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Workplace violence form

This form is to be used by employers to document workplace violence incidents.

2 minutes to complete

Eligibility

The workplace violence form is open to any employee who has been a victim of workplace violence.

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Questions for Workplace violence form

Questions

1.

Have you ever experienced workplace violence, or been the victim of workplace violence?

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

If you answered yes to the previous question, please describe the incident/incidents in as much detail as possible.

The answer should be a text input.
3.

Do you feel that your workplace is generally safe, or are there safety concerns that you have?

The answer should be a text input.
4.

Have you ever witnessed workplace violence, even if you were not the victim?

The answer should be a single choice:
  1. Yes
  2. No
5.

If you answered yes to the previous question, please describe the incident/incidents in as much detail as possible.

The answer should be a text input.
6.

In your opinion, what are the root causes of workplace violence?

The answer should be a text input.
7.

What do you think could be done to reduce or prevent workplace violence?

The answer should be a text input.
8.

Do you have any other comments or suggestions regarding workplace violence?

The answer should be a text input.

Forms Similar to Workplace violence form

  • Violence in the workplace form
  • Workplace aggression form
  • Workplace bullying form
  • Harassment in the workplace form
  • Threats in the workplace form

Here are some FAQs and additional information
on Workplace violence form

What is workplace violence?

Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening behaviour that occurs at the work site. This can include but is not limited to, threats or attempts to physically harm another person, property damage, and theft.

What are some signs that someone may be a victim of workplace violence?

Some signs that someone may be a victim of workplace violence include, but are not limited to: -Unexplained absences from work -Decreased productivity -Increased absenteeism -The decreased quality of work -Increased use of sick days -Increase in accidents or errors -Difficulty concentrating -Withdrawal from co-workers or social activities -Changes in eating or sleeping habits -Unexplained weight loss or gain

What are some signs that someone may be a perpetrator of workplace violence?

Some signs that someone may be a perpetrator of workplace violence include, but are not limited to: -Making violent or threatening statements -Displaying aggressive or erratic behaviour -Making repeated personal threats -Violating workplace policies -Possessing weapons or making threats to use weapons -Stalking co-workers or other employees -Engaging in harassment or bullying

What are some steps that employers can take to prevent workplace violence?

Some steps that employers can take to prevent workplace violence include, but are not limited to: -Developing a zero-tolerance policy for workplace violence -Encouraging employees to report any incidents of workplace violence -Conducting regular training on workplace violence prevention -Creating a safe and secure work environment -Monitoring employee behaviour for warning signs of violence -Providing counselling and assistance to employees

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