IRTSOZOC - Incident Report IRTSOZOC Incident Report Page 1 of 3 Wednesday January 27, 2016 07.37'01 AM Institution/Region: Location of Incident: Exact Location of Ineldent: Il'ICldent Date: IHCIdent Time: Staff Member Completing Report: Facility/DCC Office: Waupun Correctional Institution 00180550 Waupun Correctional Institution Social Sewices I None I 09/17/2015 08:30'00 AM JOHNSON, MCKINSIE A 6125 ApprOXimate: ApprOXImate: Job Title: Social Worker?Corrections (C) Overall IR Status: Finalized Incident Types Results/Actions Escape Other Placed In Bed Restraints: E: Assault E5 PREA Threats: Cell Entry Phy5ica In]ury Property Damage: Fll'e Property Damage Contraband: Death Threats Phy5ical Force: Disturbance Accident PhYSical Injuries: Informational Health Discharge Firearm Custody Self Harm Misconduct LEP (Limited English ProfICIency) -, STG Choose up to 3 Types from above* Additional Information Employee on Duty: Yes Reported to Law Enforcement: Unknown Staff Involved (1 1 of 1) Staff Name ID Primary Work Site Job Title Involvement Type JOHNSON, MCKINSIE A 6125 Waupun Correctional Institution Soaal Worker?Corrections (C) Other Offenders Involved (1 - 2 of 2) Offender Name DOC Photo Involvement Type AVERY, STEVEN 122987 PrinCIpai THOMASCHASKE, JASON P. 349577 PrinCIpal Other Persons Involved . 1/27/2016 IRTSOZOC - Incident Report Page 2 of 3 Person's Name (Last, First) Involvement Type No Rows Found Description of Incident On the above date and apprOXimate time, this writer Johnson, met With Inmate Jason Thomaschaske #349577 for PRC purposes. During the course of the interVIew he stated that he is havmg problems With his cell mate, Steven Avery #122987. When I asked further about what some of his Issues where Inmate Thomaschaske stating the followmg: "he is disrespectful, a disgusting human being, he never leaves his cell". Inmate Thomaschaske said, want to kill the guy" this writer did not take that as a threat but more of his frustration With reSIding in a cell With Inmate Avery. Inmate Thomaschaske said he addressed the issue With the cell hall sergeant, which Inmate Avery knows. Since addressmg it With cell hail staff, Inmate Thomaschaske stated that Inmate Avery is now intentionally domg things to mate him and Inmate Avery stated to Inmate Thomaschaske, ?go ahead and do something, then I can sue WCI for not protecting me' Since Inmate Thomaschaske has discussed With cell hall staff their issues and he hasn't been moved. I encouraged him to follow the chain of command and to write to Captain Bauer. TimeStamp: 17 September 2015 10:24.51 User: M. Johnson/WCI Author Status: Submitted for by Supv As of Date: 09/17/2015 Author Signature: M, JOHNSON 6125 Actions Taken as Result of Incident Supervisor Name: TRIIT, KYLE Job Title: SuperVismg Of?cer 1 IR Declared Confidential: No Primary IR: Reasons Returned to Author None I Supervisor Comments Informational. Cell mate are not getting along and they informed the cell hall superwsor who is gomg to have them moved into new cells. Supervisor IR Status: Submitted to Director/Chief As of Date: 09/18/2015 Superwsor Signature: K. 15288 see Further Action Taken by Security Director/Regional Chief Staff Name: MELI, ANTHONY Title: Corrections Security Director IR Declared Confidential: No Reason(s) Returned to Author or SuperVIsor INone I Security Director/Regional Chief Comments [Copy to Capt. Bauer for reView. Referred to Other DOC Staff (1 - 1 of 1) Date Staff Name ID Primary Work Site Job Title 09/18/2015 BAUER, WAYNE A 5121 Waupun Correctional Institution Supewismg Of?cer 2 ://Wics. doc .Wi. gOV/eomis/servlet/commarquis. . . 