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UNCLASSIFIEDULAW ENFORCEMENT SENSITIVE (When Completed) <br />Are facility staff certified in CPR and basic first aid? <br />C Yes C No <br />With the exception of emergencies, does the facility submit a request to the district to request approval for outside <br />medical services? <br />C Yes C No <br />Does the facility immediately notify the district in the event of a USMS prisoner medical emergency? <br />C Yes r No <br />Suicide Prevention <br />Does the facility have a suicide prevention program? <br />C Yes f' No <br />Does the facility document staff training for prisoner suicide prevention? <br />C Yes C' No <br />Does the facility have procedures for identifying prisoners at risk for suicide? <br />C Yes C No <br />Does the facility have procedures for monitoring prisoners at risk for suicide? <br />C Yes C No <br />How often are welfare inspections conducted on suicidal prisoners? <br />❑ Constant Observation ❑ Every 15 mins ❑ Every 30 mins ❑ Every 45 mins <br />❑ More than 1 hour ❑ Never <br />Does the facility report suicidal gestures, remarks, tendencies, and attempts to the USMS? <br />C Yes C No <br />Does the facility provide mental health services to suicidal prisoners? <br />C Yes C No <br />Does the facility report restrictive housing of suicidal prisoners to the USMS? <br />C Yes C No <br />How many suicidal prisoners were placed in restrictive housing during the rating period? <br />Prisoner Death <br />Does the facility have procedures to respond to a prisoner's death? <br />C Yes C No <br />Does the facility immediately notify the USMS in the event of a USMS prisoner death? <br />(` Yes C No <br />Does the facility review each prisoner death? <br />C Yes C No <br />❑ Every hour <br />NOTICE: This document is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL information <br />which is for the sole use or the intended recipient(s). Any unauthorized review, use, disclosure. or distribution is prohibited. If you are not the intended <br />recipient, please contact the sender and destroy all copies of this document. Any Protected Health Information contained in this document is to be used <br />only to aid in providing healthcare services to federal prisoners, Any other use is a violation of Federal HIPAA Law and/or the Privacy Act and will be <br />reported as such. <br />UNCLASSIFIEDULAW ENFORCEMENT SENSITIVE (When Completed) <br />Form USM-218 <br />Page 14 of 27 Rev. 02125 <br />