Form 583 Report of Incident¶
Incident #: NYM-19-0082 Submitted By:¶
Section 1: General Information¶
| 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 |
| □ Inmate Death | □ Geographical Conflict |
| □ Institution Disturbance | □ Interfering with Staff duties |
| □ Introduction Of Contraband | □ Property Issue |
| □ Lethal Weapons Discharge | □ Racial Conflict |
| □ Self Mutlation | □ 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_00000796¶
EFTA_00000020¶
EFTA00134560¶
Form 583 Report of Incident¶
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: | 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 |
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 be used for the purposes of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general.¶
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_00000797¶
EFTA_00000021¶
EFTA00134561¶
Form 583 Report of Incident¶
| Incident #: NYM-19-0082 | Submitted By: | Date/Time Of Incident: 8/10/2019 6:33 AM |
|---|
Name: Thomas, Michael Medical Attention Required: No Injury Category: No Injury Sexual Assault: No¶
Person Type: Staff Death: No Staff Injury by Inmate: 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_00000798¶
EFTA_00000022¶