PRIVILEGED AND CONFIDENTIAL

FORM 5-IA
REVISED: 12/01/02

CORRECTIONS CORPORATION OF AMERICA

INCIDENT REPORT
INCIDENT NUMBER:04-i205-245-I
DATE OF INCIDENT:September 14.2004
I.

Type of Incident:
PRIORITY I

q
q
q
q

Death - any person
Escape
Rape (forced sexual assault)
Inmate disturbance (major property
damage or injury)
0 Loss of firearm
q Facility damage (major property damage)
q Hostage @king
0 Employee work stoppage
q Erroneous release
q Work-related accident involving employee
injury requiring admission to a hosstai
q Other -

q

PRIORITY II

Assault resulting in Serious Physical
Injury
q Attempted escape
q Attempted suicide/self-mutilation
requiring treatment or admission
to a hospital
0 Discovery of significant amount of
drugs, alcohol or controlled substance

II.

Description of incident:

FACILITY:Lee Adiustment Center
MILITARY TIME OF INClDENT:approx. 1’925hrs

q

PRIORITY II (CONTINUED)

Interruption of institution services that
affect the daily facility operations
q Inmate disturbance (no major
property damage or injury)
0 Use of force resulting in Serious
Physical Injury
0 Firearm discharged
q Loss of security keys or any tool that
is capable of causing death/ serious
physical injury or facilitate an escape
q Discovery of ANY firearm/
ammunition
q Walk-away
0 Work-related accident involving
employee injury requiring outside
medical attention
0 Any arrest of any employee/visitor

PRIORITY Ill
0 Multiple food illness complaints
within 24 hours
0 Work-related accident involving
employee injury not requiring
medical attention

PRIORIN Ill (CONTINUED)
0 Attempted rape (sexual assault)
0 Assault or fight with less than
Serious Physical Injury and more
than Superficial Injury
[7 Use of force resulting in less than
Serious Physical Injury and more
than Superficial Injury
0 Other -

PRIORIN IV
0 Failure to return
q Assault or fight with superficial or no
injuries
0 Use of force with superficial or no
injuries
0 Self-mutilation or an attempted
suicide not requiring treatment at nor
admission to a hospital
0 Discovery of other potentially
dangerous contraband
0 Other -

(Include precise location in the facility the incident occurred)

On 9114104 at approx. 1925hrs C/O Brian Adkins made a call for assistance on the Lee Adjustment Center Loop
/Recreation Yard) and Capt. Harold Kinq radioed for all available units to respond to the Loop. C/O Adkins was workinq
the tower on the LOOP when four inmates beqan to tear the tower down with concrete ciqarette butt containers. The
inmates proceeded to pull several 2x4 railinqs loose from the tower rails. At this time C/O Adkins began to video the
incident. C/o’s Sammy Harold and Greq Ten-v were also assiqned to the Loop, and beqan to qive verbal directives to the
inmates to halt the property damaqe. Recreation Coordinator Calr Briscoe was also present on the LOOP monitorinq a
horshoe tournament. C/O Monica Davidson was the first responder to arrive at the Loop. Once there C/O M. Davidson
took the video camera from C/O Adkins and continued to video the incident. The inmates who were attemptinq to tear
down the tower moved to the side of the maintenance buildinq and beqan to use the 2x 4’s in an attempt to qain entry into
the masonry room. Capt. Kinq requested that Capt. Nathan Mullins respond with MK9 O.C. foqqers obtained from
Senreqation and Central Control. C/O Donald Gabbard and C/O Micheal Cox responded to the Loop. Capt. Kinq and C/O
Ten-v attempted to qet the inmates who were vandalizinq the maintenance buildinq to stop at which time the inmates
beqan swinqinq the 2x 4’s at them causina the staff to back away. The inmates then told C/O M. Davidson to stop filminq
and beqan to chase her off the LOOP swinqinq the 2x4’s at her and demandinq the video camera. The responders then
beqan usinq verbal directives to qet the other inmates to exit the Loop. Capt. Kinq told the inmates that if thev let C/O
Atkins out of the tower, the staff would leave the Loop. The inmates complied and allowed C/O Atkins to come down from
the tower and leave the LOOP. After exitinq the LOOP, the staff locked the seven remaininq inmates who were vandalizing
the maintenance buildinq. on the LOOP, and beqan to trv to qet the other inmates to return to their housinq units. C/O Lee
Bennett secured the LOOP qate. Capt. Mullins arrived with the MK9 OC foqqers and the videocamera from Seqreqation
which he qave to C/O Jason Davidson to beqin filminq. At 1931 hrs, A/W Donna Stivers moved from the Administration
buildinq to Central Control, initiated the IMT process and beqan to paqe the SORT Team. IM Stivers radioed an order for
all inmates to be placed on lockdown and for all units to radio a status report. Capt Kinq and the respondinn staff beqan
cJvinq directives for the inmates on the Vard to return to their units, with no compliance. Capt. Kinq then attempted to
instruct the inmates to qo into the West Dorm smokinq area to no avail. The video camera operated bv C/O M. Davidson
beqan to stop workinq due to the battetv dvinq. Capt. Kinq then reported that the seven inmates who had been locked on
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PRIVILEGED AND CONFIDENTIAL

FORM 51A
REVISED: 12/01/02

the Loop had used the 2x 4’s to prv the Loop Qate open, had exited the Loop and were beclinninq to break windows in the
South Dorm. Capt. Kinq reported approx. thirtv to fortv inmates were trying to climb the North Dorm manaqement fence.
Capt Kina then notified IM Stivers that the seven inmates had qotten off of the Loop and that approximatelv 200 to 300
inmates were on the vard refusinq directives and causinq propertv damaqe. IM Stivers then called 911 and notified the
dispatch that she needed assistance due to a disturbance. Recreation Coordinator Briscoe went to the Recreation Room
and then proceeded to the Recreation Office. C/O M. Davidson. C/O Jason Davidson, C/O Michael Cox. C/O Andy
Gabbard and C/O Brian Atkins went to the breakroom in operations (Administrative buildina). The inmates on the vard
beqan throwinq rocks at them and breakinq windows in the Administrative buildinq. At approx. 1940hrs. a staff recall was
initiated. At 1946hrs N/O Winqs were reported locked down and staff beqan reportinq that fires were beinq set within the
institution. C/O M. Davidson advised that a fire had been set in the Administrative buildinq after inmates attempted to
break in and net the staff out unsuccessfullv. At approx. 1945hrs Chief Brvon Ponds arrived on arounds. Capt. Mullins
and Capt. Kinq beqan to move all vard staff UP the hill towards Centrat Control. Inmates from the West Dorm smokinq
area beqan to throw rocks at the staff movina up the hill. At approx. 1948hrs. Capt. Kinq and Chief Ponds entered the
armory and beaan issuinq chemical / inflammatory agents to respondinq staff which included A/W David Frye, C/O Richie
Woodard, C/O Keith Prvse and Lt. Terry Fultz (with K-9 unit Donya) and Sat. Greg Deaton who was on dutv at the time. At
approx. 1950hrs. IM Donna Stivers advised Manaqina Director Melodv Turner that she would be sendinq a response team
into the facilitv to rescue staff and that at this time, she was not sure where all staff were located. Radio reports and staff
visuals indicated the following staff locations: Maintenance Officer Kris Goldey was located in Maintenance with three
inmates, C/O Joann Estes, RN Carolyn McIntosh and RN Arnetta Fuaate were locked inside the medical file room,
Canteen Lisa Pearson was locked inside the kitchen, C/O Scott Lvcliter and Sat. Kenneth Snowden were locked in the
North Dorm upper staff bathroom, C/O M. Davidson, C/O Jason Davidson, C/O Michael Cox, C/O Andy Gabbard and C/O
Brian Atkins were trapped in Operations (Administrative buildinq) and Recreation Coordinator Carl Briscoe was locked in
the Recreation Office in the Administration Buildinq. While on the phone with M.elodv Turner, IM Stivers received reports
from perimeter that inmates were trvinq to make their way to the perimeter fence. IM Stivers then advised C/O Gary
Brandenbura to 40 to the Armory to qet shotquns and to issue them to firearms qualified respondina staff to secure the
perimeter. A total of nine shotquns were issued to the perimeter staff. At approx. 1955hrs, IM Stivers sent the response
team on clrounds to rescue the remainina staff who were in distress. Melodv Turner advised chemical I inflammatow
aqents onlv for the response team. The followinq aqents were authorized to the following staff: David Frye (MK9 Foqqer),
Brvon Ponds (MK9 I 515 Triple Chaser CS Grenade), Richard Hobbs (MK9). Richie Woodward (37mm / MK9). Keith
Prvse (37mm / MK9), Grew Deaton (37mm Multi-Launcher), Terry Fultz (MK9) - Chemical / lnflammatorv Rounds issued
for the 37mm’s included: 565 Scat CS, 501 CS Muzzle Blast, 502 OC Muzzle Blast, 570 CS Short Rancre Speedheat
Grenades, 560 CS Lona Ranqe Speedheat Grenades and RB40 Rubber Stinqer Rounds - All MK9’s were OC Foqsers.
Upon enterinq the yard and movina down the hill, inmates beqan throwinq rocks, batteries, cans of food, wood and other
items at the respondinq staff from the North Dorm smokinq area. The response team observed that the North Dorm
smokinq area fence crate was beina breached bv the inmates. The response team’s 37mm’s were fired into North Dorm
smokinq area to stop the throwina of obiects and to prevent inmates from advancinq on the response team. 37mm rounds
reported fired at this time were: I- CS Muzzle Blast (Sqt. Deaton), l- OC Muzzle Blast (Sqt. Deaton), I- OC Muzzle Blast
(C/O Woodward) and I- OC Muzzle Blast (C/O Prvse). Chief Ponds deploved l- 515 Triple Chaser CS crrenade between
South Dorm and West Dorm smokinq area due to a lame number of inmates advancing towards the response team and
failinq to follow verbal directives. A unidentified inmate picked up a portion of the grenade and threw it back at the
response team contaminatinq them with CS. At this time, the response team was forced to return to Central Control
because thev were contaminated with the chemical aqent from the qrenade. The response team did not successfully
rescue staff on the first attempt due to the chemical / inflammatory aqents being laraelv inneffective. IM Stivers advised
Melodv Turner that chemical / inflammatory agents had failed and Melodv Turner approved the use of shotcluns on the
yard. At 2015hrs. IM Stivers authorized shotquns loaded with beanbaq rounds only and birdshot in the respondinq staffs
pockets that would onlv be used if necessary. Weapons and chemicals for the second response attempt are as follows:
David Frve (Shotqun / MK9), Brvon Ponds (Shotgun / MK9), Richard Hobbs (MK9). Ritchie Woodward (37mm I MK9),
Keith Prvse (37mm I MK9), Greq Deaton (37mm Multi-Launcher I MK9), Ten-v Fultz (MK9 and K-9 Unit Donva), Marvin
Henson (Shotqun) Archie. Moore (Flex-Cuffs) - AA MK9’s were OC Fogaers. Upon enterinq the vard, inmates began to
throw rocks, batteries, cans of food, wood and other items at the response team from the North Dorm and West Dorm
smokinq areas. The response team’s 37mm’s were fired into the North Dorm smokinq area in order to stop the throwinq of
obiects and to prevent inmates from advancinq on the response team. 37mm rounds reported fired at this time were: lCS Speedheat (Sgt. Deaton), I- CS Speedheat (C/O Woodward), I- RB40 Rubber Stinqer Round (C/O Woodward) and
I- CS Speedheat (C/O Prvse). At this time, Chief Ponds directed all inmates in the West Dorm smokinq area to set on the
ground. The inmates initially complied. Two inmates attempted to qet up off the qround and Chief Ponds depfoved a short
burst of OC from his MK9 Foqqer causinq the inmates to complv with directives. At approx. 2020hrs, responders from the
second team located Recreation Coordinator Carl Briscoe who then beqan assisting the team. While the inmates were on
Proprietary information - Not for Distribution - Copyrighted
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PRIVILEGED AND CONFIDENTIAL