1/27/20 1 6 IRTSOZOC - Incident Report Page 3 of 3 Final IR Approved by Director/Chief As Of Date: 09/18/2015 Security Director/Regional Chief Signature: MELI 967 gov/eomis/servlet/commarquis eomls 1/27/2016 IRTSOZOC Incident Report Page 1 012 Wednesday January 27, 2016 07:37.20 AM Institution/Region: Of?ce: Location of InCident: Exact Location of InCIdent: InCident Date: InCIdent Time: Staff Member Completing Report: Overall IR Status: Waupun Correctional Institution 00138262 Waupun Correctional Institution Soc1a Services None 11/03/2014 01:20:00 PM JOHNSON, MCKINSIE A 6125 Finalized Apprommate: Approxmate: 30b Social Worker?Corrections (C) Incident Types Results/Actions Escape Other Placed in Bed Restraints: I: Assault PREA Threats: Cell Entry Phy5ical Injury Property Damage. Fire Property Damage Contraband: -3 Death I: Threats Phy5ical Force: Disturbance ACC'dent Phy5ica Injuries: Informational Health E- Discharge Firearm Custody .: Self Harm LEP (Limited English Prof1c1ency) STG in Choose up to 3 Types from above* Misconduct Additional Information Employee on Duty: Yes Reported to Law Enforcement: Unknown Staff Involved (1 - 1 of 1) Staff Name ID Primary Work Site Job Title Involvement Type JOHNSON, MCKINSIE A 6125 Waupun Correctional Institution Worker-Corrections (C) Other Offenders Involved (1 - 1 of 1) Offender Name DOC Photo Involvement Type AVERY, STEVEN 122987 PrinCIpal Other Persons Involved (1 - 2 of 2) Person's Name (Last, First) Involvement Type Avery, Candy PrinCIpal Avery, Earl Principal Description of Incident ?le 1 I 1/27/2016 Page 2 of 2 On the above date and apprOXImate time, this writer received a phone call from Earl Avery. Earl Avery indicated to this writer that Inmate Steven Avery #122987, continues to write him and his ex?WIfe, Candy Avery. Earl Avery indicated that while Inmate Avery #122987 was at WSPF, Earl Avery requested that Inmate Avery no longer contact him Via mail, phone or third party as the letters were threatening in nature. This writer asked that Earl Avery and Candy Avery send in the letters they received for proof that Inmate Avery was Violating the 'cease contact? order. This writer reVIewed his Soc:al Serwces File which contained a 'cease contact' order from WSPF in which Inmate Avery was ordered to cease any and all contact With Earl Avery; dated 01/20/14. This writer sent Inmate Avery another cease contact order for both Earl and Candy Avery; dated 1/03/14. When this writer receives the letters from Earl and Candy Avery I Will write a Conduct Report and forward to security. TimeStamp. 3 November 2014 13:45:59 User: M. Johnson/WCI Author StatUS- Submitted for Review by Supv As Of Date: 11/03/2014 Author Signature: m, JOHNSON 6125 Actions Taken as Result of Incident SUPGWISOF Name: LARSEN, JEREMIAH 30b Tltlel Supewismg Officer 1 IR Declared Con?dential: No Primary IR: Reasons Returned to Author {None I Supervisor Comments [Informational I supemsor IR Status: Submitted to Director/Chief As Of Date: 11/03/2014 Superwsor Signature: J, LARSEN 9027 Further Action Taken by Security Director/Regional Chief Staff Name! MELI, ANTHONY 30b Tltlei Corrections Security Director IR Declared Confidential: No Reason(s) Returned to Author or Superwsor [None 1 Security Director/Regional Chief Comments Elopy to L. Bonis - Soc:al Serwces Director for reVIew. Referred to Other DOC Staff (1 1 of 1) . Date Staff Name ID Primary Work Site Job Title 11/03/2014 BONIS, LAURA 458 Waupun Correctional Institution Institution Serwces Di Final IR Status: Approved by Director/Chief As of Date: 11/03/2014 Security Director/Regional Chief Signature: A, 967 1/27/2016 IRTSOZOC - Incident Report IRTSOZOC Incident Report