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BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE
APRIL 1994
FEDERAL BUREAU OF PRISONS
Inmate Name: Register Number Institution:
EPSTEIN, JEFFREY EDWARD 76318-064 NEW YORK MCC
Date Entered Special Housing: Reason for Placement:
07-29-2019 PENDING DHO FOR CODE 228 SELF-MUTILATION
I. Sutract (2 Cr 3 Days) Date Reviewed
3 Day Review 08-01-2019
Action Taken on the Above Date:
Continue in Special Housing Unit
Printed Name/Signature:
H. RECORD REVIEW.
(To be done weekly in the ornate's absence, beginning after the unperson 7 day review, and continuing every week between each in-person 30 day
review.)
DATE ACTION TAKEN REMARKS SIGNATURE
08-05-2019 Continue in Special Housing Unit
it Subsea: (7 or 30 Days) Review 8y (SRO): Reviewing Authority:
7 Day Review
Date inmate appeared for a Special Housing Review. Or Date inmate waived right to appear:
08-05-2019 01-01-111
Has been seen daily by Medical Staff. P1 Yes: El No
HAS been seen daily by responsible officer designated by Warden g Yes: ❑ No
Has received prescribed weekly exercise: WI Yet E Na
Proper documentation and justification 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 or psychological assessment on the inmate who has Spent 30 days in a special housing status? 1_.] Yes: ❑ No
Is there an additional assessment for every one month interval thereafter? P1 Yes: E NO
if no. why not?
Action taken on the above date by the Segregation Review Official or the Reviewing Authority:
iJ Released from Special Housing; I;s71 COntinbe in Special Housing
Did inmate in Administrative Detention receive a written copy of stairs decision and the basis for the finding at each 30 day review? g Yes; ❑ No
if no. why not (Should be given provided institutional woody not compromised)?
Remarks: (Any change in the reason for placement is bo be noted in this section. If the reason for placement changes the inmate must receive a copy of this
form):
Date of Next Resew:
08-12-2019
PriAtti Name and Signature of Segregation Renew Maud or the Reviewing Authority and Cobs Sigred.
Record Copy - Central File
That form replaces 8P-295(52) dated January 1988
file:///C:ftemp/shu/Epstein-Reno76318-054_SRO_20190729-20190810.html 8/13/2019
EFTA00036573