Facility: <Enter Facility Name>

ANNUAL REPORT

CORRECTION LAW §611(1)(e)

Facility: <enter facility name>

Reporting Official: <enter name of reporting official>

Below is a report of every individual use of restraints on a female inmate, as required to be reported to the New York State Commission of Correction per section 611(1)(e) of the Correction Law:

[1]

(a) The full name of the restrained woman: <enter name>

(b) The restrained woman’s date of birth: <enter date of birth>

(c) The date and time the restraint was applied: enter date and time>

(d) The date and time the restraint was removed: <enter date and time>

(e) A description of the type(s) of restraint(s) used: <enter description>

(f) The intended transport destination: <enter destination>

(g) The name and rank of official/officer who authorized the restraint: <enter name and rank>

(h) A description of the facts and reasons justifying the use of restraints: <enter description>

[2]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

[3]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

[4]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

[5]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

[6]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

[7]

(a) The full name of the restrained woman:

(b) The restrained woman’s date of birth:

(c) The date and time the restraint was applied:

(d) The date and time the restraint was removed:

(e) A description of the type(s) of restraint(s) used:

(f) The intended transport destination:

(g) The name and rank of official/officer who authorized the restraint:

(h) A description of the facts and reasons justifying the use of restraints:

*** CONTINUE IN NUMERICAL PROGRESSION AS NEEDED ***