OREGON DEPARTMENT OF CORRECTIONS
Unusual Incident Report

r!?5l 2Ct () V{ G()OIS

UIR#:

Referred to State Police:

~Yes

DNo

State Police Case #: -!.:10"--o"'02::o6"'0c..c72"----_ _ _ _ _ _ _ _ _ _ _ _ _ _ __

-

Location-

Health Services

:"nFi',i!!i'!, ':"i!!!:!i'';';:':'i)'::,!:!!

'\il'irii,'iii,"i',,!,

Date:

°1120/10

Tiino:

4:00 5:00 a.m.

Medical Attention Required:
Functional Unitiinstitution-

Dyes

~No

OSP

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'tm-clt"
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C ;: -n lea ors:
ve :'~-!!::':':,!i'I'h-i'!n!.i-i!"::!!i
i

Use afForce

<Specify>

Inmate Assault

<Specify>

Escape

<Specify>

Contraband

<Specify>

Inmate Death

Apparent Natural Cause

Property

<Specify>

Medical Emergency

<Specify>

Emergency

<Specify>

Self Injury

<Specify>

<Specify>

Type afForce Used:

Attempted Suicide

<Specify>

EmployeeNolnoteer/
Contractor/Citizen

Blood and/or Bodily Fluid

<Specify>

Other:

i:"

"~I'

<Specify>

Staff Assault

(OR)

°

<Specify>

!~!Ti;:::~~f~~l,;:i't:\:i :;l;!J!J[;'n,~§"~~~!;:J!: !
",Location, iL (r!iIDformation:

I. Iacob, Stefan

15168617

Life

I.

2.

2.

3.

3.

4.

4.

5.

5.

Page I of2

CD i 15 (08/05)

1,:1

I' '

3. Incident: Describe Incident in detail: (Times, dates, locations, weapons involved, sequence of events, inmateslstaff involved, etc. For escapes only:
include a detailed description of the inmate(s); height, weight, color ofhair/eves, clothing last worn, and other significant info.
On 01/20/10 I received a phone call from Officer Nicholas assigned as the Infirmary Officer informing me that Inmate Iacob, Stefan 15168617 had been
pronounced dead at 4:40 am by Nurse Mark Ebner. I informed Officer Knutson to go to the Infirmary and start a crime scene log for bunk nnmber 13. I
informed Master Control to start the notifications. At 6:40 am Chief Medical Examiner Rick D. Thompson and Oregon State Police Detective Sarah M.
Fryling arrived at the Infirmary and conducted the investigation. The body was then released and was taken out of the institution at 7:57 am. All staff
involved with the unusual incident was offered ESS.

4. S ecffic Information: (personal in' ,ro e damaae, notification ofkin .
Mother: Maria Iacob, Massillon OH. Phone nnmber (330) 834-9217 Cell phone nnmber (330) 837 2304
Misconduct Issued? DYes

[glNo

5. Communicated To:

I;.,':;" '.i:i, iii'!i:',i',',',:,:,!,',','f" LUlU,I!',':',1, 'ii!!!,i,::!i,'!~':'!:,li':i.~.itl~ 'i',',!', ,'i 'i:.!i)~i~!i.!i'!;!,!!1Jiill!¢!!;!l!
';";'r:'-;
,

I. Mrs. M. Dodson
2. Mr. M. Yoder
3. Mr. J. Premo
4. State Police
5. Medical Examiner

~jPIO

cO

Asst. Supt
Super.
Dispatch
M.E

6. Mr. T. Randall

1/20/10
1120110
1/20/10
1120110
1/20110

7. Chaplin Holbrook
8.

':il"-!:-;!,i:,!;!,

N.M.
Chaplin

,:,-j

"i','i"i:"i';!.:,J ::,:.Ii.l-i'

120/10
1/20/10

'-iSS'",,S.;l, \0.

9.
10.

6. Report Completed By:
James M. Taylor
Print Full Name

Lieutenant
Title

'Signature

01120110
Date

Page 2 of2

Security/OIC 1st shift
Functional Unit

.........

CD US (08/05)

Oregon Department of Corrections (ODOC)
Offender Information System (OIS) Report
Produced by TAYLORJA 01/20/2010 05:02:39 AM

Mission: To promote public safety
by holding offenders accountable
for their actions and reducing the
risk of future criminal behavior

, - - - - - - - - - - - - - - - - - - - - Public Information
A Public Records request is REQUIRED for releasing information outside the Public information box.
Offender Name:

IACOB, STEFAN

Age:

44

DOB:

Sex;

Male

06/25/1965

Race:

White

Height: 5' 11"

Hair:

Brown

Weight: 200

Eyes:

Hazel

Caseload: 001 06 BUCHHOLZ,MARSHALL 503-373-1665
SID: 15168617

OREGON STATE PENITENTIARY
Location: Cell: IN-13
Flag: D';'ainer/Notifler
Status: InmateO
DNA Coliecled

