••-•4'

••-•4' OB§P.IWAMONISif , NAME: 'PS-1R PEGlSTF:ATIONS: .7V6 o sq OBSERVATION STARTED: 2-2I / OBSERVATION ENDED: 7 7 e / PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. THANK YOU. FAS ALLOWED: Regular Clothes Safety Toothbrush Newspaper/Magazine Books (softcover only) Safety Pen and Paper _ItfToilet Paper , r'. Mail SW Blanket & SW Mattress must he used even on Psych Observations. If nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket ,:re allowed. 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"' ,--- ,/ ri.vhci 3 / r . - urt .04 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. SON Y_O3CO6392 EFTA_00000477 EFTA00134896