Form 583 Report of Incident Incident NYM-19- Submitted By: 0076 Date/Time Of Incident: 7/23/2019 1 7 AM Section 1: General Information Staff Aware Date: 7/23/2019 127 AM FBI Notified: No USMS Notified: No Location Level 1: SHU Indicate Where Incident Occurred: Main Facility Level 2: Housing Unit, Special (SHU) Typs,Ofh 1N: K Assault On Inmate K Assault On Staff K Assault, Attempted On Inmate K Assault, Attempted On Staff K Disruptive Behavior K Escape From Non-secure Facility K Escape From Secure Facility K Escape, Attempted From Non-secure Facility K Escape, Attempted From Secure Facility K Fight K Inmate Death K Institution Disturbance K Introduction Of Contraband K Lethal Weapons Discharge K Self Mutilation K Setting A Fire K Sexual Ad, Non-consensual On Inmate K Sexual Assault On Staff K Sexual Contact, Abusive On Inmate K Sexual Harassment, Repetitive K Staff Homicide K Strike, Food K Strike, Work EI Suicide Attempt K Use Of Force K Use Of Force/Applications Of Restraints K Use of Restraints, PregnanUPostpartum Method: Hanging/Asphyxiation Level 3: 9 SOUTH SHU Institution Locked Down: No Modified Operations: No Cause Of Incident Known? No Cause Of Incident K Alcohol K Commissary K Debts K Disrespect Issue K Drugs K Ethnic Conflict K Food Issue K Geographical Conflict K Interfering with Staff duties K Property Issue K Racial Conflict K Recreation Equipment K Religious Issue K Security Threat Group Conflict K Sexual Pressure K Sporting Events K Telephone K Theft K Visiting K Work Issue Section 2 Inmates Involved UNCLASSIFIEDILIMITED OFFICIAL USE ONLY/LAW ENFORCEMENT SENSITIVE This document is marked Unclassirvd/Limited Official Use Only/Law Enforcement Sensitive and may be disseminated, with proper attribution. to active Law Enforcement, DOD, or U.S. Intelligence Agencies. This document or any segment/attachment thereof. may not be released without the approval of the Bureau of Prisons to any