Form 583 Report of Incident Incident #: NYM-19-0082 Submitted By: 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 | | □ Innate 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 SDNY_00013430 EFTA00123089 ## Form 583 Report of Incident Incident #: NYM-19-0082 Date/Time Of Incident: 8/10/2019 6:33 AM
Reg #: 76318054Name: EPSTEIN, JEFFREY
Role: Not KnownMedical Attention Required: OutsideInjury Category: Fatal Injury
Weapon(per inmate): NoUse of Force(per inmate): NoChemical Used(per inmate): No
CIMS: NoSTG: Yes
Restraints(per inmate): Escort Only
Death(per inmate): No
Section 3: Others Involved
Name:Person Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: No
Name:Person Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: No
Name:Person Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: No
Name:Person Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: No
Name: Noel, TovaPerson Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: 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 SDNY_00013431 EFTA00123090 ## Form 583 Report of Incident Incident #: NYM-19- 0082 Date/Time Of Incident: 8/10/2019 6:33 AM
Name: Thomas, MichaelPerson Type: Staff
Medical Attention Required: NoDeath: No
Injury Category: No InjuryStaff Injury by Inmate: No
Sexual Assault: 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. Inmate Epstein was pronounced deceased at 7:36 am. Section 7: Attachments
File DateFile NameOriginal Entered ByOriginal Loc.Code
8/10/2019Operation Memorandum.pdfTF18990NYM
8/10/2019Unit Roster.pdfTF18990NYM
8/10/2019Staff Roster.pdfTF18990NYM
8/10/2019Medical Assessment.pdfTF18990NYM
8/10/2019Staff Memorandum.pdfTF18990NYM
Approved By: SUBMITTED ## 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). 3 of 3 SDNY_00013432 EFTA00123091