EFTA00140463



A0298
N.17




INCIDENT REPORT


## J.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

# Part I – Incident Report

1. Institution: MCC New York
   Incident Report Number: 3283555

2. Inmate's Name: Epstein, Jeffery
   Date of Incident: 07/23/2019
   Time: 1:27am

3. Register Number: 76518-054

4. Place of incident: SHU M-Tier Cell 124
   Assignment: Unassigned

5. Unit: ZA

6. Incident: Self-Mutilation
   10. Prohibited Act Code(s): 228

11. Description of Incident (Date: 07/23/2019 Time: 1:27AM) Staff became aware of incident:

On July 23, 2019 at approx. 1:27 AM While working in the Special Housing Unit Myself and board noise coming from the M key cell 124 Upon arrival IIM's Epstein, Jeffery#76318-054 cell mate UIM Tartaglione#76514-054 was at the door stating IIM Epstein, Jeffery#76318-054 had attempted to hang himself. I kept a visual while grabbing the door keys and called for assistance. After Securing IIM Tartaglione#76514-054 and removing him from the cell, entered then placed IIM Epstein on his side and removed a orange homemade rope from his neck. IIM was breathing at this time.

But unresponsive. Addition staff and Ops arrived IIM was then removed from SHU.

12. Typed Name/Signature of Employee:
   13. Date And Time: 07/23/2019 3:00am

14. Incident Report Type Name/Signature of Inmate By
   15. Date Incident Report Delivered:
   16. Time Incident Report Delivered:

# Part II – Committee Action

17. Comments of Inmate to Committee Regarding Above Incident:

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.

18. 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=signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings).

Chairman (Typed Name/Signature): Member (Typed Name): Member (Typed Name):

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.

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



PDF

Prescribed by P5270

Replaces BP-A0288 of AUG 11

EFTA00140464

23. Inmate Advised Of Right To Remain Silent: You are advised of your right to remain silent at all stages of the discipline process. Your silence may be used to draw an adverse inference against you at any stage of the discipline process. Your silence alone may not be used to support a finding that you have committed a prohibited act.

The Inmate Was Advised Of The Above Right By ___ At (Date/time) ___

24. Inmate statement and attitude

25. Other facts about the incident, statements of those persons present at scene, disposition of evidence, etc.

26. Investigator’s comments and conclusions

27. Action taken

Date and Time Investigation Completed ___

Printed Name/Signature Of Investigator ___ Title ___

*OF* Prescribed by P5270 Replaces BP-S288.052 OF MAY 94