BP-A0292 APR 16¶
SPECIAL HOUSING UNIT RECORD¶
U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS¶
| NEW YORK MCC (Institution) | ||||
| Inmate Name: | EPSTEIN, JEFFREY EDWARD | Reg. No. 76318-054 | ||
| Team/caseworker: | Regular Unit:5UNT MGR. N. REID EXT 6421/6301Cell:5 | |||
| Violation or Reason: | N/A | Date Rec'd: | N/A | Time Rec'd:N/A |
| Admittance Authorized: | N/A | Date Rel.: | N/A | Time Rel.:N/A |
| Pertinent Information: | N/A | |||
| Date | Shift | Meals | SH | Exercise | Out of cell time (Total min/hrs) | Comments | Medical Staff Sign | OIC Signature | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| B | D | S | |||||||||
| 08-04-2019 | Morn | Y | |||||||||
| 08-04-2019 | Day | Y | |||||||||
| 08-04-2019 | Eve | Y | |||||||||
| 08-05-2019 | Morn | Y | |||||||||
| 08-05-2019 | Day | Y | |||||||||
| 08-05-2019 | Eve | Y | |||||||||
| 08-06-2019 | Morn | Y | |||||||||
| 08-06-2019 | Day | Y | |||||||||
| 08-06-2019 | Eve | Y | No | ||||||||
| 08-07-2019 | Morn | Y | |||||||||
| 08-07-2019 | Day | Y | |||||||||
| 08-07-2019 | Eve | Y | No | ||||||||
| 08-08-2019 | Morn | Y | |||||||||
| 08-08-2019 | Day | Y | |||||||||
| 08-08-2019 | Eve | Y | |||||||||
| 08-09-2019 | Morn | Y | |||||||||
| 08-09-2019 | Day | Y | |||||||||
| 08-09-2019 | Eve | Y | |||||||||
| Morn | |||||||||||
| Day | |||||||||||
| Eve | |||||||||||
EXPLANATORYNOTES:Pertinent Info: i.e., Epileptic; Diabetic; Suicidal; Assaultive; etc. Meals/SH: Shower - Yes (Y); No (N); Refused (R)Out-of-Cell Time: (LL) Law Library,(LV) Legal Visit, (U) Unit Team, (P) Psychology, (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue, (V) Visit, (M) Medical, (C) Court, (O) Other – Yes (Y) if applicable / Enter Actual Time Period Start and End (i.e., 0930 – 1030 hrs) in Out of Cell Time Block.¶
Medical: Medical providers will sign the segregation log each shift and the record sheet each time the inmate is seen by a medical provider. At a minimum, the record sheet must be signed at least once each day by the medical provider. Comments: i.e., Conduct, Attitude, etc. Additional comments on reverse side must include date, signature, and title. OIC Signature: OIC must sign all record sheets each shift. (OIC - Unit Officer)¶
PDF¶
Prescribed by P5270¶
This form replaces BP-292(52) dated AUG 2011.¶
EFTA00143155¶