13P.AnCia ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE
JAN 17 FEDERAL BUREAU OF PRISONS
NEW YORK MCC
instsition
Date/Time- 07-29.2019 12-.21
TO: Special H ng Unit Officer
FROM: (Name/rite)
EPSTEIN. JEFFREY EDWARD Reg. No. 76318-054 in Administrative Detention
SUBJECT: Placement of
(a) Is pending an investigation for a vrolation of Bureau regulations:
(b) Is pending an SIS investigation.
(c) Is pending investigation or trial for a cnminal act:
(d) Is to be admitted to Administrative Detention
(1) Since the inmate has requested admission for protection;
I hereby request placement in Administrative Detention for my own protection.
Inmate Signature/Register No.:
Staff Witness Printed Name Signature:
admission; referral of
(2) Since a serious threat exists to individual's safety as perceived by staff, although person has not requested
the necessary information wit be forwarded for an appropriate hearing by the SRO.
(e) Is pending transferor is in holdover status during transfer
(f) is pending classificatory or
(9) Is terminating confinement In Disciplinary Segregation and has been ordered Into Administrative Detention by the Warden's
designee.
presence in the general
II is the Correctional SupenAsor's decision based on all the circumstances that the above named Inmate's continued
institution because'
population poses a serious throat lo !de. property, self, staff, other inmates. or to the security or orderly running of the
PENDING UDC FOR CODE 228 SELF-MUTILATION
received a copy of this Order on
Therefore, the above named Inmate is to be placed in Administrative Detention unti further notice. The Inmate
(date / time)
Date
Staff Witness Signature/Printed Name
Supervisor 24 hour review of placement: Signature/Printed name
independent review and decision. which I
• In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an
documented here.
Manager, Copy • Operation Supervisor
Record Copy - Inmate Concerned (not necessary if placement is a result of holdover status); Copy - Captain: Copy - Unit
-
Administrative Detention Unit; Copy — Psychology. Copy Central Fib
PDF Prescribed by P5270 (Replaces BP-A0308 of JAN 88.)
EFTA00035216