School Counselor Crisis Intervention Report
Date
Time
Student Name
Grade/Year
Student ID
Location of Incident
Referred by
Crisis Description
Type of Crisis
Emotional
Behavioral
Suicidal Ideation
Harm to Others
Trauma
Other
Describe the Crisis Situation
Immediate Actions Taken
People Notified (e.g., parent, admin, authorities)
Follow-Up Plan
Recommendations
Follow-Up Date
Additional Notes