HTML Preview Simple Behavior Incident Report page number 1.
Behavioral Incident Report
This form should be used by faculty, staff and students to voluntarily report “red flag behaviors”, incidents, or situations that
pose, or may reasonably pose, a threat to the safety and well-being of the campus community. An incident, in this context, is an
event that does not warrant immediate intervention. In an event that requires immediate intervention, call 911 or Campus
Police - 281 756-3700. This report will provide a mechanism for responding to individual incidents and to reveal patterns of
disruptive behavior of specific students/employees. The report provides a standardized method for recording observations of
troublesome behaviors and of alerting staff of potential concerns. In accordance with the Alvin Community College Student
Code of Conduct, information provided may also be used to determine appropriate disciplinary action with the individual.
Provide the following information about the person whose behavior is being reported (please enter
as much information as possible).
Name: Student ID#
Address: Phone:
Incident Information:
Date of Incident: Date form completed:
Class/Location of incident: Time of incident (approximate):
*Name of person reporting incident:
Phone: Email address:
Are you a □ student □ employee □ other (please explain):
Name(s) of others involved:
Please provide a detailed description of the incident, paying particular attention to the behaviors of the student/employee.
Concrete, specific observations are most useful. Avoid providing judgments, assessments and opinions:
Please describe conversations you have had with the student/employee and any action you have taken regarding this
incident:
This form is located on G: drive in the FORMS folder.
Please submit completed form to ACC Campus Police, the Dean of Students or Human Resources.
*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 as appropriate.
Form obtained through “Best Practice”, provided by Lakeland College 7/13