EFTA00131467



BP-A0288
JUN 10




INCIDENT REPORT CDFRM


U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

# Part I - Incident Report

1. Institution: MCC New York

2. Inmate's Name
   Epstein , Jeffery

3. Register Number
   76318-054

4. Date of Incident
   07/23/2019

5. Time
   1:30 am

6. Place of Incident
   SHU M-Tier Cell 124

7. Assignment
   Unassigned

8. Unit
   ZA

9. Incident
   Self-Mutilation

10. Prohibited Act Code(s)
    228

11. Description Of Incident (Date: 07/23/2019 Time: 1:27 am Staff became aware of incident)
   On July 23, 2019 at approx. 1:27am While working in the Special Housing Unit Myself and S/O heard noise coming from the M tier Cell 124.Upon arrival inmate Epstein’s cell mate (I/M #78514-054) was at the door stating I/M Epstein #76318-054 had attempted to hang himself. I kept a visual while Officer grabbed door keys and called for assistance.After securing I/M and removing him from the cell, I entered then placed I/M Epstein on his side and removed an orange homemade rope from his neck. I/M was breathing at this time.But unresponsive.Addition staff and Ops Lt arrived I/M was then removed from the SHU.

12. Typed Name/Signature of Reporting Employee

13.Date And Time
   7/23/2019 1:30 am

14. Incident Report Delivered to Above Inmate By (Type Name/Signature)

15. Date Incident Report Delivered

16. Time Incident Report Delivered

## Part II - Committee Action

17. Comments of Inmate to Committee Regarding Above Incident

18. A. It is the finding of the committee that you:
   ___ Committed the Prohibited Act as charged.
   ___ Did not Commit a Prohibited Act.
   ___ Committed Prohibited Act Code(s)

B. ___ The Committee is referring the Charge(s) to the DHO for further Hearing.
C. ___ The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days.

19. Committee Decision Is Based on Specific Evidence as Follows:

20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act)

21. Date And Time Of Action ___ (The UDC Chairman’s signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings.)

Prescribed by P5270

Replaces BBPBBBBB(H2-S24A/052-Of MAY 94



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