INCIDENT REPORT

/ Ao2rd INCIDENT REPORT nit J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Part I — Incident Report 1. Institution: MCC New York Incident-F(6PM Nunfintal..3 Cy 2. Inmate's Name: Epstein . Jeffery 3. Register Number 16318-054 4. Date of Incident: 07/23/2019 1:27am 6. Place oflnadent: SHU M-Tier Cell 124 7. Assignment: Unassigned B. Un ZA • 9. Incident Sell-Mutilation . 1-0. Prohibited Act Code (s): 228 11. Description of Incident (Date: 07/23/2019 Time: • 1•27AM Staff became aware of incident): On July 23.2019 at approx. 1:27am While working in the Special Housing Unit Myself and S/O1. hoard noise coming from the M tier cell 124.Upon arrival UM's Epstein,Jelfery#76318-05 mate (UM TartaglioneW78514-054)was at the door stating UM Epslein.Jefferya76318-054 had attempted to hang himself:I-Wept a visual while SIC) grabbed the door keys and called for assistance. After Secunng UM Tartaghonee /8514.054 and removing turn from the toe entered men placed UM Fli nn on side and-removed -a orange homemade rope from his neck.UM was breathing at this time But unresponsive. Addition staff and Ops LI arrived I/M was then removed from SHU 12. Typed ame/ ign rang Employee: i4. Incident Report (Type Name/Sig 13. Date And Time: 07/23/2019 3:30am to Above Inmate By r i5. Date Incident Report Delivered: 16. Time In en epon Delivered: art H- Committee Action 17. Comments of Inmate to Committee Regarding Above Incident: 18 A It is the finding of the committee that you: B. The Committee is referring the Charge(s) to the DHO for further the Prohibited Ad as charged: _C- 1 FCle.raliri The Committee advised the male of its finding and of the right Did not Commit a Prohibited Act. fEE Committed Committed Prohibited Act Code (s). to an appeal within 20 calendar days. 19. Committee Decision is Based on Specific Evidence as Follows: e 20. Committee action and/or recommendation if referred to DHO (Contingent upon DUO finding inmate committed prohibited act): 21. Date and Time of Action: (The UDC Chairman=s signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings). man (typed Name/Signature). Member (Typed Name) Member (Typed Name): INS1RUCTIONS: All items outside oT heavy rule are for staff use only. Begin entries with the number 1 and work up. Entries not completed will be voided by staff. Distribute: Original-Central File Record: COPY-1.DHO: COPY-2-Inmate after UDC Action, COPY 3-Inmate within 24 hours of Part I Preparation PDF Prescribed by P5270 SONY 00017351 Replaces BP-A0288 of Auu EFTA00138988