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 #: 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¶
| Name: | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff Injury by Inmate: No |
| Sexual Assault: No | |
| Name: | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff Injury by Inmate: No |
| Sexual Assault: No | |
| Name: | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff Injury by Inmate: No |
| Sexual Assault: No | |
| Name: | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff Injury by Inmate: No |
| Sexual Assault: No | |
| Name: Noel, Tova | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff 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, Michael | Person Type: Staff |
| Medical Attention Required: No | Death: No |
| Injury Category: No Injury | Staff 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 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¶
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¶