### 13P.AnCia

JAN 17

### ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

|                                                                                                                                               |                                                                                                                                                   |                     |           | NEW YORK MCC                                                                                                                                                          |
|-----------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------|---------------------|-----------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|                                                                                                                                               |                                                                                                                                                   |                     |           | instsition                                                                                                                                                            |
|                                                                                                                                               |                                                                                                                                                   |                     |           | Date/Time- 07-29.2019 12.21 -                                                                                                                                         |
| ng Unit Officer<br>TO: Special H                                                                                                              |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
| FROM:                                                                                                                                         |                                                                                                                                                   | (Name/rite)         |           |                                                                                                                                                                       |
| SUBJECT: Placement of                                                                                                                         | EPSTEIN. JEFFREY EDWARD                                                                                                                           | Reg. No.            | 76318-054 | in Administrative Detention                                                                                                                                           |
|                                                                                                                                               | (a) Is pending an investigation for a vrolation of Bureau regulations:                                                                            |                     |           |                                                                                                                                                                       |
| (b) Is pending an SIS investigation.                                                                                                          |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | (c) Is pending investigation or trial for a cnminal act:                                                                                          |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | (d) Is to be admitted to Administrative Detention                                                                                                 |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | (1) Since the inmate has requested admission for protection;                                                                                      |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | I hereby request placement in Administrative Detention for my own protection.                                                                     |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | Inmate Signature/Register No.:                                                                                                                    |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | Staff Witness Printed Name Signature:                                                                                                             |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | the necessary information wit be forwarded for an appropriate hearing by the SRO.                                                                 |                     |           | (2) Since a serious threat exists to individual's safety as perceived by staff, although person has not requested admission; referral of                              |
| (e)                                                                                                                                           | Is pending transferor is in holdover status during transfer                                                                                       |                     |           |                                                                                                                                                                       |
| (f)<br>is pending classificatory or                                                                                                           |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
| Is terminating confinement In Disciplinary Segregation and has been ordered Into Administrative Detention by the Warden's<br>(9)<br>designee. |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | population poses a serious throat lo !de. property, self, staff, other inmates. or to the security or orderly running of the institution because' |                     |           | II is the Correctional SupenAsor's decision based on all the circumstances that the above named Inmate's continued presence in the general                            |
| PENDING UDC FOR CODE 228 SELF-MUTILATION                                                                                                      |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
|                                                                                                                                               | Therefore, the above named Inmate is to be placed in Administrative Detention unti further notice. The Inmate received a copy of this Order on    |                     |           |                                                                                                                                                                       |
| (date / time)                                                                                                                                 |                                                                                                                                                   |                     |           |                                                                                                                                                                       |
| Staff Witness Signature/Printed Name                                                                                                          |                                                                                                                                                   |                     |           | Date                                                                                                                                                                  |
|                                                                                                                                               | Supervisor 24 hour review of placement: Signature/Printed name                                                                                    |                     |           |                                                                                                                                                                       |
| documented here.                                                                                                                              |                                                                                                                                                   |                     |           | • In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an independent review and decision. which I |
|                                                                                                                                               | Administrative Detention Unit; Copy — Psychology. Copy - Central Fib                                                                              |                     |           | Record Copy - Inmate Concerned (not necessary if placement is a result of holdover status); Copy - Captain: Copy - Unit Manager, Copy • Operation Supervisor          |
| PDF                                                                                                                                           |                                                                                                                                                   | Prescribed by P5270 |           | (Replaces BP-A0308 of JAN 88.)                                                                                                                                        |

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