleeéhis= 3.45 . mh 4.0Q0A 18@4¢h1= 5:00am ‘Inmate sitter? on bed? | 5:45 Ay na_At Goo | gs 00AM lomate Sanding at deo | Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00110507