EFTA00035257.pdf

Type

pdf

Source set

data-set-8

Original source

Extracted text

Suicide Watch 
Chronological 
Log 
Inmate Companions Log 
Name of inmate on watch: 
Institution: 
Date Watch Began / Ended 
ONLY ITEMS ALLOWED: 
To be completed by Chief Psychologist at conclusion of watch: 
Booklet 
of 
Suicide Mattress 
SWCL - INMATE 
EFTA00035257


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: 
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. 
EFTA00035258


Suicide Watch Observation Log 
Name of inmate 
— 
I „ 
on watch: 
4JY -it i ( „., 1 
Reg a: 
Date: —1 23 e 
Time 
Observations: Briefly note your observations. Initial all entries. 
Initials 
'yr7Mv
M  
S re( ‘'
4 
141- 
65tubn 
40 
1/1 It I. &E eel I 'P[.(
'P[.(
1 Lis 
A 
b‘ 
0 kt ge-a 
2. akm 
% 
I 
Ar 
2 J 
i r l ie.i.
2 
lb, 
fr. , scs 
k,S me (( 
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cll.
2 3 s
im 
SW) 
6{i -Irti iw h r? y, 4.4 
(AAA 
4 f
2 434
t 
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ov ;3 F i3 
Avi 
t W 
C i N 
u. 
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IC 
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) 
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 Am 
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Note to all observers: Legibly print gnd sign your name at the beginning of your shift. 
EFTA00035259


Suicide Watch 
Chronological 
Log 
Staff Suicide Watch 
Observers Only 
Name of inmate on watch:
Ep54-elin. J. 
Register #: 
Institution: 
MOT', New \leyK 
Date Watch Began / Ended 
July 23,'2.01C1 J-v)/ 
iq 
To be completed by Chief Psychologist at conclusion of watch: 
Booklet 
of 
SWCL - STAFF 
EFTA00035260


STAPLE LOCAL PROCEDURES HERE 
Check one of the following: 
This is the initial log book for this suicide watch. 
Enter date and time watch b…

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