aP4mos ADMINISTRATIVE DETENTION ORDER JAN 17 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS TO: Special Housing Unit Officer FROM. SUBJECT: Placement of (Ramon:tie) (a) Is pending an investigation for a violation of Bureau regulations: st (b) Is pending an SIS investigation. (c) Is pending investigation or trial for a criminal act: (d) Is to be admitted to Administrative Detention Reg. No (1) Since the inmate has requested admission for protection; NEW YORK MCC Incaution Date/Time: 0748-2019 15:50 in Administrative Detention I hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.. Stall Witness Printed NameSignature: (2) Since a serious threat exists to individuars safety as perceived by staff, although person has not requested admission; referral of the necessary information will be forwarded for an appropriate hearing by the SRO. (e) Is pending transfer or is in holdover status during transfer. (f) Is pending classificabon: or (g) Is terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. his this Correctional Supervisors decision based on al the circumstances that the above named inmate's continued presence In the general population poses a serious threat to life. property, self, staff, other Mutates, or to the security or orderly running of the institution because' PENDING SIS INVESTIGATION/ THREAT ASSESSMENT Therefore. the above named inmate Is to be placed in Administrative Detention until further notice. The Inmate received a copy of this Order on (date /time) StallWdness Signature/Printed Name Date 7 l IE7 (17 Supervisor 24 hour review of placement Signature/Printed name ' In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an Independent review and decision, which Is documented here. Record Copy • Inmate Co