EFTA00080405¶
Page 0106¶
INCIDENT REPORT¶
J.S. DEPARTMENT OF JUSTICE¶
Part I – Incident Report¶
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Institution: MCC New York Incident Report Number: 3289555
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Inmate’s Name: Epstein, Jeffery Register Number: 76314-054 Date of Incident: 07/23/2019 Time: 1:27am
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Place of Inmate: SHU M-Tier Cell 124 Assignment: Unassigned Unit: ZA
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Incident: Self-Mutilation Prohibited Act Code(s): 228
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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 SIO Silva heard noise coming from the Miter cell 124 Upon arrival IMVs Epstein, Jeffery#76314-054 cell mate (IM Tartaglione#76314-054) was at the door stating IM Epstein, Jeffery#76314-054 had attempted to remove himself. I kept a visual while SIO Silva grabbed the door keys and called for assistance. After Securing IM Tartaglione#76314-054 and removing him from the cell entered them placed IM Epstein on his side and removed a orange homemade rope from his neck. IM was breathing at this time but unresponsive. Addition staff and inmates removed IM was then removed from SHU.¶
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Typed Name/Signature of Reporting Employee: Masufo Date and Time: 07/23/2019 3:30am
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Incident Report Delivered to Above Inmate By (Type Name/Signature): Date Incident Report Delivered: Time Incident Report Delivered:
Part II – Committee Action¶
- Comments of Inmate to Committee Regarding Above Incident:
B. The Committee is referring the Charge(s) to the DHO for further hearing. The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days.¶
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Committee Decision is Based on Specific Evidence as Follows:
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Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act):
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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).
Chairman (Typed Name/Signature): Member (Typed Name): Member (Typed Name):¶
INSTRUCTIONS: All items outside of 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 Replaces BP-A0288 of AUG 11¶
EFTA00080406¶
Page 0107¶
- Inmate Advised Of Right To Remain Silent: You are advised of your right to remain silent at all stages of the discipline process. Your silence may be used to draw an adverse inference against you at any stage of the discipline process. Your silence alone may not be used to support a finding that you have committed a prohibited act.
The Inmate Was Advised Of The Above Right By ___ At (Date/time) ___¶
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Inmate statement and attitude
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Other facts about the incident, statements of those persons present at scene, disposition of evidence, etc.
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Investigator’s comments and conclusions
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Action taken
Note: No images are present in this text.¶
not yet completed¶
Printed Name/Signature Of Investigator ___ Title ___¶
PDF¶
Prescribed by P5270¶
Replaces BP-S288.052 Of MAY 94¶