DOJ-OGR-00024713.pdf

--- Page 1 --- **Extracted Text:** **Form 583 Report of Incident** **Incident #:** NYM-19-0076 **Submitted By:** [No data found.] **Date/Time Of Incident:** 7/23/2019 1:27 AM **Injury Category:** No Injury **Sexual Assault:** No **Staff Injury by Inmate:** No **Section 4: Lethal Weapon Discharge** No data found. **Section 5: Use of Force** No data found. **Section 6: Description of Incident** DESCRIPTION OF INCIDENT (If Use Of Force, include details such as name of supervisor applying the chemical agent and/or restraints, reasons for use of hard restraints instead of soft restraints, etc.) Please be clear about cause(s) of the incident in your description. **Section 7: Attachments** File Date: [No data found.] File Name: [No data found.] Original Entered By: [No data found.] Original Loc. Code: [No data found.] **Approved By:** NOT COMPLETED **UNCLASSIFIED/LIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE** This document is marked Unclassified/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution, to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document, or any segment/attachment thereof, may not be released without the approval of the Bureau of Prisons to any media sources, any non-law enforcement entity, the general public or those without a "need to know." It contains information that may be exempt from public release under the provisions of the Privacy Act (5 U.S.C. 552). **3 of 3** **DOJ-OGR-00024713**