JCPS Threat Assessment and Response Protocol Form
JCPS Threat Assessment and Response Protocol Form
Affiliation: Administrator Teacher Staff Student Parent/Guardian Status: Current Former Prospective
School: Building/Program:
Home Phone:
Address:
INCIDENT:
Date Day of Week: Monday Tuesday Wednesday Thursday Time: _________ AM
Occurred: Friday Saturday Sunday PM
Location: School Property [In School Building School Grounds] School Bus School Sponsored Activity Other:
Threat Assault [Physical Sexual) Threat Suspicious Stalking Suicidal/Self-Harm Bomb threat
Type:
Unusual Communication Vandalism Disruptive Harassment Involuntary MH hold Other:
Mode: In Person Phone Text Email Letter Social Media Internet Other : Multiple Modes
Target(s) injured: Yes No Unknown Target(s) require medical attention? Yes No Unknown
Weapon involved: Yes No Unknown Type of Weapon: Firearm [ Rifle/Shotgun Pistol] Edged Bomb Other:
Details of the incident or threat. Where threats were communicated, quote where possible, use quotation marks to indicated direct quotes. Attach original
communications if available.
PART II. PERSONS INVOLVED
SUBJECT (1) Engaging in threatening, aberrant or concerning behavior:
Name: Unknown ID #:
Affiliation: Administrator Teacher Staff Student Parent/Guardian Status: Current Former Prospective
School: Building/Program:
Emergency Relationship:
Contact:
Home Phone:
Address:
What exactly did you say? And what exactly did you do?
How do you think he/she feels about what you said or did?
What are you going to do now that you have made this threat?
Additional notes:
Note: If more than one subject(s) of concern in this incident, attach additional copies of this page with subject’s information.
TARGET (1): Potential Victim (if identified)
Name: Unknown ID #:
Affiliation: Administrator Teacher Staff Student Parent/Guardian Status: Current Former Prospective
Grade:_______________(if student)
Contractor Other:_______________________________ None/Unknown
School: Building/Program:
Emergency Relationship:
Contact:
Home Phone:
Address:
Affiliation: Administrator Teacher Staff Student Parent/Guardian Status: Current Former Prospective
Grade:_______________(if student)
Contractor Other:_______________________________ None/Unknown
School: Building/Program:
Emergency Relationship:
Contact:
Home Phone:
Address:
WITNESS (1)
Name: Unknown ID #:
Affiliation: Administrator Teacher Staff Student Parent/Guardian Status: Current Former Prospective
Grade:_______________(if student)
Contractor Other:_______________________________ None/Unknown
School: Building/Program:
Emergency Relationship:
Contact:
Home Phone:
Address:
Witness Interview
What exactly happened when you were [place of incident]?
ENVIRONMENT Notes
Organizational climate concerns: e.g., bullying, bias, poor conflict mgmt.. Yes No Unknown
Chaotic or inconsistent structure Yes No Unknown
Lack of support, guidance or resources Yes No Unknown
High rates of violence, harassment, disruption, injury or harm Yes No Unknown
High perceived stress Yes No Unknown
Disproportionate rate/severity of concerns Yes No Unknown
Other: Yes No Unknown
ADDITIONAL QUESTIONS
1. What are the subject’s motives, grievances, goals and intent in their behavior?
2. Have there been any communications suggesting ideas, intent, planning or preparation for violence?
3. Has the subject shown inappropriate interest in/identification with: If yes, describe:
Incidents or perpetrators of targeted/mass violence
Grievances of perpetrators
Weapons/tactics of perpetrators
Notoriety or fame of perpetrators
4. Does the subject have (or are they developing) the capacity and will to carry out an act If yes, describe:
of targeted violence?
Expressed ideas to engage in violence
Made plans for violence
Preparing for violence (means, method, opportunity, access)
