• Incident Report
  • Student Incident Report Form

    If you feel a student is a threat to themselves and/or the college community, you can refer the student to the Student Behavioral Intervention Team (SBIT) by completing this form and clicking the "Submit Form" button at the bottom of the page.

     

    First Name:         Last Name:         
    Department:        E-mail Address:  
    Phone Number:    
     

     

     

    Incident Information: Student(s) 
    First Name:                    Last Name:

    ID Number if known:     
    First Name:                    Last Name:

    ID Number if known:     
    First Name:                    Last Name:

    ID Number if known:     
    Incident Date:             [None] Select a Date Delete the Date 
    Incident Location:          Incident Time:  
    Did incident happen during classroom / in the library / lobby / cafeteria / other?
     
    Any Witnesses? (students, employee, others)
     
    Level of Concern For The Student:     
    Relationship to Students:                
     
    If Other: (explain)                               

     

    Tell Us More: 
    Behavior:           

    Other: (explain)  
    Speech:            

    Other: (explain)  
    Mood:              

    Other: (explain)  
    Thought:            

    Other: (explain)  
    Appearance:     

    Other: (explain)  
    Judgment:        

    Other: (explain)  
    Classroom:         
    Participation:      
    Personal:           
    Do you believe this student is at risk for harming him/herself?
                 
    Do you believe this student is at risk for harming others?
                   

    Have you reported these concerns to anyone on campus?

                                               
    If “Yes”, to whom did you report these concerns and when?
     
    Have you spoken to the student about these concerns?
                                                 
    If “Yes”, please describe how the conversation went. Incidents Detail/additional comments:
     

     

     

LaGuardia Community College LaGuardia Community College 31-10 Thomson Ave. Long Island City, NY 11101 LaGuardia Community College 1-718-482-7200 LaGuardia Community College Map & Directions
Copyright © All Rights Reserved