If this is an emergency, please call Campus Police at 706-649-1933 or 911. Please fill out the form below. Required fields are indicated with a * symbol. Thank you.

Full Name (Optional - Form may be submitted anonymously)

First Middle Last Suffix

I am a

Email (Please provide your email address so that we can contact you if we have follow up questions about this report.)

Phone Number (Please provide your phone number so that we can contact you if we have follow up questions about this report.)

Report Type(s)*

Report Type - Other (Please briefly describe the situation you are reporting).

Individual of Concern - (Please include the individual's full name if available).

Does this individual need immediate attention?*

Yes
No

Do you believe this individual is a risk to themselves?*

Yes
No

Do you believe this individual is a risk to others?*

Yes
No

Description - Please provide as much information as possible about the situation*

Parties Involved - Please list the names of the any other individuals involved or witnesses i.e. other students, faculty or staff.

Desired Outcomes - Please provide your desired resolution/outcome for the situation.

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BIT Reporting Form

BIT Online Reporting Form

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Division of Health Sciences and Nursing

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