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 ¥ EFTA00140484

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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. EFTA00140485

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| time | ___ Observations: Briefly note your observations. initial allentries. | initials | Wry | Yu Sreaght Dan do Surcike cent Fd | Sil fan [ey ow Be Cd Sm [fw Gilhhg wy Se Jeleng — | Wie | fw SS feks7 Wis Collmote driv fe Fil | cM ———_— —_ Cl i“g _ te | fn Sing Ge) trying Ht vtmen be] mul) hi hat AntTyY —— ET [Yu Si frig wy Be —— & Ft [Ym Sith on Be +d Sn Bees dctues of Ju | A 56 ‘tua Gi ia ya Lt O —~ Neh EFTA00140486

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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 EFTA00140487

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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. . EFTA00140488

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Suicide Watch Observation Log Observations: Briefly note your observations. Initial all entries. , oa a 7 a | Ny Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00140489