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ch day bY the medical provider. Comments: i.e., Conduct. Attitude, etc. Additional comments on reverse side must include date. signature. and title. OIC Signature: OIC must sign all record sheets each shift. (O1C - Unit Officer) PDF Prescribed by P5270 This form replaces BP-292(52) dated AUG 2011. EFTA00054978

gy, (E) Education, (H) Haircut, (C) Chapel. (R) Recreation. a() Properer Issue. (V) Visit (M) medical, (C) Court, (0) Other — Yes (Y) ifapplicable / Enter Actual Time Period Start and End (i.e., 0930 — 1030 nrs) In Out of Cell Time filedc. NIA DS* N/A ADStaks Medical: Medical providers val sign the segregation log each shift and t

ch day by the medical provider. Comments: i.e., Conduct, Attitude, etc. Additional comments on reverse side must include date, signature, and title. OIC Signature: OIC must sign all record sheets each shift. (OIC - Unit Officer) PDF Prescribed by P5270 This form replaces BP-292(52) dated AUG 2011. Page 1118 M

y, (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue, (V) Visit, (M) Medical, (C) Court, (0) Other - Yes (Y) if applicable/ Enter Actual Time Period Start and End (i.e., 0930 - 1030 hrs) in Out of Cell Time Block. Medical: Medical providers will sign the segregation log each shift and the record sheet each tim

h day by the medical provider. Comments: i.e .. Conduct. Altitude, etc. Additlonal comments on reverse side must include date, signature, and title. OIC Signature: OIC must sign all record sheets eac:h sllift. (OIC - Unit Officer) PDF Prescribed by P5270 This fo1111 replaces BP-292(52) dated AUG 2011. Page 312

gy, (E) Education, (H) Haircut, (Cl Chapel, {R) Recreation, (X) Property Issue, M Visit, (M) Medk:31, {C) Court, (0) other - Yes (Y) If appllcabfe / Enter Actual Time Period Start and End (i.e., 0930 -1030 tus) In Out of ceu Time Block. Medical: Medical providers wiH sign the segregation log each shift and the record sheet each time t