EFTA00035087

.RVATION LOG _Y I NAME: C . ES±e REGiSTRATIONtf: 7(.2-6 I & 0 sel OBSERVATION STARTED:_ 7 - 2‘1 — 20. Ict PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. THANK YOU. crguis ALLOWED: • I' Regular Clothes fr\s• 71 - Safety Toothbrush .. i r Newspaperfivlagazine O00kS (softcover only), ) v Safety Pen and Paper Toilet Paper Mail Other SW Blanket & SW Mattress must he used even on Psych . Observations. If nothing is checked with a silver marker, only a Suicide Smock and Suicide Blanket.:re allowed. EFTA00035087 Name of Inmate On Suicide Watch or Psych Observation: e;adf if Registration It: 9 -6 pjr EATING/SHOWER CHART DATE BREAKFAST LUNCH DINNER LIQUIDS OFFERED RECEIVED SHOWER SHOWER / 7t V — IV " e.--- - "----- "..--> t./ 19 j,,,,er• - WM ‘.e2. '• (/ / li • , — _ _._ ___L-: ::., .,___.:„..• • .: Please check the appropriate box if the person on 'Suicide Watch/Psych Observation actually eats his meal. Do not check the box if helust received it, but did not eat it. Place a check in the "Liquids" box each time the person drinks. Thank you. EFTA00035088 EiaALLS*:&31taact_ -7 - aq-zolef t_Sak a t a c49,0-2."_ 1:7 'rite p 7150114, 5C1,74.- rce -Or0 c51(24pLaticr_c-2151:4-1/4 Asa; meg iberpottn,,bly ,-)e, -7-t2t2tbs-t r psifa;r1 743:17V --6 ' ,Sep vi lb/ 4.54 - it is ics..N-:75. t (..2812__ Z. 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