Page 1 of 2 Wednesday January 27, 2016 07 37:46 AM Institution/Region: Waupun Correctional Institution 00109512 Of?ce: Waupun Correctional Institution Location of Incident: NCH Exact Location of Inc1dent: NCH A InCIdent Date: 03/12/2014 Approximate: InCident Time: 05:00:00 pM ApprOXImate: 5; Staff Member Completing Report: HARDRATH, TIMOTHY Job Title: Correctional Officer 14963 Overall IR Status: Finailzed Incident Types Results/Actions Escape Other Placed in Bed Restraints: F- Assault [2 PREA Threats: Cell Entry Physical Injury Property Damage: T: Fire PFODEITY Damage Contraband: Death Thr?ats Phy5ical Force: Disturbance g; Accmlent Physical Injuries: Informational Health Discharge Firearm E: Custody Self Harm Misconduct :7 LEP (Limited English ProfiCiency) STG Choose up to 3 Types from above* Additional Information Employee on Duty: Yes RepOrted to Law Enforcement: Unknown Staff Involved (1 - 1 of 1) Staff Name ID Primary Work Site Job Title Involvement Type HARDRATH, TIMOTHY 14963 Waupun Correctional Institution Correctional Of?cer PrinCipal Offenders Involved (1 - 1 of 1) Offender Name DOC Photo Involvement Type AVERY, STEVEN 122987 Princ1pal Other Persons Involved Person's Name (Last, First) Involvement Type No Rows Found .. 1/27/2016 IYRTSOZOC Incident Report Page 2 of 2 Description of Incident On the above date and time, I COII T. Hardrath discovered that Inmate Avery, Steven DOC 122987 Just arrived at this Institution. (Waupun Correctional Institution) Let it be known that I'm very familiar With Inmate Avery's case. I knew who his 'VIctim was. She was from the same small town as myself and went to the same high school. I also know other members of her family. I went to high school With one of her brothers who is a friend of mine. Author Status: Submitted for Review by Supv AS 0f Date: 03/13/2014 AUthOl? Signature- T. HARDRATH 14963 Actions Taken as Result of Incident Superwsor Name: LARSEN, JEREMIAH Job Title: Of?cer 1 IR Declared Confidential: Yes Primary IR: Reasons Returned to Author lNone Supervisor Comments Informational reccomend a copy of inCIdent report to Capt. O'Donovan for p055ible SPN. It should be noted that Officer Hardrath is the Bath House #2 officer and Is reqUIred to conduct showers for general population inmates at WCI Of?cer Hardrath was interv1ewed and stated that he was unsure if he could be impartial when dealing With inmate Avery due to the relationships he has had With inmate Avery's Victims family. Supervisor IR Status: Submitted to Director/Chief As of Date: 03/13/2014 Superwsor Signature: J, LARSEN 9027 Further Action Taken by Security Director/Regional Chief Staff Name: MELI, ANTHONY Job Title: Corrections Security Director IR Declared Confidential: No Reason(s) Returned to I: Author or SuperVisor [None Security Director/Regional Chief Comments Copy to Capt. O'Donovan to review however based on the information an SPN is not likely. Lt. Larsen to follow with staff member regarding profeSSIonal behaVIor. Referred to Other DOC Staff (1 - 1 of 1) Date Staff Name ID Primary Work Site Job Title 03/13/2014 ODONOVAN, JOHN 3670 Dodge Correctional Institution Correctional Sergeant Final IR Status: Approved by Director/Chief As Of Date: 03/13/2014 Security Director/Regional Chief Signature: A, MELI 967 http://wics. doc.wi. gov/e .. 