Form 583 Report of Incident
Incident #: NYM-19-0082Submitted By: N' Diaye, L.
Date/Time Of Incident: 8/10/2019 6:33 AM ## Section 1: General Information # Staff Aware Date: 8/10/2019 6:33 AM **FBI Notified:** Yes **USMS Notified:** Yes **Indicate Where Incident Occurred:** Main Facility **Location Level 1:** SHU **Level 2:** Housing Unit, Special (SHU) **Level 3:** 9 SOUTH SHU | Type Of Incident | Institution Locked Down: Yes | | :--- | :--- | | □ Assault On Inmate | Modified Operations: No | | □ Assault On Staff | Cause Of Incident Known? No | | □ Assault, Attempted On Inmate | Cause Of Incident | | □ Assault, Attempted On Staff | □ Alcohol | | □ Disruptive Behavior | □ Commissary | | □ Escape From Non-secure Facility | □ Debts | | □ Escape From Secure Facility | □ Disrespect Issue | | □ Escape, Attempted From Non-secure Facility | □ Drugs | | □ Escape, Attempted From Secure Facility | □ Ethnic Conflict | | □ Fight | □ Food Issue | | □ Inmate Death | □ Geographical Conflict | | □ Institution Disturbance | □ Interfering with Staff duties | | □ Introduction Of Contraband | □ Property Issue | | □ Lethal Weapons Discharge | □ Racial Conflict | | □ Self Mutilation | □ Recreation Equipment | | □ Setting A Fire | □ Religious Issue | | □ Sexual Act, Non-consensual On Inmate | □ Security Threat Group Conflict | | □ Sexual Assault On Staff | □ Sexual Pressure | | □ Sexual Contact, Abusive On Inmate | □ Sporting Events | | □ Sexual Harassment, Repetitive | □ Telephone | | □ Staff Homicide | □ Theft | | □ Strike, Food | □ Visiting | | □ Strike, Work | □ Work Issue | ☑ Suicide Attempt Method: Hanging/Asphyxiation □ Use Of Force □ Use Of Force/Applications Of Restraints □ Use of Restraints, Pregnant/Postpartum ## Section 2: Inmates Involved ## UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a "need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 1 of 3 EFTA00109863 Form 583 Report of Incident Incident #: NYM-19-0082 Submitted By: N' Diaye, L. Date/Time Of Incident: 8/10/2019 6:33 AM Reg #: 76318054 Name: EPSTEIN, JEFFREY Role: Not Known Medical Attention Required: Outside Injury Category: Fatal Injury Weapon (per Inmate): No Use of Force (per Inmate): No Chemical Used (per Inmate): No CIMS: No STG: Yes Restraints (per Inmate): Escort Only Death (per Inmate): No Section 3: Others Involved Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Person Type: Staff Death: No Staff Injury by Inmate: No Name: Noel, Tova Medical Attention Required: No Injury Category: No Injury Sexual Assault: No Person Type: Staff Death: No Staff Injury by Inmate: No ## UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a "need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). 2 of 3 EFTA00109864 Form 583 Report of Incident ## Incident #: NYM-19-0082 Submitted By: N' Diaye, L. Date/Time Of Incident: 8/10/2019 6:33 AM **Name:** Thomas, Michael **Medical Attention Required:** No **Injury Category:** No Injury **Sexual Assault:** No **Person Type:** Staff **Death:** No **Staff Injury by Inmate:** No ### Section 4: Lethal Weapon Discharge No data found. ### Section 5: Use of Force No data found. ### Section 6: Description of Incident **DESCRIPTION OF INCIDENT (If Use Of Force, Include details such as name of supervisor applying the chemical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear about cause(s) of the Incident in your description.** On August 10, 2019, at approximately 6:33 a.m., while serving the breakfast meal inmate Epstein, Jeffrey, Reg. No. 76318-054 was found unresponsive in his cell. Staff called for assistance and began life saving measures. He was escorted to Health Services at approximately 6:39 a.m., and EMS arrived at 6:43 a.m. He was transported to the local hospital at approximately 7:10 a.m. Innate Epstein was pronounced deceased at 7:36 am. ### Section 7: Attachments | File Date | File Name | Original Entered By | Original Loc. Code | | :--- | :--- | :--- | :--- | | 8/10/2019 | Operation Memorandum.pdf | TF18990 | NYM | | 8/10/2019 | Unit Roster.pdf | TF18990 | NYM | | 8/10/2019 | Staff Roster.pdf | TF18990 | NYM | | 8/10/2019 | Medical Assessment.pdf | TF18990 | NYM | | 8/10/2019 | Staff Memorandum.pdf | TF18990 | NYM | Approved By: SUBMITTED N' Diaye, L **UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE** This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a "need to know." It contains information that may be exempt from public release under the provisions of the 3 of 3 EFTA00109865