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Workplace violence restraining order form

A Workplace Violence Restraining Order Form is used to protect an individual from another person who has threatened or committed acts of violence against them. The form is typically used in situations where an individual feels threatened by another person in their workplace.

2 minutes to complete

Eligibility

If you are an employee, you are eligible to fill out a Workplace violence restraining order form if you were subjected to violence at work or if you have a reasonable belief that you will become a victim of violence at work.

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Questions for Workplace violence restraining order form

Questions

1.

What is your name?

The answer should be a text input.
2.

What is your current address?

The answer should be a text input.
3.

What is your current phone number?

The answer should be a phone number.
4.

What is your date of birth?

The answer should be a date input.
5.

Are you currently employed?

The answer should be a single choice:
  1. Yes
  2. No
6.

If yes, where do you work?

The answer should be a text input.
7.

What is your job title?

The answer should be a text input.
8.

What are your job duties?

The answer should be a text input.
9.

Have you ever been the victim of workplace violence?

The answer should be a single choice:
  1. Yes
  2. No
10.

If yes, please describe the incident(s).

The answer should be a text input.
11.

Have you ever been the perpetrator of workplace violence?

The answer should be a single choice:
  1. Yes
  2. No
12.

If yes, please describe the incident(s).

The answer should be a text input.
13.

Do you have any history of violence outside of the workplace?

The answer should be a single choice:
  1. Yes
  2. No
14.

If yes, please describe the incident(s).

The answer should be a text input.

Forms Similar to Workplace violence restraining order form

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Here are some FAQs and additional information
on Workplace violence restraining order form

What is workplace violence restraining order?

A workplace violence restraining order is a civil order that protects you from someone who has threatened or harmed you at work. The order requires the person to stay away from you and your workplace and to not contact you.

How do I get a workplace violence restraining order?

You can get a workplace violence restraining order by filing a petition with the court.

What do I need to show the court to get a workplace violence restraining order?

To get a workplace violence restraining order, you must show the court that: • the person has threatened or harmed you at work; • you are afraid of the person; and • you need the order to be safe.

How long does a workplace violence restraining order last?

A workplace violence restraining order can last up to three years.

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