If a student is in crisis and answers "Yes" to any of the following three 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? If any of the questions above answer "Yes" please fill use the following form: Student Information Student Name Age Gender College Year _ Freshman Sophomore Junior Senior Incident Details Date of Incident Time Location Nature of the Incident Student made 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 Notes: Information about the 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 the person used to hurt him/herself? Were there any secondary means involved (alcohol, drugs, medication)? What were they??