Suicide Watch Chronological Log Inmate Companions Log Name of inmate on watch: Register #: GSLI Institution: Date Watch Began / Ended ONLY ITEMS ALLOWED: 2 U co b.O co cci tw C a C) C) tn To be completed by Chief Psychologist at conclusion of watch: Booklet of Suicide Mattress L b it C er• O. E ▪ E rc mons c c ▪ sn SWCL - INMATE EFTA00106353

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. EFTA00106354

Suicide Watch Observation Log Name of Inmate - on watch: ‘ eff5Ae'n Reg*: 1,p5i ta (64 Date: 1 23I e Time Observations: Briefly note your observations. Initial all entries. Initials : LICA' 1M & -"A 5 k+ r)6tvin 40 CIA IY i• Lc CP I 1 VII ,G-- I . L I C h v i ` 1 . 1 ‘ 1 , 4 1 ) Iv 0\ 0,,, g V 3 ------ _ O .2 <LAW 1/v, 4141 Go , e--J J A- / fel — . ---- Z Aw. ` 'w, i-s1-15 / 14. e, ei 1 (44,-k ) id 4 ,.« k :m 2 5 6640 i em Si 01 it 61 evi ()4' i -hil I cy 17 r -e w .44( Lyr . --- W lit A A 2 2.-ii SAVA I tiAree,-,f, (-6'm ./3 $4 I 041 (, (5 <9 —0S-- 5, „A k v., S, (k Er le 6 l 5 ( -,,A Le7 i4,3,4fr, 9 4-4 kij eft fungi 6° 'iv ( 3_ Lklcgv\ ivv Sr4 .- 24Th R ----- "re v ‘..Acil --7,to S it Ito 1° IF Srin\- ---A' Cf I4 Jr- bet/ C 411-- ( FA, 1 te - t)----- : q C 1/4' m ).-5k It — il An leo 7 J ai WW1 1 I 111;4 A f4-4 C) -'--7 ( i, 5 lc*" 3 1-64-1N-Lit II* (-Ci t - 79414 i IA' chelA ` 1 ' fri 144 -- 6 coc Cs' Aw, "it, rii r h - -•,_ 3 ow I3C(4 - ((k r, l im -.-1- 1--hd vV- 4 OM/ e.- ----- i Note to all observers: Legibly print and sign your name at the beginning of your shift. EFTA00106355

Suicide Watch Observation Log Name of Inmate on watch: Reg 0: Date: Time Observations: Briefly note your observations. Initial ell entries. Initials Note to all observers: Legibly print egg sign your name at the beginning of your shift. 2 EFTA00106356

Suicide Watch Chronological Log Staff Suicide Watch Observers Only Name of inmate on watch: Epol-ein. J. Register #: 1 (23ia-054 Institution: MCC, Net,/ `ICVK Date Watch Began / Ended duly 2 ,"2-014 JO/ To be completed by Chief Psychologist at conclusion of watch: Booklet of SWCL - STAFF EFTA00106357

STAPLE LOCAL PROCEDURES HERE Check one of the following: Lad' This is the initial log book for this suicide watch. Enter date and time watch began: JUN 2;12aq a4. r.40A0 This a continuation log book for this watch. Enter date and time this watch book was initiated: Instructions to Observer: Document your observations every 5 minutes. Legibly print and sign your name at the beginning of your shift. EFTA00106358

Nam of Inmate on watch: Time 1.40Am Reg #: 1(0-51 5.21. Date: 1 Observations: Briefly note your observations. Initial all entries. nryoie. bro VA- down to c iettcyle Cel 23 iq Initials IA5,44 in rnd+e 1 in on bed 2',(X)Am 51-14; en led +d I King 2.16,4)..4 I nmetit. Ottai-e5 5 cellrnek. +o wli hin 23o,44 .2.4f5 AM a.co,e0.4 a 15Atvt 1,30Am 8'.446Am 4:.(x)At.4 15,0A4 4.30Atvt 4.-45,o4 5. ooAhl 5 I 5 A Iv, 5.30Am 5:45Am Co'. GUAM Co H5 A m (ol,3oAm to'.45AM •• a:IAN/A vihr1.1- hcipperth Inmate (5.4+; on bed r9 In nee_ • (1 en bed 46<es pid-ures i niena Inrmita (5i4--hro on Ivri lnmo+e 5i 4-1-irn on bed Inonale. S4--ting on he'd inpin4e. ai-Hinq on bed Inrnn+e aF door 4alicirg Inmn4e_. (5-karriirkr‘ door .1-0116 inmalp 51-l-fin.of on bed Inmak oldniir9 door c5-frincji no at door name, Min° a+ door Intrate Siondin3 a4- door Inmate, thaM in° 44- door retel4e. (.5k/rater) A+ nay Incethe. nj nnor In mal-e• <Nandinn CO- door Note to all observers: Legibly print and sign your name at the beginning of your shift. 1 EFTA00106359

Suicide Watch Observation Log Name of Inmate on watch: Time Reg #: Date: Observations: Briefly note your observations. Initial all entries. Initials Note to all observers: Legibly print and sign your name at the beginning of your shift. 2 EFTA00106360