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CARE Report Form
If you feel you or someone else is in immediate danger of an act of violence or if this is an emergency situation, do not complete this form. You may call 911 immediately or access the one-way announcement system (Dial 8801) from any BCC phone on campus to announce the situation. This report is an official communication with the College and is confidential. Be as clear as possible and only report observed facts and personal impressions when describing the behavior. Do not report things you did not see/hear or make assumptions based on other's impressions.
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* Indicates required question
Acknowledgement
*
By selecting "yes". I acknowledge that BIT is not an emergency response team
Yes
Today's date
*
MM
/
DD
/
YYYY
Pick the appropriate action
*
Information only report (no contact is needed)
Have BIT member contact me within 72 hours
Report Type
*
Please select the type of situation that you are reporting
Choose
Academic Concern
Campus Disruption
Class Disruption
Medical Concern
Mental Health Issue
Physical Well-being (e.g. food/shelter)
Safety Concern
Other
What is the student's BCC ID number (if known)?
Leave field blank if BCC ID# is unknown
Your answer
Name of Student of Interest
Enter the student's full name
Your answer
ONLY describe the person being reported if the name is unknown
Provide basic details: (example: gender, race/ethnicity, height, weight, clothes, hair length, etc.)
Your answer
Descriptive Information
*
Please provide as much information as possible about the observed behavior
Your answer
In what way(s) does this behavior concern you?
*
Your answer
Date of initial observation
*
MM
/
DD
/
YYYY
Time of initial observation
*
Time
:
AM
PM
Location of the occurrence
*
Choose
Classroom Building 1
Student Services & Continuing Education Building 2
Classroom Building 3
Law Enforcement Building 4
Maintenance Building 5
Classroom Building 6
Option 7
Learning Enhancement Center Building 8
BCC Auditorium Building 9
Essic Williams Administration Building 10
Machine Shop Building 11
Welding Shop Building 12
Electrical & Industrial Maintenance Building 13
Louis F. Parker Building 17
Lynn G. King Allied Health Building 20
Student Parking A
Student Parking B
Student Parking D
Faculty and Student Parking F
Faculty and Student Parking G
Gazebo
Other
Additional Location Information
If applicable, please provide any additional location details
Your answer
Course and Section (if applicable)
Please provide the course number and section number (e.g. CIS 110 01WA)
Your answer
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