Surveillance, stalking or rehearsal
5. Is the subject experiencing or expressing hopelessness, desperation, and/or despair?
6. Does the subject have a positive, trusting, sustained relationship with at least one responsible person?
7. Does the subject see violence as an acceptable, desirable – or the only – way to solve a problem?
8. Are the subject’s conversation and “story” consistent with his or her actions?
9. Are other people concerned about the subject’s potential for violence?
The threat assessment is designed to identify and assess risks in a deliberate and thorough manner. In determining response
strategies to mitigate the risk and to provide assistance, as needed, it is helpful to classify threats by level. Based on the
information collected, the threat assessment team may classify threats using the following basic criteria:
Transient (Low risk threat)* individual/situation does not appear to pose a threat of violence or serious harm to self/others,
and any exhibited issues/concerns can be resolved easily. Key components of this threat level include:
• Non-genuine expression
• Non-sustainable intent to harm
• Temporary feelings of anger
• Tactic in argument
• Intended as joke or figure of speech
• Resolved on scene or office (time-limited)
• Conflict is resolved and ends with apology, retraction, or clarification
*WHEN IN DOUBT, consider threat as substantive and assess further
Serious Substantive (Moderate risk)** threat person/situation does not appear to pose a threat of violence, or serious
harm to self/others, at this time; but exhibits behaviors that indicate a continuing intent and potential for future violence or
serious harm to self/others; and/or exhibits other concerning behavior that requires intervention. This type may also
involve instances of threats to assault. Key components of a this threat level include:
• Specific, plausible details such as a specific victim, time, place, and method
• Threat has been repeated over time or related to multiple persons
• Threat is reported as a plan or planning has taken place
• Recruitment of accomplices or invitation for an audience
• Physical evidence of intent to carry out threat (e.g., lists, drawings, written plan)
• Involves a threat to assault
**Factors to consider in which substantive threats are more likely: Age of student, credibility of account, or
documented history of aggression
Critical Substantive (High risk threat)*** A high risk threat is one in which the person/situation appears to pose a threat of
violence, exhibiting behaviors that indicate both a continuing intent to harm and efforts to acquire the capacity to carry out
the plan; and may also exhibit other concerning behavior that require intervention. This would include threats to kill, rape,
or inflict severe injury or involves the use of weapons. Key components of a this threat level include:
• Specific, plausible details such as a specific victim, time, place, and method
• Threat has been repeated over time or related to multiple persons
• Threat is reported as a plan or planning has taken place
• Recruitment of accomplices or invitation for an audience
• Physical evidence of intent to carry out threat (e.g., lists, drawings, written plan)
• Threat to kill, rape, or inflict severe injury or involves the use of weapons
***Factors to consider in which substantive threats are more likely: Age of student, credibility of account, or
documented history of aggression
PART V. CASE MANAGEMENT INTERVENTIONS & SAFETY RESPONSE
Complete the checklist and corresponding intervention template to develop a specific safety, intervention, and case
management plan for the threat.
Transient Threat
Required Responses:
Contact student’s parents
Administer due process if applicable
See that threat is resolved through explanation, apology, or making amends
Follow discipline procedures outlined in SSBIH
Caution the subject about the consequences of carrying out the threat
Consult School Threat Assessment Team / Maintain threat assessment protocol documentation if applicable If ECE, Review BIP and FBA
If ECE, Review BIP and FBA
If ECE, Schedule ARC as necessary
Notify JCPS Bullying Prevention if applicable
Document event in IC
Allegations of sex and gender-based discrimination, harassment, and violence and/or retaliation must be reported to the Title IX Coordinator
Optional Responses:
Serious Threat
Required Responses
Administer due process if applicable
Mobilize threat assessment team
Provide direct supervision of subject
Document event in IC
Follow discipline procedures outlined in the SSBIH
If ECE, Review BIP and FBA
Call JCPS Communication regarding Notification of School Community (parents, etc.) with direction from assistant superintendent
Notify JCPS Security and Investigations and complete Threat Assessment Matrix
Refer to BCBA or BEST Team Member
Critical Threat
Required Responses:
Mobilize threat assessment team
Notify subject/threat actor & parents and/or guardians
Provide direct supervision of subject until parents, law enforcement and/or guardians assume control
Caution the subject about the consequences of carrying out the threat
If enrolled at treatment facility or juvenile facility, attempt to identify release date
Monitor social media
Develop contingency plan if student is absent from school
If ECE, Review BIP and FBA
If ECE, Schedule ARC as necessary
Document event in IC
Notify JCPS Student Relations
Notify JCPS Security and Investigations
Optional Responses:
Notify law enforcement
Target/Victim Interventions:
PART VI. THREAT ASSESSMENT UPDATE (to be updated regularly while case is active)
This section should be completed by the Team Leader, or others, as appropriate.
Actions with potential target(s) of the threat or students impacted by the threat:
Offered supportive counseling? Yes No Provided brief supportive counseling? Provided Declined
Altered schedule to minimize contact with subject who made the threat? Yes No
Advised targets(s) and/or parent(s) or guardian(s) of their right to contact police? Yes No
Name of staff member who provided this information: Date and Time:
Name of staff member who will monitor target: Date and Time:
Additional Comments:
Actions with Subject making the threat:
List any additional behaviors that have occurred since the original threat:
Develop/Update Functional Behavioral Assessment and/or Behavior Intervention Plan for IEP? Yes No
Informed target(s) and parent(s) or guardian(s) of updated/changes to plan? Yes No N/A Date and Time:
List additional changes or recommendations to the original threat assessment response and intervention plan:
Print name of Team Leader: ____________________________________ Date: __________________
(Signature indicates agreement with identified level of threat and the above actions have been taken.)