EFTA00056065

# Suicide Watch Chronological Log

## Inmate Companions Log

## Name of inmate on watch:

Register #:

7431E.054

Institution:

Date Watch Began / Ended

ONLY ITEMS ALLOWED:

Sack Meal

To be completed by Chief Psychologist at conclusion of watch:

Suicide Smock/Slippers

Booklet ___ of ___

Suicide Sleeping Bag

Suicide Mattress

Paper Cup

Tampons or

Foam Sanitary Belt/Napkin



SWCL - INMATE


EFTA00056066

## 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: ___



□ 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.





EFTA00056067

Suicide Watch Observation Log

<table border="1"><tr><td>Time</td><td>Observations: Briefly note your observations. Initial all entries.</td><td>In</td></tr><tr><td>1:40am</td><td>I m Brought Down to Surprise roll thru</td><td></td></tr><tr><td>1:45am</td><td>I m Laying on Bed</td><td></td></tr><tr><td>2:00am</td><td>I m Sitting on Bed talking</td><td></td></tr><tr><td>2:15am</td><td>I m Stalk his cellmate need to kill him</td><td></td></tr><tr><td></td><td>I m</td><td></td></tr><tr><td>2:30am</td><td>I m Sitting on Bed trying to remember what happened</td><td></td></tr><tr><td>2:45am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>3:00am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>3:15am</td><td>I m An insomnia takes pictures of me</td><td></td></tr><tr><td>3:30am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>3:45am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>4:00am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>4:15am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>4:20am</td><td>I m Standing at Door talking</td><td></td></tr><tr><td>4:45am</td><td>I m Standing at Door talking</td><td></td></tr><tr><td>5:00am</td><td>I m Sitting on Bed</td><td></td></tr><tr><td>5:15am</td><td>I m Standing at Door</td><td></td></tr><tr><td>6:00am</td><td>I m Standing at Door</td><td></td></tr></table>

Note to all observers: Legibly print and sign your name at the beginning of your shift.

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