EFTA00059419.pdf

PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. HANK YOU. ITEMS ALLOWED: Regular Clothes Safety Toothbrush Newspaper/Magazine Books (softcover only) Safety Pen and Paper Toilet Paper Legal Mail Other SW Blanket & SW Mattress must be used even on Psych Observations. A lf nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket are allowed. 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Si+_16 0 Ffii.e.nolig06 1/ ac 5imne5 (e5ftonsti9ils I - - __,IW-3"W"kte4S-W4Tirl‘51t-V51-1 iv) cei(Vriq I inmoOre Cps -Ft-m.1S_ aco‘Ancl k\ne coon:. 10 11.1\0A-e: tiost_4411;:si4-61- 8:64 the bed t1 s *Ai _40441E. fs\kki 4 -5?-44-40-#1 EFTA00059429 7 -1/464 c- ikttv-T E On _Iptotiie_tjost4i is exin room agn S tsne_ efn, lA C 6 SLoc,...re.:— (2r) e, s•LC l'}(5 1 nri to is o Htng cke5 Czr 10441 ef \lis4 Oni 9:0D il,nyn.54e Cps Ina5 en4grect regiaCal \nw9inq LAYwit.a717 tr_ _ DO 0C IvkcI)Rrie 4411-16g05ir EFTA00059430 Name of Inmate On Suicide Watch or Psych Observation:AESErk Registration #1: 1631S — 65 1 4 EATING/SHOWER CHART DATE BREAKFAST LUNCH DINNER LIQU 7 OFFERED RECEIVED SHOWER SHOWER -7-91 7/i4 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. EFTA00059431