FORM 5-‘IA
RRIISED: 1 Z/O1 102

._

the around; more respondinq staff who had lust arrived at the facilitv beqan to use flex-cuffs to restrain the inmates in the
front. Durinq this time, Records Clerk Barbara Estes was brieflv qrabbed from behind bv an unknown inmate and then
released. At approx. 2040hrs, due to the smoke from a qarbaqe can fire in KLM Winq (West Dorm). IM Stivers authorized
evacuation of KLM into the hallwav of West Dorm. Durinq the evacuation, an inmate attempted to strike Sqt. James
Withers with a closed fist. Sqt. Withers struck the inmate with his hands in order to defend himself. Also at approx.
2040hrs. the team radioed that C/O M. Davidson, C/O Jason Davidson. C/O Michael Cox, C/O Andv Gabbard and C/O
Brian Atkins had been rescued from Operations (Administration buildinq). C/O M. Davidson and C/O J. Davidson had
taken the tapes out the video cameras and put them in their pockets, leavinq the cameras on the tables in Operations due
to the inmates earlier statements about wantinq the cameras. At approx. 2047hrs. the response team reached the
sidewalk bv the kitchen and ordered the inmates present to lav on the qround. Sqt. Deaton spraved a 1 second MK9 OC
Foqqer burst at the qround due to noncompliant inmates attempting to rise to their feet after initiallv lavinq on the qround.
At approx. 2048hrs. AW Frve .radioed that he had rescued Lisa Pearson from the kitchen and that the team must qo to
North Dorm to net staff in the Upper North bathroom due to distress calls over the radio. Also at approx. 2048hrs,
perimeter advised that there were ‘inmates close to the perimeter fence. IM Stivers advised that if inmates attempt to climb
the fence, to use what force is necessary to prevent escape (Vice President Operations Jimmv Turner verballv qave IM
. Stivers that directive bv phone). At 2058hrs, IM Stivers advised the response team to qo to the North Dorm staff bathroom
to retrieve the two staff members trapped in the Upper North staff bathroom. Once the team entered the North Dorm, AiW
Frve and one team entered one side of the dorm and Chief Ponds and a second team entered the other side of the dorm.
Inmates were qiven directives to qet on the floor and submit to cuffs while staff beqan to place flex-cuffs on them. Once
the lower floor was under control, the two teams moved to the upper floor and initiated the same process. After securinq
the top floor, C/O Scott Lvcliter and Sat. Kenneth Snowden were rescued from the North Dorm Upper staff bathroom. At
approx. 2102hrs Chief Ponds, AiW Frve and Lt. Fultz entered the West Dorm and placed handcuffs on an inmate that
was discharqinq two fire extinquishers in N davroom. At approx. 2104hrs. a mild explosion was reported in the area of the
Chaplain’s office. At 2108hrs. KSP arrived and beqan to provide perimeter support. Response teams called in to Central
Control and advised that all North Dorm inmates were beinq restrained and that the dorms were beinq brouqht under
control. At this time, staff advised that thev needed to evacuate North Don-n due to the fire in the Administration buildinq.
IM Stivers approved for the North Dorm inmates to be evacuated into the qrassy area beside medical after thev had been
restrained. Inmates from the North Dorm were evacuated, escorted to the qrassv area and instructed to sit down in the
