FormsStaffHealth/Safety → Suicide Risk Reporting Form

Suicide Risk Reporting Form

About this Form

Form number: 335-54

Audience:  School Staff

Last revised: August 2017

Related Forms

Form 270-1 - Summary of Parent Conference

Form 336-32 - Authorization for Release/Exchange of Confidential Information

Form 560-10 - Crisis Center Referral Information

Under Maryland law, MCPS staff members have a legal duty to act when they suspect a student’s suicidal intent.

This law has two essential elements: 
Intervene: MCPS staff have a duty to use reasonable means to attempt to prevent a suicide when they are on a notice of a student’s suicidal intent.
Parent/Guardian Notification: MCPS staff are required to warn parents/guardians of any suicide threat, including secondhand information, even when the student denies the threat.

Please complete all items on the form before the end of the school day. Indicate date and time when each step occurred. Some steps are mandatory.

Adobe PDF Suicide Risk Reporting Form129 KEnglish
Adobe PDF Formulario para Reportar Riesgo de Suicidio470 KSpanish
Adobe PDF Formulaire pour Signaler le Risque Suicidaire70 KFrench
Adobe PDF Đơn Báo Cáo Nguy Cơ Tự Vận493 KVietnamese
Adobe PDF 自殺風險報告表702 KChinese
Adobe PDF 자살 위험 보고 양식481 KKorean
Adobe PDF ራስን የመግደል ጥርጣሬ ሪፖርት የሚደረግበት ቅጽ79 KAmharic

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat