Threat assessment reporting form: Student Concern Reporting Form Template (Free, Printable)
A free printable form for staff, students, and parents to report a concern about a student to the school threat assessment team. Based on NTAC guidance.
Use this form to get concerns about a student to your threat assessment team in a consistent way. Print it, adapt it to your district's procedures, or use it to design an online form. Replace the bracketed text with your school's details before using it.
If someone is in immediate danger, call 911 now. Then tell a school administrator. Don't wait to fill out this form.
Instructions for the reporter
Thank you for speaking up. You don't need to be sure something is wrong, and you're not getting anyone in trouble. Reports help the team make sure students get the support they need.
- Describe what you saw, heard, or read, in your own words.
- Include as much detail as you can, but don't investigate on your own.
- Return this form to [team contact name / office / email], or report at [online link or phone number].
About you (optional)
You can leave this section blank to report anonymously.
| Field | Details |
|---|---|
| Your name | |
| Your role (student, teacher, staff, parent, other) | |
| Best way to reach you | |
| May the team contact you for more information? | ☐ Yes ☐ No |
About the student
| Field | Details |
|---|---|
| Student name | |
| Grade | |
| School | |
| Other students or people involved |
What happened
| Field | Details |
|---|---|
| Date and time it happened | |
| Where it happened (classroom, hallway, bus, online, off campus) | |
| How you learned about it (saw it, heard it, someone told you, online) |
Describe what the student said, wrote, posted, or did. Use their exact words if you can.
Did it involve any of the following? Check all that apply.
- ☐ A threat to harm someone else
- ☐ Talk of suicide, self-harm, or hopelessness
- ☐ A weapon, or talk about getting or using a weapon
- ☐ Interest in past school attacks or attackers
- ☐ Bullying or harassment (by or of the student)
- ☐ A sudden change in behavior, mood, appearance, or grades
- ☐ Withdrawal or isolation from friends
- ☐ Something else that worried you
Is there evidence? (a screenshot, an assignment, a note) ☐ Yes ☐ No. If yes, describe it and where it can be found. Don't share images of weapons or explicit content with others; give them to the team.
Has anyone else seen or heard this? Who?
Is there anything else the team should know?
For team use only
| Field | Details |
|---|---|
| Received by | |
| Date and time received | |
| Immediate safety concern? | ☐ Yes (law enforcement notified at ____ ) ☐ No |
| Case number | |
| Assigned to |
Frequently asked questions
Who should fill out this form?
Anyone with a concern about a student: teachers, staff, students, parents, or community members. Make it easy to find and easy to submit.
Can reports be anonymous?
They should be able to be. NTAC recommends an anonymous option because students are more likely to report when they don't fear retribution. Leave the reporter section optional.
What if the concern is urgent?
Don't use a form. If someone is in immediate danger, call 911, then notify a school administrator right away.