Custody Cycle:
Institution Admission Date

1-1-6
09/16/2004

Earliest Release Date:

life
4

Classification:

031215/01

CLAC

MURDER

UF

Inmate

09/1612004

Life

031215/02

CLAC

BURGLARY I

AF

Inmate

09/1612004

000-055-000

Page 1 of 1

Offender SID: 15168617 Name: IACOS, STEFAN

r..~:~jl>~ , .....~.~, ;j~j~ir:~l'J~I~tl~,ut':l~C!:: iil'1~ .$::'(....":!1er.r:"«iI1~~.!ar.i'.:1!t~b!!.I?nS-'tlgll(J ~t"4.'D~rr.lld,e~t!o:'is ..; Tt'I~":ir!oon3t~~;.,.t'(!~!!.1';d~~:J~ =t';~ad, enC/or ~U?'pm'~c;Jau;:<mdl!: Intendlld fer "ppropriatc and <ltlp:o~p';f use under eXisting department rul(ls,
t"1"'~1r-c~ .... ··..".OtP~!lr.i!I) ";!.,'I':1{:~.mU2.1:1?I~r·'iiQ'.o;i,~~~~~C'<",..i:I~A~~i!c.:ImT~;:'"Ils>Gt.OJnv:r~'" ~t."·.';r..::o;~tt<,.::t,.." DOC 2"r.:r.'ir:ii•.-j.....'o/.'!-.!lro!l::hf,JWt!r.lrY.ll·:C:"'!1f~lilTtt~L~ Md .pn:'I::'.~~tdl!~trc~,·tt:'l i'1lomlo1Jon .:;nj"l~'or .:!orot~ Ih... dOCUr.ll!!"» in(ormolJon from vo\.lr computer "'ystcm.

OPS5011
TAYLORJA

Corrections lntormation systems
Offender Public Information

4:42:52
1/20/10

Offender .. 15168617 lACOB, STEFAN
Location .. OSP
OREGON STATE PENITENTIARY
Age
Sex
Height
Weight

44
Male
5'11 11
2001bs

DOB
6/25/1965
Race WHITE
Hair BROWN
Eyes HAZEL

Caseload 00106 BUCHHOLZ,MARSHALL
Classification 4
--Court Case
Cnty ORS Abbrev CIs
031215/01
CLAC MURDER
UF
031215/02
CLAC BURG I
AF

Status. Inmate
Cell. IN-13
DOC cycles. 01-01-06
DNA Collected
lnst admission date ... 09/16/2004
Earliest release date. Life

503-373-1665

*DESIGNATOR*
MurderMin=Y
Type Begin Date Yrs-Mos-Days Term Date & Code
I
9/16/2004 Life
I
9/16/2004 000-055-000

Bottoj11
F3=Exit
F11=Menu bar

F4=Prompt
F12=Cancel

F5=Refresh
F6=PTA Case load
F17=A11 offenses

F9=Retrieve

+
STATE OF OREGON
DEPARTMENT OF CORRECTIONS
INTEROFFICE MEMO

DA1'E:.January 20, 2010
TO: U. J. Taylor O.I.C 1st shift
FROM: C/O. T. Nicholas

On 01-20-2010 I was the assigned infirmary officer, at
approximately 0440hrs infirmary orderly Kelley, Casey
#16370345 told me that it appeared that inmate Iacob #
15168617 may have passed away, I immediately secured the area
with crime scene tape and walted for officer Knutson to take
over the crime scene log. At approximately 0450hrs R.N Mark
Ebner pronounced inmate Iacobb dead.

fi1.M'~

STATE OF OREGON
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

DATE:

January 20, 2010

TO:

00 Michael Yoder
Oregon State Penitentiary

FROM:

C/O L. Knutson
Oregon State Penitentiary

SUBJECT:

In Custody Death of Inmate Iacob, Stefan #15168617

INTEROFFICE MEMO

On 1/20/2010, at 4:45am, I was assigned to the Oregon State Penitentiary as an extra
staff. At this time orc Lt. Taylor instructed me to start a crime scene log in the infirmary. Upon
my arrival at 4:48am I was informed by infirmary Officer T. Nicholas that I/M Iacob, Stefan SID#
15168617 had expired. C/O Nicholas proceeded to secure bed #13. All notifications were made
by C/O Nicholas. I ensured crime scene security until the arrival of the Medical Examiner and
Oregon State Police. At 6:40am Rick D. Thompson, Chief Medical Examiner, and Sarah M. Fryling,
Oregon State Police Detective arrived at the crime scene. They conducted their investigation, and
released the inmate at 6:55am. I notified C/O Nicholas and Lt. Richards that the body had been
released. Master Control, Cpl. Lara was notified and the body was moved to side room #6 until
the arrival of the MortiCian. I remained with the body until it was released to the Mortuary at
7:57am.

cc:

File

osp Health Services
UrHl~wl!

