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Other Incident Report Form


If you need to report an emergency, call 911 immediately. Then contact the Human Resources Office at 541-278-5850 or the Office of Student Services at 541-278-5760.

Please use this incident report form to report any behaviors of concern or incidents of safety involving Blue Mountain Community College. Reportable behaviors may include "Student Code of Conduct" violations, an individual you may feel is struggling physically or psychologically, or any other behaviors of concern that you would like to see addressed or would like to discuss. This incident report form may also be used for incidents involving personal injury or accident at the college.

When completing this form, please include your name, title, and contact information. Please note that anonymously submitted forms may limit our effectiveness in responding to the reported concern. Questions regarding filing an incident report may be directed to Human Resources or the Office of Student Services.

Background Information

 
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Email address must be of a valid format.
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Campus, Center, Building, Room/Office Number
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Select the reason for this report.
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Involved Parties

Please list the individuals involved. Include as many of the listed fields as you can provide. For non-students you may omit the Student ID#.

Involved party 1

Reason(s) for Report

Please indicate the relevant category(s) that pertain to this incident report.

Student Conduct(Required)
You must make at least one selection.
Behavioral Concern(Required)
You must make at least one selection.
Personal Safety(Required)
You must make at least one selection.
This field is required.
For Incidents Requiring Emergency Response - Select any of the following that apply:(Required)
You must make at least one selection.
Was this incident a bias related incident? The term 'bias related’ refers to language and/or behaviors which demonstrate bias against persons because of, but not limited to, others’ actual or perceived: color, disability, ethnicity, gender, gender identity and expression, national origin, race, religion, and/ or sexual orientation.(Required)
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission