EFTA00110609¶
BP-A295.052 APRIL 1994¶
SPECIAL HOUSING UNIT REVIEW¶
U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS¶
| Inmate Name: | Register Number:85993-054 | Unit:7 | Institution:NEW YORK MCC |
| Date Entered Special Housing:07-16-2019 | Reason for Placement:PENDING SIS INVESTIGATION/THREAT ASSESSMENT/COURTS SAY INMATE FELT THREATEN ON UNIT. | ||
| I. Subject:(2 or 3 Days)3 Day Review | Date Reviewed07-19-2019 | ||
| Action Taken on the Above Date:Continue In Special Housing Unit | |||
| Printed Name/Signature: | |||
| DATE | ACTION TAKEN | REMARKS | SIGNATURE | |
|---|---|---|---|---|
| 07-23-2019 | Continue in Special Housing Unit | |||
| 07-30-2019 | Continue in Special Housing Unit | |||
| 08-06-2019 | Continue in Special Housing Unit | |||
| III. Subject: (7 or 30 Days) 7 Day Review | Review By (SRQ): | Reviewing Authority: | ||
| Date inmate appeared for a Special Housing Review: 07-23-2019 | 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: 08-13-2019 | ||||
| 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¶
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8/6/2019¶
EFTA00110610¶
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EFTA00110612¶