EFTA00106353.pdf

Suicide Watch Chronological Log Inmate Companions Log Name of inmate on watch: ONLY ITEMS ALLOWED: b.O Register #: co cci Suicide Mattress GSLI tw C Institution: a C) b L it C) tn C er• 2 O. E Date Watch Began / Ended U ▪ E rc co mons c ▪ csn To be completed by Chief Psychologist at conclusion of watch: Booklet of SWCL - INMATE EFTA00106353 STAPLE LOCAL PROCEDURES HERE Check one of the following: ❑ This is the initial log book for this suicide watch. Enter date and time watch began: ❑ This is a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: minutes. Document your observations every of your shift. Legibly print and sign your name at the beginning EFTA00106354  Suicide Watch Observation Log Name of Inmate - on watch: ‘ eff5Ae'n Reg*: 1,p5i at (64 Date: 1 23I e Time Observations: Briefly note your observations. Initial all entries. Initials : LICA' 1M & -"A 5 k+ r)6tvin 40 CIA IY i• Lc CPI 1 VII ,G-- I Iv 0\ 0,, ------ _ O gV3 LIChvi `1.1‘ 1,41) . .2 <LAW 1 /v, 4141 Go , e--J J A- / fel — . ---- Z Aw. ` 'w, i-s1-15 / 14. e, ei 1 (44,-k ) id 4 ,.« k :m . --- 2 5 6640 i em Si 01it 61 evi ()4' i -hil I 17 r -e w .44( Lyr W lit A A tiAree,-,f, cy 2 2.-ii SAVA I l $4 I (-6'm 041 ./3 (, (5 <9 5, „A k v., S, (k Er le 6 —0S-- 5 ( -,,A L e7 i4,3,4fr, 9 4-4 kij eft fungi 6° 'iv ( 3_ Lk lcgv\ ivv Sr4 .- 24Th v S ‘..Acil it Ito -7,to - "re R ----- 1° IF Srin\- ---A' Cf I4 Jr- bet/ C 411-- ( FA, 1 te - : qC 1 4/ ' m It — il ).-5k An leo 7 i, J ai WW1 1 I 111;4 A f4-4 ( C) -'--7 t)----- 5 lc*" 3 1-64-1N -Lit II* (-Ci t - 79414 i IA' chelA ` 1 ' fri 144 -- 6 coc ' Aw, Cs "it, 3 -•,_ow rii r h - I3C(4 - ((k r, l im -. -1- 1--hd vV- 4 OM/ e.- ----- i Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00106355  Suicide Watch Observation Log Name of Inmate Reg 0: Date: on watch: Time Observations: Briefly note your observations. Initial ell entries. Initials Note to all observers: Legibly print egg sign your name at the beginning of your shift. 2 EFTA00106356  Suicide Watch Chronological Log Staff Suicide Watch Observers Only Name of inmate on watch: Epol-ein. J. Register #: 1 (23ia-054 Institution: MCC, Net,/ `ICVK Date Watch Began / Ended duly 2 ,"2-014 JO/ To be completed by Chief Psychologist at conclusion of watch: Booklet of SWCL - STAFF EFTA00106357 STAPLE LOCAL PROCEDURES HERE Check one of the following: Lad' This is the initial log book for this suicide watch. Enter date and time watch began: JUN 2;12aq a4. r.40A0 This a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: Document your observations every 5 minutes. Legibly print and sign your name at the beginning of your shift. EFTA00106358 Nam of Inmate on watch: Reg #: 1(0-51 5.21. Date: 1 23 iq Time Observations: Briefly note your observations. Initial all entries. Initials 1 .40Am nryoie. bro VA- down to c iettcyle Cel IA5,44 inrnd+e 1 in on bed 2',(X)Am 51-14; en led +dIKing 2.16,4)..4 Inmetit. Ottai-e5 5 cellrnek. +o wli hin 23o,44 vihr1.1- hcipperth .2.4f5 AM Inmate (5.4+;r9 on bed a.co,e0.4 In nee_ • (1 en bed a 15Atvt 46<es pid-ures i niena 1,30Am Inrmita (5i4--hro on Ivri 8'.446Am lnmo+e 5i 4-1-irn on bed 4:.(x)At.4 Inonale. S4--ting on he'd 15,0A4 inpin4e. ai-Hinq on bed 4.30Atvt Inrnn+e aF door 4alicirg 4.-45,o4 Inmn4e_. (5-karriirkr‘ door .1-0116 5. ooAhl inmalp 51-l-fin.of on bed 5 I5 AIv, Inmak oldniir9 door 5.30Am c5-frincji no at door 5:45Am name, Min° a+ door Co'. GUAM Intrate Siondin3 a4- door Co H5 A m Inmate, thaMin° 44- door (ol,3oAm retel4e. (.5k/rater) A+ nay to'.45AM Incethe. nnor nj •• a:IAN/A In mal-e• <Nandinn CO- door Note to all observers: Legibly print and sign your name at the beginning of your shift. 1 EFTA00106359  Suicide Watch Observation Log Name of Inmate on watch: Reg #: Date: Time Observations: Briefly note your observations. Initial all entries. Initials Note to all observers: Legibly print and sign your name at the beginning of your shift. 2 EFTA00106360