Behavioral Incident Report Form

This Behavioral Incident Report Form (BIR) is designed to enable faculty, staff, and students to voluntarily report:

1.    Actions that are highly disruptive and may be intimidating or threatening to others.

2.    Behaviors that indicate harm to oneself, such as suicidal thoughts or self-infliction of injuries.

Examples include: threats to act out violently; fascination with weapons; loud, disruptive rants; other students are fearful of the student; highly agitated or unable to control temper; hallucinations; and diminished self-care.

The BIR should NOT be used for routine conduct matters or student misconduct, such as pulled fire alarms, fights, idle threats, or visitation violations.

In the event of an emergency that requires immediate intervention, call 9-1-1.

The BIR form will provide a mechanism for responding to individual incidents, reveal patterns of disruptive behavior of specific students, and provide aggregate data on the nature/frequency of disruptions at UCA. The BIR form, therefore, provides a standardized method for recording observations of troublesome behaviors and for alerting staff of potential concerns.

CLICK HERE for Behavioral Intervention Plan

CLICK HERE to submit a Behavioral Intervention Report Form (BIR)