DOJ-OGR-00025280.pdf

Page 1057 INCIDENT REPORT U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 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 11. Description of Incident (Date: 07/23/2019 Time: 1:27AM Staff became aware of incident): [redacted] 12. Typed Name of Reporting Employee: [redacted] 13. Date And Time: 07/23/2019 3:30am 14. Incident Report (Type Name/Signature): [redacted] 15. Date Incident Report Delivered: 7-30-19 16. Time Incident Report Delivered: 12:40pm 17. Comments of Inmate to Committee Regarding Above Incident: Jim was read his rights and stated [redacted] Part II - Committee Action 18. A. It is the finding of the committee that you: Committed the Prohibited Act as charged: Did not Commit a Prohibited Act. Committed Prohibited Act Code (s) [checked] 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: UDC refers this to the DHO based on the severity of the offense. 20. Committee action and/or recommendation if referred to DHO (Contingent upon DHO finding inmate committed prohibited act): Is found to have committed prohibited act of code 228, UDC recommends D/S time, loss of GCT and privileges. 21. Date and Time of Action: 7-30-19 5:11 (The UDC Chairman's signature certifies who sat on the UDC and that the completed report accurately reflects the UDC proceedings) [redacted] 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 DOJ-OGR-00025280