Student/Employee Concern Report

The Behavioral Intervention Team (BIT) responds to non-immediate concerns and takes a proactive approach to discuss potential issues, intervene early, and provide support and behavioral response to students displaying varying levels of disruptive, disturbed, and/or distressed behaviors before they rise to the level of a crisis.

Name*
First Last
Date*
MM slash DD slash YYYY
What is your role at College of Alameda?*
Email Address*
Phone Number*
Student ID (if you do not have one leave blank)
Nature of this report*
Threat to self or others*
Date of Incident*
MM slash DD slash YYYY
Student or Employee*
Please provide a detailed description of the incident/concern focusing on fact, including people involved (who, what, when, where, why, and how).*
Do you want to remain anonymous?*
- Yes
- No
Please detail any action(s) that you have taken in response to this incident. If no action was taken, then type "none" in the text box below.*
Concerning Behavior (Select all that apply)*
If this claim is about discrimination or a hate crime, please select one or more of the following actual, perceived, or associated protected classes.*
Please submit any supporting documents (email, photos, videos, etc).
Drop files here or

Max. file size: 128 MB.
Acknowledgment and Submission*
I acknowledge that the information i provided in this report is accurate and truthful to the best of my knowledge.

There are NO concerning behaviors
Concerning Eating Behaviors
Disturbing Writing or Discussion
Extreme Mood Swings
Loner/few or no close friends
Physical Self Harm
Threats (Direct or Veiled)
Agressive Behavior
Dating/Domestic Violence
Disheveled Appearance
Emotional Outbursts
Missing after attempts to contact
Seeing/Hearing Things
Suicidal Remarks/Attempts
Unusual Bruises, Cuts, or Abraisions
Bizarre/Disjointed Thoughts
Depression or Extreme Sadness
Excessive Anxiety
Homelessness
Obsessively Suspicious/Paranoid
Significant Change in Appearance/Behaviors
Talking to Self
Withdrawal from Social Groups