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Faculty or Staff Threat Reporting Form

If you believe a person may pose a threat of imminent danger to him/herself or to others, call 911 and then contact the Office of Public Safety at 410.337.6112.

Identify the person about whom you are concerned

	His or Her First Name*

	His or Her Last Name*

	His or Her Department

	His or Her Email Address

	His or Her Phone Number

	How do you know this person?

Identify yourself

By identifying yourself, the Threat Assessment Team will be able to more fully investigate and respond to your concerns. Without your identifying information, we may not have enough information to address the situation you have described. Anonymous reports will be pursued, but the ability of the Threat Assessment Team to respond may be limited. Thank you for your referral.

	Your First Name

	Your Last Name

	Your Email Address

	Your Phone Number

Nature of Report

Please provide as much information as you can.

	Primary Nature*

	Date of Incident

	Description of Concern or Incident*

Observations of Appearance or Behavior

Grooming/Hygiene:


	Changes for the worse


	Change of weight


	Unkempt appearance


	Odor

Emotional Signs of Distress:


	Tearfulness/crying


	Extreme mood swings


	Shows no emotions


	Seems to be seeing or hearing things

Physical Signs of Distress:


	Bruising


	Burns or cuts


	Frequent injuries


	Slurring words

Behavior in the Workplace


	Often absent


	Worsening performance


	Often at odds with others or picks fights

	Other Observations of Appearance or Behavior

General Observations

	Issues reported or issues known to you (If a person appears ready to harm themselves or others, please immediately call 911 and report.)

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