University of South Carolina Lancaster
Behavioral Intervention Team
Incident Report

All information shared with the BIT will be held
in strict confidentiality.
If this is an emergency situation, do not complete this form.
Instead, immediately call 911 or 9-911 (if on campus) and
identify the location of the incident.

Student about whom the report is being made:
Last 4 digits of SSN ID (if available):
Student's E-mail Address (if available):
Date of Incident (mm/dd/yyyy):
Time of Incident (hh:mm AM/PM):
Location of Incident:
May we contact you regarding this incident if further information is necessary? Yes     No


In the space below, please provide as much detail as you can about the incident as well as any other information that you feel may be important.

Call (803) 313-7120 with any additional questions.



Last Updated: 04/07/10