grass. At approx. 2115hrs C/O Vickv Bennett went to the main qas shut off valve and cut off qas to the facilitv to prevent
an explosion. At approx. 2119hrs. Archie Moore advised that he had retrieved C/O Joann Estes. RN Carolvn McIntosh
and RN Arnetta Fuqate from medical. At approx. 2122hrs. while assistinq in escortinq inmates from the North Dorm to the
qrassv area beside medical, C/O Richie Woodward discharqed a 1 second MK9 OC Foqqer burst towards an unidentified
non-compliant inmate and accidentallv contaminated C/O Pryse and C/O Steve Turner. Also at approx. 2122hrs. C/O
Greqq Bowlinq discharqed a 1 second MK9 OC Foqqer burst into the air above the qrassv area to qain compliance from
North Dorm inmates who were standinq up and refusinq to sit down. At approx. 2123hrs a perimeter fence check was
completed and the perimeter fence was reported to be intact with no breaches. At 2124hrs. inmates were reported to be
breakinq windows out of West Dorm cells. At approx. 2130hrs. Maintenance Officer Kris Goldev was retrieved by
members of the. response team. At approx. 2134hrs, several small explosions were reported from the canteen. Followinq
the sucessful evacuation of North Dorm, several of the respondinq staff beqan to conduct the same handcuffinq process
in the South Dorm that had been used to restrain the North Dorm. It was observed bv the response team that a portion of
the South Dorm smokinq area fence had been pulled away from the around. At 2149hrs. staff advised that all dorms were
under control, all inmates were restrained and preparation for an institutional count was initiated. At 2150hrs. all staff were
accounted for. At 2153hrs an institutional count was conducted. At 2214hrs. the Fire Department arrived with thirty
members to attempt to contain the various fires. At 2241hrs, the canteen fire was reported to be under control. At approx.
2225hrs. twentv-one Eastern Kentucky Correctional CERT team members arrived at the facilitv. At approx. 2320hrs. six
Marion Adiustment Center SORT members arrived at the facilitv and at approx. 2325hrs eleven Otter Creek Correctional
SORT members arrived at the facilitv. At approx. 2327hrs. all CERT and SORT members entered the vard and beqan
assistins with escortinq the inmates from the qrassy area to West Dorm. At approx. OOOOhrs, four more Marion
Adiustment SORT members arrived to assist. At approx. 0030hrs. Manaqinq Director Melody Turner alonq with five
Metro-Davidson SORT members arrived. At approx. 0141 hrs. after all fires were under control, .all fire fiqhters exited the
facilitv and Beatvville Police Department entered the faciiitv. At 0224hrs, a second qroup of five Metro-Davidson SORT
arrived. At 0334hrs. all kevs and radios were accounted for. At 0330hrs, all inmates were secured in West Dorm. At
0337hrs. an Institutional Book (ID) Count was conducted. At 0356hrs, the Institutional Book Count was cleared. At
0348hrs, all masonrv tools were accounted for. Correctional Officer Brian Adkins was sent directlv to the local hospital by
LAC medical due to lacerations to his hand from an earlier attempt to break out a window while trapped in Operations and
was treated and released. Inmate Stratton, Jeffrev #330019 was sent to the local hospital with a broken riqht thumb and
was later admitted. Inmate Bruce, Darrell #312834 was sent to the local hospital with a lacerated left index finqer and was
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FORM 5-1A

