EFTA00033896.pdf

Type: pdf
Source set: data-set-8
Extracted text

fitignariON.020, 
I NAME: 
PEG STRATIONef: 
OBSERVATION STARTED:_  7  -2 qZL 
rt 
OBSERVATION ENDED: ____7 
PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE 
OBSERVATION HAS ENDED. 
ThANK YOU. 
ITEIVIS ALLOWED: 
Regular Clothes 
Safeh.. Toothbrush 
Newspaper/Magazine 
Books isoftcover only) 
Safety Pen and Paper 
Toile( Paper 
; 
_--_Legal Mail 
Other 
SW Blanket & SW Matti ess 
. Observations. 
if nothing is checked with silver marker, only a Suicide 
Smock and Suicide Blanket are allowed. 
UUNI- lUtIN I IAL 
SDNY_00009599 
EFTA00033896


Name of Inmate On Suicide Watch or Psych Observation: e
.19a--6e-i -j
Registration #: 17 -63/0" 
-- Ur
—se 
EATING/SHOWER CHART 
DATE 
BREAKFAST 
LUNCH 
DINNER 
LIQUIDS 
OFFERED 
SHOWER 
RECEIVED 
SHOWER 
Please check the appropriate box if the person on 
Suicide Watch/Psych Observation actually eats his 
meal. Do not check the box if heiust received it, 
but did not eat it. 
Place a check in the "Liquids" box each time the 
person drinks. 
Thank you. 
CONFIDENTIAL 
SDNY_00009600 
EFTA00033897


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