1/27/201 6 IRTR161 - 12 DEPARTMENT OF CORRECTIONS DOC-2466 (Rev 12/2008) WICS REPORT WISCONSIN ADMINISTRATIVE CODE Chapter DOC 306 INCIDENT DATE: 03/13/2014 APPROXHVIATE No GION: Waupun Correcnonal Institutlon LOCATION OF INCIDENT: Waupun Correctional Other EXACT LOCATION OF DVCIDENT: Inmate 18 NCH STAFF MEMBER COMPLETING REPORT: JOB TITLE: Correctional Sergeant OVERALL H1 STATUS: Finalized HAWKINS, JONATHAN INCIDENT TIME: IRNUMBER: 00109731 1410100 APPROXIMATE Yes INCIDENT TYPE: Informational INCIDENT IONS: EMPLOYEE ON DUTY: Yes REPORTED TO LAW ENFORCENIENT: Unknown STAFF INVOLVED JOB TITLE Correctronal Sergeant STAFF HAWKINS, JONATHAN INVOLVEMENT TYPE OFFENDERS INVOLVED OFFENDER NAIVIE DOC INVOLVENIENT TYPE AVERY, STEVEN 122987 Pnncipal OTHER PERSONS INVOLVED INVOLVEMENT TYPE NONE DESCRIPTION OF INCIDENT: On Thursday (03/ 13/20 14) I learned that Steven Avery was here at CI My cousin, Calumet County Shenff Deputy Jeremy is the ev1dence custodian mmate Avery's case. Delay in report 18 due to ?ndmg out the o?i01alcapac1ty of my cousms 1nvolvement in Avery's case. CANNED DOCUMENTS ATTACHED PHOTO TYPE PAGE IMAGE NONE .I HAWKINS 3871 03/ 15/20 14 AUTHOR SIGNATURE DATE SUPERVISOR ACTIONS TAKEN SUPERVISOR NANIE: LARSEN, JEREMIAH JOB TITLE: Supervrsing Of?cer 1 IR DECLARED No PRINIARY IR 0010973} CONIPAN ION IR SUPERVISOR COMMENTS: Informanonal reccomend a copy of Incident report to Captain O'Donovan LARSEN 9027 03/15/2014 SUPERVISOR SIGNATURE DATE SECURITY DIRE CT CHIEF ACTIONS TAKEN STAFF NAME: MELI, ANTHONY JOB TITLE: Correctlons Security Director IRDECLARED CONFIDENTIAL: Yes SECURITY CHIEF COMIVIENTS: Copy to Capt O'Donovan - SPN not bemg sought. REFERRED TO OTHER DOC STAFF: DATE STAFF NAME JOB TITLE 03/ 1 7/ 2014 ODONOVAN, JOHN Correctronal Sergeant A MELI967 03/17/2014 SECURITY DIRECT CHIEF DATE IRTR161 - 12 DEPARTMENT OF CORRECTIONS DOC-2466 (Rev 12/2008) WICS INCIDENT REPORT WISCONSIN ADMINISTRATIVE CODE Chapter DOC 306 INCIDENT DATE: 02/01/2016 Wisconsm Secure Program aetlIty LOCATION OF INCIDENT: Wlsconsm Secure Program Facility, Unit EXACT LOCATION OF INCIDENT: SUPV OFFICE STAFF MEMBER COMPLETING REPORT: KOOL, BRIAN JOB TITLE: Corrections Unit SuperVIsor OVERALL IR STATUS: Finalized APPROXIMATE No INCIDENT TIME: IR NUMBER: 00199590 082000 APPROXIMATE No INCIDENT TYPE: Informational INCIDENT Threats Verbal EMPLOYEE 0N DUTY: Yes REPORTED TO LAW ENFORCEMENT: No STAFF INVOLVED STAFF NAME JOB TITLE INVOLVEMENT TYPE KOOL, BRIAN Witness Superwsor OFFENDERS INVOLVED OFFENDER NAME DOC INVOLVEMENT TYPE AMSRUD, DAVID 205891 Other AVERY, STEVEN 122987 Other KURTZ, JASON 495483 Principal OTHER PERSONS INVOLVED NAME INVOLVEMENT TYPE NONE DESCRIPTION OF INCIDENT: Jason Kurtz #495483 came Into my O?'Ice on the above date and time and stated (apprOXImately). "Years ago (2009), Steven Avery #122987 said he wanted to take an extenSIon cord and choke Dave Amsrud #205891 then Amsrud #205891 ran over to Avery #122987 and threatened/dismspected him and Amsrud #205891 got sent to the hole. I am concerned If It leaks to the media I wanted to be able to say I told someone about Avery's #122987 violent threat Inmate Kurtz #495483 stated he was concerned with all the recent news about Avery #122987 that prompted him to make this report Writer told inmate Kurtz #495483 that it would be reported DOCUMENTS ATTACHED PHOTO DOCUMENT TYPE PAGE NONE KOOL 10858 02/01/2016 AUTHOR SIGNATURE DATE SUPERVISOR ACTIONS TAKEN SUPERVISOR NAME: BROWN, LEBBEUS A JOB TITLE: Of?cer 2 IR DECLARED CONFIDENTIAL: N0 PRIMARY IR 00199590 COMPANION IR SUPERVISOR CONIMENTS: Documentation of an mmate statement related to inmate Avery BROWN 7352 02/02/2016 SUPERVISOR SIGNATURE DATE SECURITY DIRECT CHIEF ACTIONS TAKEN STAFF NAME: GARDNER, DAVID JOB TITLE: Supervrsing Of?cer 2 IR DECLARED CONFIDENTIAL: Yes SECURITY CHIEF COMMENTS: Noted inmate's comments 1n regards to Inmate Avery and WCI SD to be copied on the IR Inmate Amsmd Is not currently mcarcerated. REFERRED TO OTHER DOC STAFF: DATE STAFF NAMLE JOB TITLE 02/02/2016 BOUGHTON, GARY A Warden 02/02/2016 JOHNSON, TRACY A 02/02/2016 KARTMAN, MARK Corrections Securlty Dlrector 02/02/2016 MELI, ANTHONY Corrections Securlty DlrectOr 02/02/2016 WINKLESKI, DANIEL Deputy Warden GARDNER 3716 02/02/2016 SECURITY CHIEF DATE DEPAETTMENTOF CORRECTIONS WISCONSIN of Code 00098 (Ft 6 04) a DOC 306 INCIDENT REPORT 96 INCIDENT REPORT NUMBER INSTRUCTION: Attach addIttonal sheets If necessary. If addItIonat Sheets are used, 8 ?1 7 7 note the InCIdent Report Number at the top of each sheet. INSTITUTION LOCATION OF INCIDENT DATE OF INCIDENT TIME OF INCIDENT Ce: can: - thy/#02 I310 ELM. STAFF MEMBER COMPLETING REPORT (Pnnt or Type) STAFF ME BER TITLE I it TYPE OF INCIDENT (CHECK ALL THAT APPLY) ESCAPE OFFENDER PLACED IN FULL SED RESTRAINTS INFORMATIONAL ASSAULT FIRE [3 OTHER - SPECIFY [j CELL EXTRACTION USE OF FORCE [j DISCHARGE OF FIREARM DISTURBANCE DEATH INTERMEDIATE WEAPON USED - SPECIFY PRINCIPAL PERSON INVOLVED - Name STATUS DOC NUMBER OFFENDER VISITOR 1 ICISTAFF I NAME OF WHO DISCHARGED FIREARM NAME OF STAFF MEMBER WHO DISCHARGED NAME OF SUPERVISOR PRESENT WHEN INCAPACITATING AGENT INCAPACITATING AGENT WAS DISCHARGED M/t M/r I we NAMES OF ADDITIONAL INDIVIDUALS INVOLVED STATUS (Offender. Staff, Other) DOC NUMBER 81 HOUSING UNIT (II Offender) 91% NAMES OF WITNESSES (Other than those above) STATUS (Offender? Staff. Other) DOC NUMBER HOUSING UNIT (It Ottender) IF PERSONS) INJURED-SPECIFY WAS ANYONE WAS THERE ANY PROPERTY WAS THERE ANY CONTRABAND STATUS (Check a? ma] MEDICAL TREATMENT DAMAGE INVOLVED EOFFENDER NO EYESSPECIFY WHO: 5 NO No YES-DISPOSITION DVISITOR OTHER I ft/o Nu! DESCRIPTION (State all relevant facts IncIUdIng CIrcumstances teadIng Up to and/or caUSIng Inmdent. contrIbutIng Iactors and, If any, evidence. If anyone was InIured Include the name of the person and the extent Of the Injury. IncIUdIng any verbal statements 5n IA GIN-L CINE Wt we I Pita? 2. BEN cm IARWA tta 636? Pam IWMQAEA RES Col amt 15 Cbnrentty abe'mj Remit In I Icmw Ind Themch Home. M5 Htho?k m/I/ 43w racy/5v bath (Um; aha In owl/{Iii #le a? I DE) DESCRIPTION 9F INCIDENT (contlnuedn?t It - I r, 1135*}. I .1 m" i hbnmuj Jay 1 hiij )1 JUL InnLg-[f ?pafje/ drug. erMInjy 79a) GVU?I'mxaf. 0/3 SIGNAT RE OF STAFF MEMBER RESORT DATE COMPLETED V65 I ACTIONS TAKEN As RESULT OF INCIDENT ACTION FOR ACTION #71628? wwt?m ,inf f/ A 0 I. ?4 :if% SIGNATU TITLE DATE SIGNED Moon I dB at- I DI CTOR M77J-de) j?r/Jd?l/L/W? f/Z Afmz?a/fz?; ,745'74?7 WM 4477% K'w?z?wr/ gm/J/??zww?/?r/??/JMWI?Z 3337/? #3 (7i dig?)4 ?5 I EwZ/a 4m (1/157,pr xe? ijEV 6M SIGNAWREO a! My I A) To CORRECTIONS DIVIsion olAdult Instnutrons 11/95) INCIDENT REPORT WISCONSIN Administratlve Code Chapter DOC 306 INCIDENT REPORT NUMBER DAMAGE [2 NO I: YES-SPECIFY: STATUS (Check all thatapply) STAFF DVISITOR OTHER 1 GWEN MEDICAL TREATMENT No EYES-SPECIFY WHO. INSTRUCTION: Attach addItipnaI sheets if necessary. If additional Sheets are used, {3 7 L1 2 note the Inmdent Report Number at the top of each sheet. INSTITUTION LOCATION OF INCIDENT DATE OF INCIDENT TIME OF INCIDENT - Hui STAFF MEMBER COMPLETING REPORT (PrInt or Type) STAFF MEMBER TITLE F236 tar? TYPE OF INCIDENT (CHECK ALL THAT APPLY) ESCAPE j OFFENDER PLACED IN RESTRAINTS INFORMATIONAL ASSAULT FIRE OTHER - SPECIFY- CELL ENTRY I: USE OF FORCE DISCHARGE OF FIREARM [j DISTURBANCE El DEATH :1 USE OF CHEMICALAGENT-TYPE PERSON INVOLVED Name I STATUS DOC NUMBER EVISITOR 10113383 I Brenden 5/6 9576 NAME OF PERSON WHO DISCHARGED FIREARM NAME OF STAFF MEMBER WHO NAME OF SUPERVISOR PRESENT WHEN CHEMICAL AGENT CHEMICAL AGENT WAS DISCHARG ED ft I NAMES OF ADDITIONAL INDIVIDUALS INVOLVED STATUS (Offender, Staff. Vlsitor, Other) DOC NUMBER (ltOffender) NAMES OF WITNESSES (Other than those above) STATUS (Offender, Staff, Other) DOC NUMBER (ItOtfender) IF PERSOMS) INJURED-SPECIFY WAS ANYONE WAS THERE ANY PROPERTY I WAS THERE ANY CONTRABAND INVOLVED NO YES -DISPOSITION. DESCRIPTION OF INCIDENT (State all relevant facts including circumstances leading up to and/or causing incident, Contributing factors and. if any, evidence. If anyone was injured include the name of the person and the extent of the injury. Including any verbal statements.) Iworked HUI whence DELSSE: IVI ?Is housed; 00.3ng had a high pnofiie acme with his uncle Meg/I Of??ih Hits (I93 I Limit Marla en MORRIS was and The h?R? This, To Counsel Int/node. and +ell him Ii? is dr?smpr?I?I/e comdudL eaml (Another I'nmaie Refer To OASSBJ as has in5+puc+ed The OAHCI uJon'rL (CONTINUE 0N REVERSE SIDE) DESCRIPTION INCIDENT (continued) To [9 no ILC: was sTa?Pga - - 92 3* a r; x: a -xx ?I-a5?-.-.1, I. 2?r 115; - -. 19432? 5 9.9ACTIONS TAKEN AS RESULT OF INCIDENT ACTION REASONS) FOR ACTION (g giggIEID/Tsse . 5 MIC/alp? A/?f/Mfg ?/b/J-Ze a .59? ?/zy?gym?/jasn a c2 gig/xy- ?at. f1?/2/5 - -. SIGNATUHEI IZINGAOTION - - -I. 9.55.-I..- .k3,. I u. I .v FURTHER ACTION TAKEN BY SECURITY DIRECTOR ?p?-.-. .-I.1 x: .- -I.I -. 2(5 .1xi: DEPARTMENT OFCORRECTIONS a; Adu1l I1 - ev. 8p er REPORT INCIDENT REPORT NUMBER INSTRUCTION: Attach additional sheets if necessary. If addrtional Sheets are used, 8 3 7 7 note the Incident Report Number at the top of each sheet. INSTITUTION LOCATION OF INCIDENT I DATE OF INCIDENT TIME OF INCIDENT 0% I Hm - I Ago AM. STAFF MEMBER COMPLETING REPORT (Print or Type) STAFF MEMBER TITLE F0 57% I 59 7L TYPE OF INCIDENT (CHECK ALL THAT APPLY) ESCAPE OFFENDER PLACED IN RESTRAINTS INFORMATIONAL ASSAULT FIRE - I: OTHER - SPECIFY CELL ENTRY USE OF FORCE DISCHARGEOF FIREARM Ej DISTURBANCE :1 DEATH USE OF CHEMICAL AGENT-TYPE PRINCIPAL PERSON Name STATUS DOC NUMBER - - IZOFFENDER I ESTAFF ZIOTHER 4" NAME OF PERSON WHO DISCHARGED FIREARM NE OF STAFF MEMBER WHO DISCHARGED NAME OF SUPERVISOR PRESENT WHEN CHEMICAL AGENT CHEMICAL AGENT WAS DISCHARC ED NAMES OF ADDITIONAL INDIVIDUALS INVOLVED STATUS (Offender, Staff, ViSItor, Other) DOC NUMBER (IfOtfender) NAMES OF WITNESSES (Other than those above) STATUS (Offender. Staff, Other) DOC NUMBER (IfOffender) IF PERSONS) INJURED-SPECIFY WAS ANYONE WAS THERE ANY PROPERTY WAS THERE ANY CONTRABAND STATUS (Check all that apply) GWEN MEDICAL TREATMENT DAMAGE INVOLVED 1: STAFF No NO I: YES-SPECIFY- NO YES - DISPOSITION. DOTHER I 0F (State all relevant facts" including Circumstances leading Up to and/or cauSing incident,? contributing factors and. if any, evidence If anyone was injured include the name of the person and the extent of the injury. including any verbal statements.) Today I did acell Search on 0665633 I Checked/U5 0T9 I Suave Men ShamIOOCFCOI/Idltfonep was wai'er?y. If ThoughT it was Lorna/CU) o/Ecmer?. ,4?51 fr?mshe? dumping realt'zad The Smell was noT bun!? shampocb. wth/T Iasked OQSSEU wharf? was I and (CONTINUE ON REVERSE SIDE) INCIDENT (contlnued) I 3/4 Jrk? as If "waiLur?med 7L0 Theddyf?Odfm/ 11?9qu a 0? UEW/n?rpr?ao/ logs (ix/Luisa} Shari/IP00 he 6 3 anrlH wn+e?n. p? a .3, 3:1? 2 g? .- 1 xix: (I. -. Ix H. Jazz: I a! )a?ld 1 er I..- "a c-r?l-h Hr .. 1 in .- sm'h . I a ACI TAKEN AS RESULT OF INCIDENT ACTION REASONS) FOR ACTION I .- 060?? {Warez/ram gr; y/q, 11' 4 O/Um/plitj 4/2 liamcl?Lgs SQVQO (9/1 I SIQNAWHEQ PERSGN HUN vi"- .- -.-. .- -. .--..-. [3:2 1 5 . :55 ?w FURTHER ACTION TAKEN BY SECURITY DIRECTOR Jjaw?w? 47:7 319m: 1 ax xx- .- infra.- ?5?xzrzxn,yxxk -.-. Mil/.