PSYCH OBSERVATION LOG Enstkin 163 ae 7 OBSERVATION ENDED: [10/19 / Am >. “i Ve PLEASE RETURN LOG TO PSYCHOLOGY AFTER Ma “THE OBSERVATION HAS ENDED. can, GTHANK YOU. A Cape tyes 00 IN a Si Da Oe. tems auowen: lA ; fs Regular Clothes ae ale Safety Toothbrush Thee y op 4 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. "7 If nothing is checked with a silver marker, only a “8 Suicide Smock and Suicide Blanket are allowed. SDNY_00010960 EFTA00139536

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Name of Inmate On Suicide Watch or Psych Observation: ERE PSHein Registration #: ~ DATE BREAKFAST | LUNCH EATING/SHOWER CHART OFFERED RECEIVED 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. CONFIDENTIAL SDNY_00010961 EFTA00139537

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