Behavioral Intervention Team (BIT) Report

Reporter's Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of Report(Required):

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Please select whether this is a new report or an update of one previously submitted:

Urgency of this report(Required):

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What do you believe is the level of urgency for this report? There isn't a wrong choice.

Date of Incident(Required):

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Time of Incident:

Location of Incident(Required):

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Specific Location:

Involved Parties

Please enter as much information as possible for the student(s).

Name of Student(s)

ID Number

Question

Have you addressed your concern with the person being reported?

Yes No

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What is the approximate duration of the behavior(s) you are reporting?(Required)

Single Incident Ongoing

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If the behavior is ongoing, when was it first observed? This field is required.

In the box below, describe the individual’s behavior(s) that prompted this report. Please be as specific and detailed as possible, and refrain from using clinical or diagnostic language. BIT referrals should only include objective, observable, and factual information. We ask that you avoid labels, stereotypes, and referrals based on hearsay or assumptions. Include the name(s) of any available witness(es) who also observed the described behavior(s).(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select Copy Recipients

If you are a faculty member, please select the Dean of your academic area so that they will receive a copy of this report. If you are not a faculty member, please leave this section blank.

John Haworth, Humanities & Fine Arts

Lindsay Holland, Social & Behavioral Sciences

Chad Jaynes, Business Division

Martina Harris, Nursing & Allied Health

Tremaine Powell, Engineering & Information Technologies

Karen Eastman, Math & Sciences

Jessica Green, TCAT

Email me a copy of this report

Reporter's Information

Involved Parties

Question

Supporting Documentation

Select Copy Recipients

Submission