EFTA00035225.pdf

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

.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: • 
fr\s
I' 
Regular Clothes 
• 
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. 
EFTA00035225


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 
SHOWER 
RECEIVED 
SHOWER 
/ 
V
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— 
_ 
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. 
EFTA00035226


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