EFTA00033958.pdf

Type

pdf

Source set

data-set-8

Original source

Extracted text

Suicide Watch 
Chronological 
Log 
Inmate Companions Log 
Name of inmate on watch: 
Register #: 
Institution: 
Date Watch Began / Ended 
—1123 19 
ONLY ITEMS ALLOWED: 
To be completed by Chief Psychologist at conclusion of watch: 
Booklet 
of 
Suicide Mattress 
c 
C 
c 
to 
o 
a 
ai Q. 
no 
0 
CO 
a. 6,) f— 
( 
CONFIDENTIAL 
SWCL - INMATE 
SDNY_00009695 
EFTA00033958


STAPLE LOCAL PROCEDURES HERE 
Check one of the following: 
K 
This is the initial log book for this suicide watch. 
Enter date and time watch began: 
K 
This is a continuation log book for this watch. 
Enter date and time this watch book was initiated: 
Instructions to Observer: 
Document your observations every  
 minutes. 
Legibly print and sign your name at the beginning of your shift. 
CONFIDENTIAL 
SDNY OnnnciRQS 
EFTA00033959


Suicide Watch Observation Log 
Name of Inmate E  
I nt _ 
on watch: 
t
. Yle ' ( ' 
Reg #: —}CeStr, C6 
Date: -1 23 1 lq 
Time 
Observations: Briefly note your observations. Initial all entries. 
Initials 
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M 
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Note to all observers: Legibly print and sign your name at the beginning of your shift. 
1 
CONFIDENTIAL 
SDNY_00009697…

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