- .IRTSOZOC - Incident Report IRTSOZOC Incident Report Page 1 of 3 Thursday January 28, 2016 03 08'59 AM Institution/Region: Office: Location of Incident: 092 Exact Location of Incident: Green Bay Correctional Institution 00100584 Green Bay Correctional Institution Incident Date: 12/25/2013 Incident Time: 08:29:00 PM Staff Member Completing Report: SCHULTZ, KELLY 21771 Overall IR Status: Finalized P?s g! ApprOXImate: Apprommate: 30b Title! Correctional Officer Incident Types Results/Actions Escape Other Placed in Bed Restraints: Assault I: PREA Threats: B: Cell Entry [3 Physical Injury Property Damage: Fire F3 Property Damage Contraband: Death Threats Phy5ical Force: Disturbance Accident Physical Injuries: ITZ Informational Health Discharge Firearm Custody Self Harm Misconduct LEP (Limited English Proficiency) f; STG Choose up to 3 Types from above* Additional Information Employee on Duty: Yes Reported to Law Enforcement: Unknown Staff Involved (1 1 0f 1) Staff Name Primary Work Site Job Title Involvement Type SCHULTZ, KELLY Correctional Officer PrinCIpal Offenders Involved (1 - 1 of 1) Offender Name DOC Photo Involvement Type DASSEY, BRENDAN R. 516985 PrinCipal Other Persons Involved (1 - 1 of 1) Person's Name (Last, First) Involvement Type Tadych, Barbara PrinCIp?al . eomis 1/28/2016 -,In01dent Report Page 2 of 3 Description of Incident On the above date and time, I Of?cer K. Schultz was working as the Visits Officer in the Visits Room at GBCI. Inmate Dassey, Brendan #516985 was attending a vi5it With his mother, Tadych, Barbara. This is a follow up Incident Report that was preVIously reported back in June 2013, and the Incident Report that was ?lied has not shown up on my record. Barbara is a former co?worker of mine and shortly before reeleving noti?cation from the State of Wisconsm of employment, Barbara informed me that her son, Dassey was currently incarcerated at Green Bay Correctional Institution. Dassey has no previous knowledge of me, does not know who I am and doesn't make any attempts to soiiate me as an Of?cer. Barbara makes no attempt to contact or soliCIte me as a staff member. I do not believe that Dassey being housed at GBCI will hinder my Job duties and keep me from being ?rm, fair and con5istent With him or any other inmates. I believe that if he request special treatment that I will address the inappropriate behaVIor accordingly and I Will report it to a supervisor without he5itation. TimeStamp: 25 December 2013 20:51:01 User: K. Schultz Author Status: Submitted for ReVIew by Supv As of Date: 12/25/2013 Author Signature: SCHULTZ 21771 Actions Taken as Result of Incident Supervisor Name: BAUMANN, RYAN Job Title: SuperVIsmg Officer 2 IR Declared Con?dential: No Primary IR: Reasons Returned to Author lNone Supervisor Comments Report documents a staff member who worked with this inmates mother at a preVious Job. It doesn't appear as if there Will be a conflict of interest, and report is therefore a matter of record. TimeStamp: 30 December 2013 22:40:27 User: R. Baumann IR Status: Submitted to Director/Chief As Of Date: 12/30/2013 Superwsor Signature: R, BAUMANN 10389 Further Action Taken by Security Director/Regional Chief Staff Name: SCHULTZ, Job Title: SuperVISIng Officer 2 IR Declared Confidential: Yes Reason(s) Returned to AUthor 0" SUPGWISOV None Security Director/Regional Chief Comments Informational report. Staff to notify a Supewisor if a conflict arises. No action needed at this time. Incident report made confidential. TimeStamp: 2 January 2014 17:28:44 User: M. Schultz Referred to Other DOC Staff (1 - 2 of 2) Date Staff Name ID Primary Work Site Job Title 01/02/2014 