Create

Welcome to the Behavioral Intervention Team (BIT) Referral Form

Note: If there is evidence of immediate harm to self or others, call 9-1-1 and then call Campus Security at 253-589-5682.

Your Information

Your First Name

M. I.

Last Name

Primary Phone

Other Phone

Primary Email

Other Email

Relationship to CPTC

Person of Concern's Information

Person's First Name

M. I.

Last Name

Phone

SID

Do you feel this person is displaying harmful behavior to self or others

Is this behavior an immediate danger to self or others

If the behavior is an immediate danger, please call the police at 911, and/or campus security at 253-589-5682

Incident Details

Date Occurred

Time Occurred

Location

While writing your BIT referral, it is very important to only document observable behaviors and facts in the narrative. Avoid subjective feelings, diagnostic labels, and/or derogatory information. This information could be viewed by others so please avoid inflammatory language.

Description

Urgency

Attach File 1:

Attach File 2: