Report/Share a Concern

Behavioral Concern Report

Complete the following form to report an individual exhibiting behavior of concern seeking evaluation by the Behavioral Threat Management Team.

Note that for immediate threat of violence or substantial disruption call 911.


Individual Exhibiting Behavior of Concern

Name:
PSU ID:
(if known)
Primary Affiliation:
(choose one)
Campus:
(choose one)
Email
(if known)
Phone
(if known)
Address
(if known)

Incident/Behavior Description

Date of Incident:
Time of Incident:
Location of Incident

Please provide a detailed description of the incident(s) or situation that has caused you to file a report for possible behavioral intervention.


Person Filing Report

Name:
Telehone
Email

Human Verification


If you have an emergency, call 911.