Record a Suicide

  • Instructions

    Please note that all fields marked with an asterisk (*) are required to provide relevant and accurate reporting. These fields are not confidential in that they will be used for reporting purposes. For instance, it will be reported the number of males and females who have died by suicide, the number of states with the highest suicide rates, etc.

    Items without asterisks are not required. If provided, this information is strictly confidential and will not be disclosed without prior consent.

    If you wish to report the name of the officer you may, this will help with the vetting process but will be kept confidential. At no time will this piece of information be shared without your permission. This is not required for reporting purposes.

    Note: Contact information for the person reporting is requested so that we may ensure the information is accurate and reliable. We will not contact you unless absolutely necessary.


  • We would like to send a condolence card and/or a care package to the family to let them know they are not alone. If you think this is appropriate, please let us know the following:

    - To whom are we sending the package - widow/er, parents, siblings, children, etc.

    - If we are sending to a spouse and the children, please tell us the gender and age of the children so we can customize.

    - Mailing address

    We can also send to you for delivery to the family, just let us know
  • Gunfire, overdose, etc.
  • Would you like your loved one to be honored on our page?
  • By submitting your photo, you are giving Blue H.E.L.P. explicit permission to use the photo on our website and facebook page. Blue H.E.L.P. assumes that you have authority to grant permission to use the photo. If you have questions about photo use, please note that in the text field above and we will contact you via e-mail.
  • Your contact information

    We will only contact you if there is something pressing that we feel we need to ask. For instance, if a future study requires more information. Otherwise, we will not contact you in any way.
  • This field is for validation purposes and should be left unchanged.