Dd Form 2713 - Prisoner Observation Report
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1REPORT DATE (YYYYMMDD)
PRISONER OBSERVATION REPORT
1. NAME
2. REGISTRATION NUMBER
(Last, First, Middle)
3. CUSTODY LEVEL
4. HOUSING UNIT/DORM
5. CELL BLOCk
6. DETAIL
7. CELL #/BUNK #
8. OBSERVATION
a. TYPE OF OBSERVATION:
FAVORABLE
UNFAVORABLE
INJURY
BEHAVIOR
b. DATE (YYYYMMDD)
c. TIME
d. LOCATION
e. WAS THE PRISONER NOTIFIED ABOUT THIS REPORT?
YES
NO
9. OBSERVATION REPORTED BY
a. NAME (Last, First, Middle)
b. GRADE
c. TITLE
d. DATE (YYYYMMDD)
10. WITNESS
a. NAME (Last, First, Middle)
b. GRADE
c. TITLE
d. DATE (YYYYMMDD)
11. OBSERVATION SUMMARY (Give an in-depth description of the observation; include all necessary information, provide attachment if
necessary):
12. SIGNATURE OF REPORTING PERSON
b. DATE (YYYYMMDD)
13. WAS IMMEDIATE MEDICAL ATTENTION NEEDED?
b. DATE (YYYYMMDD)
c. TIME
YES
NO
d. DESCRIBE ANY IMMEDIATE MEDICAL ATTENTION GIVEN:
14. OBSERVATION REPORTED TO
a. SUPERVISOR NAME (Last, First, Middle Initial)
b. DATE (YYYYMMDD)
c. TIME
15. ACTIONS OF CORRECTIONS SUPERVISOR:
16. ACTIONS OF REVIEWING AUTHORITY:
17. CORRECTIONAL FACILITY/BRIG COMMANDER OR DESIGNEE REVIEW
a. NAME, GRADE, TITLE
b. SIGNATURE
c. DATE (YYYYMMDD)
DD FORM 2713, MAR 2013
PREVIOUS EDITION IS OBSOLETE.
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