PSYCH OBSERVATION LOG

NAME: Epstein

REGISTRATION#: 76318-054

OBSERVATION STARTED: 7/8/19 @ PM

OBSERVATION ENDED: 7/10/19 9 AM

PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED.

THANK YOU.

ITEMS ALLOWED:

___Regular Clothes



___Safety Toothbrush





___Books (softcover only)





___Newspaper/Magazine



Safety Pen and Paper



___ Toilet Paper





___Legal Mail





___Other



SW Blanket & SW Mattress must be used even on Psych Observations.

If nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket are allowed.

CONFIDENTIAL



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Name of Inmate On Suicide Watch or Psych Observation: Epstein

Registration #: 76318-054

EATING/SHOWER CHART

<table><thead><tr><th>DATE</th><th>BREAKFAST</th><th>LUNCH</th><th>DINNER</th><th>LIQUIDS</th><th>OFFERED SHOWER</th><th>RECEIVED SHOWER</th></tr></thead><tbody><tr><td>7-9-19</td><td>/</td><td>/</td><td></td><td></td><td></td><td></td></tr><tr><td>7/10/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if he just received it, but did not eat it.

Place a check in the “Liquids” box each time the person drinks.

Thank you.

CONFIDENTIAL



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