EFTA00033715.pdf

fitignariON.020, I NAME: PEG STRATIONef: OBSERVATION STARTED:_ 7 -2 qZL rt OBSERVATION ENDED: ____7 PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. ThANK YOU. ITEIVIS ALLOWED: Regular Clothes Safeh.. Toothbrush Newspaper/Magazine Books isoftcover only) Safety Pen and Paper Toile( Paper ; _--_Legal Mail Other SW Blanket & SW Matti ess . Observations. if nothing is checked with silver marker, only a Suicide Smock and Suicide Blanket are allowed. UUNI- lUtIN I IAL SDNY_00009178 EFTA00033715 Name of Inmate On Suicide Watch or Psych Observation: e . 19a--alli - j Registration #: 1-q-6 3., e r EATING/SHOWER CHART DATE BREAKFAST LUNCH DINNER V cV LIQUIDS OFFERED RECEIVED SHOWER SHOWER Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if heiust received it, but did not eat it. Place a check in the "Liquids" box each time the person drinks. Thank you. 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