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Behavioral Incident Report

This Behavioral Incident Report (BIR) is designed to enable faculty, staff, and students to voluntarily report (a) actions/behaviors that may raise concerns about an individual's harm to self or others and (b) incidents of student misconduct at the University of Central Arkansas. An incident, in this context, is an event that does not warrant immediate intervention.

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

The BIR 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, therefore, provides a standardized method for recording observations of troublesome behaviors and for alerting staff of potential concerns.

CLICK HERE for Behavioral Intervention Plan

Student Involved:
Please tell us about the student involved.
 
Name:
Address:
Student ID:
Phone Number:
 
Incident Information:
Please provide a detailed description of the incident, paying particular attention to the behaviors of the student (what he/she said and did). Concrete, specific observations are most useful. Avoid providing judgments, assessments, and opinions.
 
Date of Occurrence:
Time of Occurrence:
Class/Location of incident:
Details of the incident:
Please describe communications you have had
with the student, following the incident, and any
action you have taken in response to the incident:
Names of others involved:
 
Please tell us about yourself:
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.
 
Your Name:
Your E-mail Address:
Daytime Phone Number:
Evening Phone Number:
Select one:     Student     Faculty/Staff     Other