PRIVILEGED AND CONFIDENTIAL

REVISED: 1 i101102

not admitted. Carl Brisoe received a cut to his riqht hand that did not. require
. . ^outside medical assistance. Total chemical
-_A or 570 CS Speedheat Grenades, lmunitions reported deployed bv the first arid second response team rncluae: Y- stju
CS Grenade, l- RB40 Stinqer round
luzzle
Blast
Round,
I515
Triple
Chaser
501 CS Muzzle Blast Round, 3- 502 OC N
. . .
Listed
below are the inmates who were
and several MK9 OC Foqqers. Ali chemical munitions were used OUtdoors.
placed in seqreqation from September 14, 2004 throuqh September 26. 2004 for involvement / investiqation of
involvement in the disturbance. The staff listed are those staff who were directlv involved in the initial incident I response.
Ill. inmates involved:

(Placd in I” box: W for witness or P for participant )
(Place in 2”* box: S for written statement and R for refused to give written statement)

#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#

Tavtor, Bobbv
Hurst, Joel
Moore, Samuel
Talbert. Damon
Estepp. Eddie
Mears, Jason
Porter, Gordon
Boivin, Dan
Bailev, Kenneth
Luko, Jeremiah
Francis, Randy
Inqerson, James
Stratton, Jeffery
Gillean, Scott
Russin, Jason
Landrv, Wesley
Lindsay. Isaac
Touzin, Steven
Marallo. Eric
C’Mallev, Robert
Jenninqs. Jeremy
North, James
Church, Lvnn
Bentlev, Grant
Smith, Chancev
Thompson, Willie
Baker, Grant
Howard, Kevin
Howard, Jesse
White, Cameron
Morris, Chad
Chamberlain, Michael

164811
141737
140906
159334
142001
262928
319402
330167
259330
315469
322332
330071
330019
330074
280538
330161
330125
315474
296048
330092
262927
276849
259332
305942
315944
330209
287782
127225
330121
141975
330077
330195

Staff involved: (Place in box: W for witness or P for participant)

Stivers, Donna
Frve. David
Ponds, Brvon
Moore, Archie
Atkins, Brian
Herald, Sammy
Terry, Greg
Davidson, Monica
Mullins, Nathan
Kinq, Harold
Davidson, Jason
Cox, Michael

Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title

Assistant Warden
Assistant Warden
Chief of Securitv
lnvestiqator
Correctional Officer
Correctional Officer
Correctional Officer
Correctional Officer
Captain
Captain
Correctional Officer
Correctional Officer

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FORlVi 5-1A

PRlVlLEGED AND CONFIDENTIAL

Gabbard, Andy
Woodward. Richie
Prvse, Keith
Goldv, Kris
Estes. Joann
McIntosh. Carolvn
Fuqate, Ametta
Pearson, Lisa
Lvcliter. Scott
Snowden, Kenneth
Brisoe. Carl
Brandenburq, Gary
Hobbs, Richard
Deaton. Greq
Henson, Marvin
Bowiinq. Greg
Estes. Barbara
Turner, Steve
Withers, James
Fultz. Tenv
Donva

REVISED: 12101102

^

Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title
Title

5 Yes q No

Staff involved using force:
Ponds, Brvon
Frye, David
Hobbs, Richard
Woodward. Richie
Ptyse, Keith
Deaton, Greq
Fultz. Terrv
Henson. Marvin
Moore, Archie
Bowlinq. Greqg
Withers, Harold

Justification for use of force:
q Self defense or defense of a third party
q Enforce institution rules and regulations

If yes?
Title

If planned, person authorizing: Melodv Turner

Type of Force - Check all that apply
5 Chemical Agents
q Physical Handling
q Restraint Equipment 0 Straight Batons

Enteen (Kitchen) Worker
Correctional Officer
Serqeant
Recreation Coordinator
Correctional Officer
Lieutenant
Serqeant
Correctional Officer
Correctional Officer
Records
Correctional Officer
Serqeant
Lieutenant
K-9 Unit

q YesM No

5-I C attached from all involved staff and inmates?
IV. Was force used in this incident?

Correctional Officer
Correctional Officer
Correctional Officer
Maintenance Officer
Correctional Officer
RN

q

0 Spontaneous

Planned

Manaqinq Director, Division II

Chief of Securitv
Assistant Warden
Lieutenant
Correctional Officer
Correctional Officer
Serqeant
Lieutenant
Correctional Officer
lnvestiaator
Correctional Officer
Serqeant

q
q

0 Deadly
Taser
Inflammatory Agents
[XI oc 0 oc/cs

0 Physical
0 Electronic Stun Shield
q Other S.I.M.3 - Stinqers

5 Halt destruction of property
5 Quell a disturbance

q

Prevent escape
0 O t h e r

What steps less than force were attempted? (Spontaneous, verbal command, IPC, show of force, etc.)
Numerous verbal commands bv on dutv and respondinq staff combined with show of force.

