If you are concerned about the welfare of a student you can use this form to report your concerns. The form can be used by staff, students, friends or family.

This form is not reviewed outside of normal business hours, including bank holidays and closure periods. If you consider the situation to be an emergency, ie. someone is at immediate risk or harm, please contact Security on your campus.

The University will keep information you submit in confidence in accordance with data protection legislation. However, we may need to take specific actions based on the submitted information to protect the health and welfare of the University community. Although the Behaviour Intervention Team strives to ensure the privacy of reporters and other involved parties, we cannot guarantee confidentiality.

Reporting a concern

Please tick below the relevant box(es)	Behavioural concern Alcohol/drug use Harassment Mental health issue Physical endangerment/threat of violence Self-harm concern
Student involved Please provide as much information as possible identifying the student(s) of concern, eg. name, address, email address, department and phone number.
Date/time incidence(s) occurred (if applicable)
Witness(es)
Description Please provide a brief, factual explanation of your concern or observation, including location.
Reporter section (optional)
Please note that due to data protection legislation, we may not be able to notify you of any outcome following your submission of this report. However, please be assured that all concerns are followed up.
Name
Email address
Contact number
Do you give consent for us to share your name with the student concerned?