Suicide Concern Report Form
Important note: The Suicide Concern Reports are not reviewed after-hours, on the weekends, or during university holidays or breaks. If you consider the situation to be an emergency, please contact 911 to report your concerns.Central Washington University takes all concerns for student health and safety seriously. Appropriate support and outreach to students at risk of suicide can be provided when information is reported quickly and clearly. When a Suicide Concern Report is submitted, CWU professionals with the Office of Case Management (OCM) and Student Counseling Services (SCS) review the information provided and initiate timely outreach to the student. In the outreach, the student is provided with resources and is invited to follow up with a Case Manager or SCS Counselor to receive personalized support and assistance. Type of outreach and number of contact attempts are dependent on the student’s risk level and response as assessed by OCM staff.
Any concerned party can complete CWU’s Suicide Concern Report form. Once submitted, reporting parties should see a confirmation message that the report is in process. Reports are sent to staff with the Office of Case Management and with Student Counseling Services and reviewed the next business day. Outreach to the student (or facility if hospitalized) is initiated that day. Reporting parties who include their contact information will receive confirmation of general staff outreach plans by OCM staff. Additional information is not typically shared with reporting parties, however any follow up questions or concerns can be directed to the Office of Case Management by calling 509-963-1515 (FERPA restrictions & considerations apply).
Please describe all suicide-related behaviors for the student you are concerned about in the report below. Suicide-related behaviors can include:
- Direct statements regarding desire to die or die by suicide
- Implied or indirect statements about a desire to die (e.g., others would be better off if I were dead;
I’m only a burden on others; no one would miss me if I were dead; I wouldn’t mind if a car hit me; etc.)
- Direct or indirect statements can be communicated verbally, in writing (class assignments, email, text, etc.)
or through social media posts
- Behavior that shows a reckless disregard for the person’s own health and safety and could reasonable result
in significant injury or death (e.g., intentionally driving in a very reckless manner, walking at night in the
cold not properly dressed, excessive use of substances – prescribed or recreational, self-injury near vital areas
of the body, etc.)
- Actions or near-actions (started but stopped before carrying through) that were done with the intent/desire to
die by suicide
Other information related to the student’s circumstances (recent stress factors, losses, or general concerns) are also helpful to include. If additional information is available but you are unclear if it should be submitted in writing, please include a statement below so that staff can contact you to collect any other details to inform outreach/response plans before actual contact with the student is made.
IF YOU HAVE REASON TO BELIEVE A STUDENT IS AT IMMINENT RISK OF HARM TO SELF, PLEASE FIRST CALL 911 TO REPORT YOUR CONCERNS BEFORE COMPLETING THIS REPORT. Completion of this report in addition to contacting emergency response informs and prompts CWU staff to follow up with students post-crisis to provide additional support.
