DOJ-OGR-00024712.pdf

--- Page 1 --- **Extracted Text:** **Form 583 Report of Incident** **Incident #: NYM-19-0076** **Submitted By:** **Date/Time Of Incident: 7/23/2019 1:27 AM** **Section 3: Others Involved** | **Name:** | **Person Type:** | **Staff Death:** | **Staff Injury by Inmate:** | | --- | --- | --- | --- | | [b]18; [b]77[C] | Staff | No | No | | Medical Attention Required: No | | | | | Injury Category: No Injury | | | | | Sexual Assault: No | | | | | Name: [b]18; [b]77[C] | Person Type: Staff | Death: No | Staff Injury by Inmate: No | | Medical Attention Required: No | | | | | Injury Category: No Injury | | | | | Sexual Assault: No | | | | | Name: [b]18; [b]77[C] | Person Type: Staff | Death: No | Staff Injury by Inmate: No | | Medical Attention Required: No | | | | | Injury Category: No Injury | | | | | Sexual Assault: No | | | | | Name: [b]18; [b]77[C] | Person Type: Staff | Death: No | Staff Injury by Inmate: No | | Medical Attention Required: No | | | | | Injury Category: No Injury | | | | | Sexual Assault: No | | | | **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 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). **2 of 3**