EFTA00106561



BP-A0292
APR 16


SPECIAL HOUSING UNIT RECORD

U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS

<table><thead><tr><th rowspan="2">Date</th><th rowspan="2">Shift</th><th colspan="3">Meals</th><th rowspan="2">SH</th><th rowspan="2">Exercise</th><th rowspan="2">Out of cell time<br>(Total min/hrs)</th><th rowspan="2">Comments</th><th rowspan="2">Medical Staff Sign</th><th rowspan="2">OIC Signature</th></tr><tr><th>B</th><th>D</th><th>S</th></tr></thead><tbody><tr><td>08-04-2019</td><td>Mom</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-04-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-04-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-05-2019</td><td>Mom</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-05-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-05-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-06-2019</td><td>Mom</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-06-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-06-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-07-2019</td><td>Mom</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-07-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-07-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-08-2019</td><td>Mom</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-08-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>08-08-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Mom</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Day</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Eve</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

EXPLANATORYNOTES:Pertinent Info: i.e., Epileptic; Diabetic; Suicidal; Assaultive; etc. Meals/SH: Shower - Yes (Y); No (N); Refused (R)Out-of-Cell Time: (LL) Law Library,(LV) Legal Visit, (U) Unit Team, (P) Psychology, (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue, (V) Visit, (M) Medical, (C) Court, (O) Other – Yes (Y) if applicable / Enter Actual Time Period Start and End (i.e., 0930 – 1030 hrs) in Out of Cell Time Block.

Medical: Medical providers will sign the segregation log each shift and the record sheet each time the inmate is seen by a medical provider. At a minimum, the record sheet must be signed at least once each day by the medical provider. Comments: i.e., Conduct, Attitude, etc. Additional comments on reverse side must include date, signature, and title. OIC Signature: OIC must sign all record sheets each shift. (OIC - Unit Officer)

Prescribed by P5270

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This form replaces BP-292(52) dated AUG 2011.