INCIDENT REPORT

FEDERAL BUREAU OF PRISON

# 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: 1:27am
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: 1:27AM Stuff became aware of incident)

On July 23,2019 at approx: 1:27am While working in the Special Housing Unit Myself and S/O Silva heard noise coming from the M tier cell 124 Upon arrival I/M's Epstein, Jeffery#76318-054 cell mate I/M was at the door stating I/M Epstein, Jeffery#76318-054 had attempted to hang himself. I kept a visual while I/M grabbed the 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 a orange homemade rope from his neck. I/M was breathing at this time.

But unresponsive. Addition staff and Ops Li arrived I/M was then removed from SHU.

<table><thead><tr><th>12. Typed Name<br>Masullo,J</th><th colspan="2"></th><th>13. Date And Time:<br>07/23/2019 3:30am</th></tr></thead><tbody><tr><td>14. Incident Report<br>(Type Name/S)</td><td colspan="2">15. Date Incident Report Delivered:<br>7-20-19</td><td>16. Time Incident Report Delivered:<br>12:40 pm</td></tr></tbody></table>

17. Comments of Inmate to Committee Regarding Above Incident:





<table border="1"><tr><td>A. It is the finding of the committee that you:Committed the Prohibited Act as chargedDid not Commit a Prohibited ActCommitted Prohibited Act Code(s)</td><td>B. The Committee is referring the Charge(s) to the DHO for further HearingC. The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days.</td></tr></table>





19. Committee Decision is Based on Specific Evidence as Follows



10. Commence decision is based on special 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)

<table border="1"><tr><td>Chairman(Typed Name/Signature)</td><td>Member(Typed Name)</td><td>Member(Typed Name)</td></tr></table>

INSTRUCTIONS: All items outside of heavy rule are for staff use only. Begin entries with the number 1 and work up. Entries not completed will be voided by staff.

Original Central File Record: COPY-1-DHO. COPY-2-Inmate after DC Action: COPY 3-Inmate within 24 hours of Part I Preparation

Replaces BP.A0286 of AUG 11



Prescribed by P5270


EFTA00134650