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BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE
APRIL 1994
FEDERAL BUREAU OF PRISONS
wave Name Register Number Unit Institution
EPSTEIN, JEFFREY EDWARD 76318-054 5 NEW YORK MCC
Date Entered Special Housing: Reason for Placement
07-10-2019 PENDING CAPTIANS REVIEW
1. Subject: (2 or 3 Days) Date Reviewed
3 Day Review 07-15-2019
Action Taken on the Above Date:
Continue in Special Housing Unit
Printed Name/Signature:
II. RECORD REVIEW.
(To to done weekly in the inmates absence, beginning after the in-person 7 day review, and cord nuing every week between each in-person 30 day
review.)
DATE ACTION TAKEN REMARKS SIGNATURE
07-19-2019 Continue in Special Housing Unit
III. Subject (7 or 30 Days) Review By (SRO): Reviewing Authority:
7 Day Review
Date inmate appeared for a Speoal Housing Review: Or Date inmate waived right to appear
07.19.2019 01-01-111
Has been seen daily by Medical Staff Yes: El No
Has been seen daily by responsible officer designated by Warden- Yes; ❑No
Has received prescribed weekly exercise: RI Yes: ICI No
Proper documentation and jusecation In the Central File (Incident Report. OHO Report copies of Special Housing Review Form): g Yes; ❑ No
if no, why not?
Is there a written psychiatric a psychologal assessment on the inmate who has spent 30 days in a special housing status? g yes; DNo
Is there an additional assessment for every one month interval thereafter? 7‘1 Yet
4 CINo
if no, why not?
Action taken on the above date by the Segregation Review Official or the Reviewing Authority:
❑ Released from Special Housng; WI Continue in Special Hoeing
Did inmate In Administrative Deletion receive a written copy of Staffs decision and the basis for the finding at each 30 day review? Yes; ❑ No
if no, why not (Should be given provided institutional security not compromised)?
Remarks: (My change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of this
form):
Date of Next Review
07-26-2019
PrEntPa Marne' and Sinnature of Segregation Review Official or the Reviewing Authority and Date Signed:
Record Copy Central Fie
This form replaces BP-295(52) dated January 1988
file:///C:/temp/shu/Epstein-Reno76318-054_SRO_20190710-20190723.html 8/13/2019
EFTA00036572