tact: (d) Is to be admitted to Administrative Detention (1) Sincethe inmate has requested admissionfor protection: I herebyrequestplacement in Administrative Detentionfor my own protection Inmate Signature/Register No.'. Staff Witness Printed Name Signature: (2) Since a serious threat exists to individual's safe

: (d) Is to be admitted to Administrative Detention (I) Since the inmate has requested admission for protection, I hereby request placement in Administrative Detentionfor my own protection Inmate Signature/Register No.: Staff Witness Pnnted Name Signature (2) Since a serous threat exists to individual's safety as

al act: (d) Is lobe admitted to Administrative Detention (1) Since the mate has requested admission for pi-Mellen. I hereby request placement in Administrative Detentionfor my own protection Inmate SignatureiRegister No - Staff Witness Printed Name Signature' (2) Since a serious threat exists to individual's safely