This Behavioral Incident Report is designed to enable faculty, staff and students to voluntarily report concerning behaviors that may raise concerns about incidents of emotional well being or of student misconduct at South Suburban College. An incident, in this context, is an event that does not warrant immediate intervention. In the event of an emergency or crisis situation that requires immediate intervention, call SSC Campus Police at (708) 596-2000, ext. 2235.
The Behavioral Incident Report will provide a mechanism for responding to individual incidents and will reveal patterns of disruptive behavior or concerns about specific students. It will also provide aggregate data on the nature and frequency of disruptions at South Suburban College. This report provides a standardized method for recording observations of troublesome behaviors and for alerting staff of potential concerns. In accordance with the South Suburban College Student Code of Conduct, information provided in the Behavioral Incident Report may also be considered in determining appropriate disciplinary action with students.
Date of Incident:
Time of Incident:
Class/Location of Incident:
*Name of Person Reporting Incident:
Are you a(n):
Name(s) of others involved or witnesses:
Please provide a detailed description of the incident, paying particular attention to the behaviors of the students. Concrete, specific observations are most useful.
Please describe conversations you have had with the student and any action you have taken regarding this incident:
* Individuals are allowed to make anonymous reports, however, if a name is not provided it may hamper the team's ability to seek follow-up information that may be critical in determining an appropriate course of action. If a name is provided, the team will provide feedback regarding actions taken.
* Please note that false reports may result in disciplinary action.
Source: Adapted from Lake Land College Behavioral Incident Form
Keywords: Threat Assessment, Forms, Student Threat & Safety