Blank suicide watch observation log book for an MCC inmate

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:¶

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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¶

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

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

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