BIT Incident Report - Washington Adventist University

Behavioral Intervention Team Incident Report
Student Full Name:
First Last
Last 4 digits of SSN ID (if available):
Student Email Address (if available):
Your Name:
First Last
Your Title:
Your Phone:
Your Email Address:
Date of Incident:
Date Format: MM slash DD slash YYYY
Time of Incident:

: HH

MM
Location of Incident
Please provide a detailed description of the incident using specific, concise, objective
language. Forward all documentation to the Counseling Services and/or any electronic
communication/supporting documentation to jrwillia@wau.edu. Please call x4089 with any additional questions.
Incident Details
Additional Documentation (if available)
*Note: If you are submitting additional documentation, please check with
jrwillia@wau.edu to ensure your documentation was received.