EFTA00110607 BP-A295.052 APRIL 1994 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS
Inmate Name:Register Number:Unit:7Institution:NEW YORK MCC
Date Entered Special Housing:07-16-2019Reason for Placement:PENDING SIS INVESTIGATION/THREAT ASSESSMENT
I. Subject:(2 or 3 Days)3 Day ReviewDate Reviewed07-19-2019
Action Taken on the Above Date:Continue in Special Housing Unit
Printed Name/Signature:
II. RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.) | DATE | ACTION TAKEN | REMARKS | SIGNATURE | | :--- | :--- | :--- | :--- | | | | | | | | | | | | III. Subject: (7 or 30 Days) | Review By (SRO): | Reviewing Authority: | | Date inmate appeared for a Special Housing Review: | Or Date inmate waived right to appear: | | Has been seen daily by Medical Staff: □ Yes; □ No | | Has been seen daily by responsible officer designated by Warden: □ Yes; □ No | | Has received prescribed weekly exercise: □ Yes; □ No | Proper documentation and justification in the Central File (Incident Report, DHO Report, copies of Special Housing Review Form): □ Yes; □ No if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? □ Yes; □ No Is there an additional assessment for every one month interval thereafter? □ Yes; □ No if no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: □ Released from Special Housing; □ Continue in Special Housing Did inmate in Administrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? □ Yes; □ No if no, why not (Should be given provided institutional security not compromised)? Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of this form): Date of Next Review: 07-23-2019 Printed Name and Signature of Segregation Review Official or the Reviewing Authority and Date Signed: Record Copy - Central File This form replaces BP-295(52) dated January 1988 Page 1 of 1 7/19/2019