Behavioral Incident Report
This Behavioral Incident Report is designed to enable faculty, staff and students to voluntarily report “red flag” behaviors that may raise concerns and incidents of student misconduct at Black Hawk 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 911.
The Behavioral Incident Report will provide a mechanism for responding to individual incidents and will reveal patterns of disruptive behavior of specific students. It will also provide aggregate data on the nature and frequency of disruptions at Black Hawk College. This report provides a standardized method for recording observations of troublesome behaviors and for alerting staff of potential concerns. In accordance with the Black Hawk College Student Code of Conduct, information provided in the Behavioral Incident Report may also be considered in determining appropriate disciplinary action with students.
Student of concern’s information:
Please enter as much information as possible.
Student ID #:
Date of incident:
Date form completed:
Time of incident (approximate):
Location of incident:
QC Campus/Outreach Center/Adult Learning Center/The Villas
EC Campus/Community Ed Center/Prairie Pointe Apartments
For example: Building Number, Class Name or Number, Class Subject, Parking Lot Location, Apartment Number, etc.
Name(s) of others involved or witnesses:
Please provide a detailed description of the incident, paying particular attention to the behaviors of the student:
Concrete, specific observations are most useful. Avoid providing judgments, assessments and opinions.
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.
Name of person reporting incident:
Are you a:
Other (Please explain below.)