DOJ-OGR-00024720.pdf

Page 106 A0288 N.47 J.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS INCIDENT REPORT Part I - Incident Report 1. Institution: MCC New York 2. Inmate's Name: Epstein, Jeffery 3. Register Number: 76318-054 4. Date of Incident: 07/23/2019 5. Time: 1:27am 6. Place of Incident: SHU M-Tier Cell 124 7. Assignment: Unassigned 8. Unit: ZA 9. Incident: Self-Mutilation 10. Prohibited Act Code (s): 228 Incident Report Number: 3282555 (b)(7)(A) (b)(6); (b)(7)(C) (b)(6); (b)(7)(C) (b)(6); (b)(7)(C) 12. Typed Name/Signature: 14. Incident Report Delivered By (Type Name/Signature): 13. Date And Time: 07/23/2019 3:30am 15. Date Incident Report Delivered: 16. Time Incident Report Delivered: Part II - Committee Action 17. Comments of Inmate to Committee Regarding Above Incident: 18. A. It is the finding of the committee that you: Commited the Prohibited Act as charged: Did not Commit a Prohibited Act. Commited Prohibited Act Code (s). B. The Committee is referring the Charge(s) to the DHO for further Hearing C. The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days. 19. Committee Decision is Based on Specific Evidence as Follows: 20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act): 21. Date and Time of Action: (The UDC Chairman=s signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings). Chairman (Typed Name/Signature): Member (Typed Name): Member (Typed Name): INSTRUCTIONS: All items outside of heavy rule are for staff use only. Begin entries with the number 1 and work up. Entries not completed will be voided by staff. Distribute: Original-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part I Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG 11 COPY (b)(6); (b)(7)(C) DOJ-OGR-00024720