q Yes 0 No If yes, 0 Commercial q Homemade
Were weapon(s) used by inmate(s) involved?
Description of weapon(s): concrete ciqarette butt containers, 2x4 wooden rails, broomsticks, stolen box-cutters ant
other assorted makeshift weapons were used by inmates - Note: several homemade knives / homemade hatche
were stolen from the Traininq Room contraband board.
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FORM 5-1A

PRIVILEGED AND CONFIDENTIAL

REVISED: 1 Z/01/02

Current location of weapon(s): The orocess of recoverinq all weapons continues - The homemade hatchet was
recovered on September 15. 2004 followinq a search of the qrounds. Several of the homemade knives were located
in the Administration buildinq followinq a search.
V. Were all participants (staff and inmates) evaluated by medical staff?
q Yes q No
If yes, are all completed medical evaluatioris attached? 0 Yes q
No
If no, explain: Still awaitinq completion of evaluations. Some inmates were transported to other facilities prior to
medical evaluations beinq performed.
.
Did injuries occur? q Yes q No
Hospital admission?
q Yes q No
If injuries occurred, list name (employee, inmate, or civilian) and nature of injury: Brian. Adkins (Correctional Officer) lacerated hand, Briscoe. Carl (Correctional Officer) - lacerated hand, Stratton, Jeffrev (330019) - broken riqht thumb
was admitted to ithe hospital, Bruce, Darrell (312834) lacerated left index finqer
VI. Was the incident videotaped? q
Yes 0 No
Camera operator: Correctional Officer Brian Atkins, Correctional
Officer Monica Davidson and Correctional Officer Jason Davidson
If no, explain why it was not videotaped:
Were photographs of injuries, contraband, or property damage taken? q
Yes q
No
If yes, number of photographs taken? 66 photoqraphs (6 Polaroid and 60 diqital) I videos were taken bv respondinq
staff and investiqatinq staff
VII. Was there any evidence recovered during the incident? q
Yes 0 No
Was chain of custody maintained? q
Yes q
No
Description of evidence recovered: photoqraphs of concrete ciqarette butt containers, 2x4 wooden rails, broomsticks,
stolen box-cutters and other assorted makeshift weapons were used bv inmates - Note: several homemade knives /
homemade hatchet were stolen from the Traininq Room contraband board.
Current location of evidence: internal Affairs Office
Criminal charges? q
Yes [17 No Pendinq completion of the investiqation.
Staff member who recovered the evidence (include title): Various
VIII.

Inmate disciplinary charges filed?

Segregation and/or
Pre-Hearing Detention

Inmate Disciplinary Charqes Pendinq lnvestiqation

q Yes q No
q Yes q No

#

#---..

Were property inventories completed on all inmates segregated? [x1 Yes

q

No

I X . Notifications that were made:
Warden
Assistant Warden of Operations
Assistant Warden of Programs
Chief of Security
Assistant Chief of Security
Divisional Health Manager
(Death Only)
Divisional Managing Director
(Priority I & II)
Contract Monitor
Notification(s) of outside agencies:
If Yes must list agency and time

[XI Yes q No

0 N/A
Time: apDrox. 1940hrs
By: Donna Stivers
H Yes fl No 0 N/A Time: On-Site
By: m
By: Donna Stivers
ixI Yes 0 No q
N/A Time: approx. 1930hrs
q Yes q No q N/A Time: approx. 1930hrs By: Donna Stivers
By: m
B ;;; 00 F q
N/A Time: m
By: N/A
o H N/A Time: N/A
[XI

q

Yes

0

Yes

No

q

0 N/A

Time: aDprox. 1940hrs

No 0 N/A Time: 2

Duty Officer: Donna Stivers

By: David Frve
By: C/O Vicky Bennett

Name: Clarke Taylor [KY)
Kevin Oddv (VT1

By: Donna Stivers
:,y; ro~,~;5hrso N/A Time: approx. 1945hrs
RR
KDOC, Kentucky State Police, Local Police and Fire Department contact was constant throunhout incident

PREPARED BY: Archie Moore
POSITION: Facility Investiqator

DATE & TIME: September 29,2004

1200hrs

SIGNATURE:

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