Enddent Nl!r~il1g Form
For SecurIty Report

Date:

Time:

lAcon, STEFAN
Inmate: 15168617
- 06-25-65

SID #:

----------------

The Inmate named abpye was seen by a nurse for examination of possible
/VIedical Issues9- IvJental Health Issues 0
Post Altercation D
In the Clinic

¥es 0

No 0

In General Population

Yes 0

No 0

Yes~

No 0

Injuries Noted

Yes 0

No 0

Medical Treatment Indicated

Yes 0

No 0

Significant IvJedical Treatment

Yes 0

No 0

Requiring Infirmary Care

Yes 0

No 0

Requiring Hospitalization

Yes 0

No 0

In Special Housing

("'l'>(!.'" ""a~/)

The following was found:

L? ~aa.5e.J.
Medical Staff Name:

/.'I,,/!: c6# t /

V

Signature:

fvl~/

This form needs to be filled out immediately after an evaluation of an inmate and
provided to the Officer-in-Charge (OlC) when incidents arise, e.g., post altercation, use
of force, death, PREA, medical emergency.

P:OSP Forms/Inmate

Oregon Department of Corrections

***Crime Scene Contamination Log***
Crime Scene.security Officer:
Location:

C;b t!-r",c< J:;,,,f.s,,~

OS(J:r"trp..,-,! &,J,# /J'

Daterrime Log Started: /- r90 c .90/0

c~,ivJ'r 6.<11..

Cril1)e:::2j,

Victim:.Z'AC<26.

0'1.- 'f 8

ste£~ .... 4- r:n("U,I?

,,*** NOTICE: ALL PERSONS ENTERING CRIME SCENE MUST READ AND SIGN ***.,1(
Admitting officer will fill out all spaces except the signature of entering person.

Only persons authorized by (m Oregon State Police supervisor, or detective in charge, shall be
permitted to enter the crime scene. Those persons may be required to give hair, fiber, 01' other
types o/samples.

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7

CD 1201 D (1/96)

Department of Corrections
Oregon State Penitentiary
Inmate Death Notification Sheet
Date:

I/';).b/(o
I
I

Time:

'-t: 'f 1.0

A.M.

OIC:

L-L Io.if( 6 r

Use Offender Information Screen, Print Public Information Screen.
1. Assign staff, Name:
D\!~. k",~\-.",..,,,,
ini tiate a Crime Scene ontantl.nal.OnLog.
2. Preserve all Evidence,
3. Witness list (Do not interview)

Time

Name of person
contacted:

Paged:

0.0.

Time
Contacted:

'-I: 5'lb AM Y;.q to AI"" .

I'V1 e. .V,.., A-e/

to secure the scene and

Comments:
1:U\",,::-'>t~ IWt ~. "", ..1'r '~\\\

~ Lr.\lw-- ,wl, '.~l,-q,-\-I'I\~.

"'S'lo~

'"

,
Asst. Supt. Security
M. Yoder·
S~""" '"'" ... (,4"<!.

£{:

s t, tl.,oI(. V: <£(.,

t\ "'1'

Superintendent:

Superintendent will determine

J. Premo

:5 : di)i\.~.

5' :c9"C,4.U\.

Asst. Dl.r. Instl.tutions

if additional notifications
beyond the intt~tu~~ nerd t~ib
be made. D\I~":~8~·".~:.~
~ii. '~;t;
To be notified before the State

Police are notified.

B. Belleque - Jan, May, Sep
M. Gower - Feb, Jun, Oct
B. Hoefel - Mar, Jul, Nov
S. Blacketter - Apr, Aug,
Dec

Unusual Incident Briefing
Summary Requested: Yes

No

Notify for attempted suicide
P.LO.
Michelle Dodson

S :5'6A.J\'\

.; ~ '5 "b tA ,1\.\ •

""~ O.d~.... 'S<>,.~ "?k ..... :1I (0,;:1-0, I\'
,1\""'1-:
O~r. I''''~,1;'p.'
~ EOL
Cd"''''', \10\1
liJ",
.~li.
/.b"
\~
I

Sta te Police

If;5'~AI<o\ l[:-5 ( A.I\.\·

~03- ~15' -~'5H
DOC. Carom. Manager:

Case

it

...... _

I o.o:;,"'o1~

After hours call home first
Unusual Incident Briefing
Summary Requested: Yes

Medical~ixaminer:

il.h

eTS Manager

--rt..."", rn~""

OSp3

-S : 6(0 ,A,I"\'
Suicide

Brian Walker

Notify for

Heal th Servioes:
T. Randall

'-;: 5 1> ;''''' Lf "5' 'b ,A., "'" •

Chapl~~I~Ne~~ of Kin:

(\\ a ,ll.

t~

1M It.. 'lOa.. <

No

~nmate

medicaL

transport after normal business
hours

6' :';;>IA.""

Funeral Home Duty Call Calendar
Alternative Burial and Cremation of Oregon, Sherwood, Or. 503-925-8685

Person Contacted:

Completed By:

E:+4e~ / k4,\..Vy(o..,

CI-' G.' t6J..t)

Time:

c::':;;;!3.A,M.