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District Behavioral Intervention Team

Incident Reporting Form

Person of Concern

St. Louis Community College is committed to the safety, security, care, and welfare of its community and to ensure the environment is conducive to learning, teaching, civility, and working. In order to provide such an atmosphere, a Behavioral Intervention Team (BIT) has been created to assess potential problems with individuals that may have violated College policies and procedures or present a danger to themselves or others. In order to take this proactive approach, we ask that faculty, staff, and students who are concerned about a person and/or his/her behavior complete the Incident Reporting Form below.

Please be assured that:

  • All reports are confidential and will only be shared on a ‘need to know’ basis.
  • A copy of your report can be emailed to you. (See checkbox on form.)

The advantages of filing a report are:

  • Behaviors that are inappropriate or unusual can be identified.
  • Behaviors will be tracked to see if the behaviors/concerns are recurring.
  • A determination can be made as to whether the situation warrants immediate action or a behavioral intervention plan.
  • Immediate threats can receive immediate action.

Your support of this process is essential. Together we can help ensure a safe, supportive learning environment.


Location


Person Submitting Form


Your last name:   First name:  
Phone number:   Student
Street address:     Staff member
City, state, zip:     Visitor
Email address:     :


Person of Concern (if known)

Last name: First name:
Phone number: STLCC ID Number:
(If applicable. Example: A0123...)
Street address:
City, State, Zip:
Email address:


Other Observers

  Other people who may have observed this incident/behavior:
    Names of persons or organizations Day phone Evening phone Email
   
   
   
   
   


Reported or Observed Behavior or Incident

Date of incident:   
Time of incident: : 
Location of incident:



  Academic Dishonesty
    Cheating
    Plagiarism
 
  Behavioral Intervention Team (BIT)
    Criminal offense: alcohol, assault, drugs, property damage, theft
    Disruptive Behavior
    Threatening/Intimidating Behavior
    Unusual Behavior
    Violation of STLCC published policies/student conduct code
 
  Has this behavior been observed in the past?
   
   
   
 
  Who else has been informed of the situation?
  I have informed my department chair/coordinator/manager of my concerns
  I have informed my dean of my concerns
  I have informed campus police of my concerns
  Yes No Don't Know
 
 
  Low
  Moderate
  High
 
 
  None needed. This was meant to be informative
  I need to speak to a member of the BIT team
  Possible disciplinary action
  Other
 


INCIDENT

Please provide a detailed description of the incident/behavior using specific, concise, detailed, factual language.

Upload supporting documentation

Please do NOT use any special characters ($, &, @, #, etc.) in the files name of any attachments.
File 1:
File 2:
File 3:
 
Verification: (Enter this number in the box to the left.)