If a student is in crisis and answers yes to any of the following 3 questions, call 911 or campus safety at 459-5151 to transport them to a hospital. 

Do you have a plan to harm yourself or someone else?

Do you have the means?

Have you set a day/time?

Otherwise fill out the following:

Student Name __________________________________________________     Age _____ Gender _____ College Year _____

Date of Incident___________________________________     Time ___________

Location ______________________________________________________________

1.  Nature of the incident:

Student make a statement indicating suicidal thoughts or a threat to harm self or others, but did not take action

Student attempted to harm him/herself or another

Student died of apparent suicide

2.  Information about Threat

Describe the events leading up to and surrounding the threat:

What was the nature of the threat?  To whom was it made?  Was it verbal or written?  What was communicated?

Did the person have a plan?  If so, what was it?  Was there a secondary plan?  What was it?

What was the primary means that t e person used to hurt him/herself?

Were there any secondary means involved (alcohol, drugs, medication)?  What?

Submit this form to Paul Bennion, Dean of Students, pbennion@collegeofidaho.edu