Get Workplace Violence Incident Report Form This Form Is To Be Completed By The Reporting Employees

This guide provides clear and supportive instructions for completing the Workplace Violence Incident Report Form online. By following these steps, you will ensure accurate reporting of any incidents related to workplace violence, which is essential for maintaining a safe work environment.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to acquire the form and open it in your preferred online editor.
2. Enter the date of the report in the designated field. This is the date when you are completing the form.
3. Select the day of the week when the incident occurred to provide context.
4. Fill in the date of the incident to document exactly when it took place.
5. Input the time of the incident in the provided field.
6. Complete the 'Reporting Employee' section by writing your name, job title, store/department, and work address. This identifies you as the person reporting the incident.
7. If you are not the victim, provide the victim’s name, job title, store/department, and work address in the appropriate fields.
8. For the alleged offender(s), if known, fill in their name. If unknown, provide identifying information such as approximate age and select their gender.
9. Identify the relationship of the alleged offender to the victim or reporting employee by selecting one of the options provided (e.g., co-worker, customer, etc.).
10. In the 'Details of the Incident' section, specify the type of incident that occurred to classify the nature of the violence.
11. Provide the location of the incident to clarify where it took place.
12. In the description section, detail the events that transpired during the incident to give a complete overview.
13. Indicate whether a weapon was involved in the incident and describe it if applicable.
14. Document any events that occurred immediately prior to the incident, as this context may be important.
15. Describe what happened immediately after the incident to provide a full picture of the event.
16. Include any comments from your manager in the designated area to capture their perspective on the incident.
17. Outline any measures taken to prevent reoccurrence of the incident, if applicable.
18. Indicate whether the victim or the assailant was referred to counseling, and whether the matter was reported to the police.
19. If the police were involved, provide the police report occurrence number and badge number as required.
20. Sign and date the form where indicated, ensuring all necessary parties have acknowledged the report.
21. After completing the form, save your changes, and choose to download, print, or share the form as needed.

Take the next step in ensuring workplace safety by completing your report online today.