BENCH, PATRICE A 14883 Green Bay Correctional Institution Payroll Benefits Spec?Conf 01/02/2014 ERICKSEN, Not Applicable marquis.eomis.EomisControllel 1/2 8/2016 IRTSOZOC 1 Incident Report Page 3 of 3 1 ?nal IR Status: Approved by Director/Chief As of Date: 01/02/2014 Security Director/Regional Chief Signature: SCHULTZ 5158 eomis 1/2 8/2016 - Incident Report inrsozoc l" Incident Report Page 1 of 3 Thursday January 28, 2016 08:08 03 AM Institution/Region: Of?ce: Location of InCIdent: Exact Location of InCident: Green Bay Correctional Institution 00195519 Green Bay Correctional Institution North Cell Hall InCIdent Date: 01/04/2016 Apprommate: InCident Time: 07:25:00 pM Approximate: Staff Member Completing Report: DEDERING, Job Title: Correctional Officer 25067 Overall IR Status: Finalized Incident Types Results/Actions Escape Other Placed In Bed Restraints: Assault PREA Threats: i" Cell Entry Physical Injury Property Damage: Fire Property Damage Contraband: Death Threats Phy5ica Force: I: Disturbance ACCident Physicai Injuries: Informational Health 3; Discharge Firearm Custody Self Harm Misconduct LEP (Limited English ProfICiency) STG Choose up to 3 Types from above* Additional Information Employee on Duty! Yes Reported to Law Enforcement: No Staff Involved (1 1 of 1) Staff Name ID Primary Work Site Job Title Involvement Type DEDERING, MICHAEL 25067 Green Bay Correctional Institution Correctional Officer PrinCIpaI Offenders Involved (1 - 1 of 1) Offender Name DOC Photo Involvement Type DASSEY, BRENDAN R. 516985 Principal Other Persons Involved Person's Name (Last, First) Involvement Type No Rows Found ://wics . doc.wi. .. 1/28/2016 Incident Report Page 2 of 3 ?Descriptionfof Incident [To whor'n'it may concern my Dad was a Investigator at Calumet Sheriffs Office he had direct involvement in the investigation of linmate Dassey, Brendan I do not expect this to be an issue feel that you should be informed of this. Author Status: Submitted for Review by Supv As of Date: 01/04/2016 Author Signature: M. DEDERING 25067 Actions Taken as Result of Incident - Supervisor Name: BAUMANN, RYAN Job Title: Supewismg Officer 2 IR Declared Confidential: No Primary IR: Reasons Returned to Author None Supervisor Comments Informational. Officer does not know this inmate, only that his father a55isted in the criminal investigation. TimeStamp: 5 January 2016 00:03:01 User: R. Baumann superViSOI? 1R StatUS! Submitted to Director/Chief As of Date: 01/05/2016 Supervisor Signature: R. BAUMANN 10389 Further Action Taken by Security Director/Regional Chief Staff Name: SCHULTZ, Job Title: SuperVISIng Officer 2 IR Declared Confidential: Yes Reason(s) Returned to Author or Supervisor None Security Director/Regional Chief Comments InCIdent report declared confidential. Informational report, forward to Personnel as an FYI. No conflict at this time. TimeStamp: 6 January 2016 14:28:44 User: M. Schultz/GBCI Referred to Other DOC Staff (1 of 5) Date Staff Name ID Primary Work Site Job Title 01/06/2016 ECKSTEIN, SCOTT 7518 Green Bay Correctional Institution Deputy Warden 01/06/2016 KIND, JOHN A 2228 Green Bay Correctional Institution Corrections Security Director 01/06/2016 COOPER, SARAH 9788 Green Bay Correctional Institution Deputy Warden 01/06/2016 FOSTER, BRIAN 18907 Waupun Correctional Institution Warden 01/06/2016 BENCH, PATRICE A 14883 Green Bay Correctional Institution Payroll Bene?ts Spec?Conf Final IR Status: Approved by Director/Chief As of Date: 01/06/2016 ://wics.doc.wi. gov/comis/servlet/commarquis. eomis 1/28/2016 IRTso'zoc Incident Report Page 3 of3 1 Security Director/Regional Chief Signature: m, SCHULTZ 5158 1/2 8/2016