FREE 7+ Violent Incident Report Forms in PDF | MS Word

Verbal abuse, vandalism, and physical assaults are some of the common types of workplace violence that some employees and staff do in their offices and assigned working areas. In order to record these violent actions, a witness or the assaulted and harassed employee must complete a document to report the incident known as a violent incident report form.

Violent Incident Report Form Sample

What Is a Violent Incident Report Form?

Violent incident report forms should only be used by an employee who has been violently harassed or abused in the workplace or on the premises of the company. The form can be used along with other documents such as accident report forms and accident incident investigation forms. Additionally, the form will also help the company in strategizing of how the concerns will be appropriately addressed and what accommodations will be needed by the harassed employee including medical examinations and mental health counseling sessions.

Employee Violent Incident Report Form

Benefits of Using Violent Incident Report Forms in the Workplace

Aside from determining who the harasser or the person who showed violent acts to the employees of the company is, the form also helps in promoting awareness in the company. When an employee submits a completed violent incident report form, the company will be able to register and record the type of incident as well as acknowledge the frequency that the same incident occurred within a specific period or a year. The statistical data that the company will obtain from the report forms will be used for planning the company’s safety measures and protocols improvement in minimizing similar cases and issues for the succeeding years.

Threat Violence Incident Reporting Form

Also, violent incident report forms are useful especially for the investigators that the company will hire for solving and naming the harasser. This is due to the range of information disclosed on the form provided by the reporting employee. However, the details and descriptions given by one employee may be different from what other employees knew, which is why it is important to collect witness statements from every employee known to be present during the incident. The witnesses can also use the report forms for them to be able to jot down every bit of the incident’s particulars.

Workplace Violence Incident Report Form

Varieties of Violent Incident Report Forms

Violent incident report forms only have a few varieties that differ on what the main subject or type of violent action category will be described in the form. Below are three of the most used varieties of violent incident report forms:

Harassment Violence Incident Reporting Form – A certification statement is what makes this violent incident report form unique from all other documents with similar titles and purposes. The significance of having a certification statement filled out and signed by the user of the form is to mainly indicate that the user has provided the data and entries on the form with the best of his knowledge. Also, the certification implies the willingness of the user to cooperate with any procedures that the company will be taking. On the other hand, if the user of the form is a minor, then the company must require his legal guardian to sign the form.

Harassment Violence Incident Reporting Form

School Employee Violent Incident Report Form – Violence and threats can occur in any workplace establishment including an educational institution’s faculty office and premises. For this, a school employee violent incident report form is the appropriate document to use by anyone who wants to report the actions of a school staff, faculty member, or any employee. The form also has a section for knowing what the institution does to follow up the parties involved regarding the aftermath of the incident in their individual well-being as well as in their health.

School Employee Violent Incident Report Form

Work Related Violence Abuse Incident Report Form – This variety of violent incident report form has an enclosed document that centers on the follow-up procedure of the company. The follow-up includes whether the company has notified their safety and security personnel about the incident or if a program has been prepared for the traumatized victims and witnesses, and if the company has communicated with the victim regarding how he is managing and doing in his counseling and duties at work. Additionally, the date of when the communication was conducted is also essential to be disclosed in the form to achieve a thorough documentation.

Workplace Violence Incident Report Form in DOC

How to Create a Violent Incident Report Form

When creating a violent incident report form, the company representative must assure to keep in mind the types of data and information that must be catered on the form. With this, the steps below will guide any company toward creating their own violent incident report forms that are effective and can be used by any employee who is a victim or a witness of a workplace violence incident:

Step 1: Make an area for the personal details of the user of the form.

The user of the form can be a mere witness or someone who was able to communicate with the harassed employee, which is why it is important to have an area where the user’s identification will be disclosed. This area of the form must be able to collect the user’s first and last name, job position in the company, relationship with the harassed employee, as well as his contact information and residential addresses. Some companies will also require the user to state his electronic mailing address in order for him to receive notice forms electronically about the updates of the report.

Step 2: Allocate a section for the injured person’s details and the nature of his injury.

The name, age, contact number, and the employment information of the injured or harassed employee must be indicated in this section. Additionally, the nature of the injury of whether it is a burn, scratch, cut, or bruise must be described along with its injury level or degree.

Step 3: Create an incident information section.

The date and time of when the incident occurred, the location and a sketch or diagram of what the witness saw if the witness is the user of the form, as well as the type of incident where a violent action was seen should be described in this section of the form. Moreover, the events that lead to the harasser’s violent actions must also be narrated in detail in this section along with the description of how the properties in the company were damaged and destroyed.

Step 4: Add a harasser’s background information section.

This refers to the frequency of the harasser’s actions in his period of employment in the company of whether the harasser has been previously involved as a harasser of the same situation before or if the harasser has been a victim of a workplace incident. Other inclusions to be considered disclosing as part of the background information of the harasser are the criminal records and behavior assessment results of the harasser. By acknowledging the harasser’s history, the company will not only be able to provide a solution for the victim and witnesses but also for the harasser as well such as treatments and special assignments that can help the harasser in becoming a better employee and person who values his morals.

Step 5: Have an area where the actions taken by the company will be enlisted.

Ranging from the actions of the company’s representative of calling the security personnel of the establishment up to the act of providing first aid treatment to the injured victim must be listed in this section. This is to identify and determine if the authorized employees of the company were informed about the company’s protocols when it comes to handling accidents and emergency situations.

Step 6: Make a table for naming the witnesses.

The list of witnesses and their personal contact numbers are useful for allowing the company in gathering more information about the incident.

Step 7: Allocate a blank space for the evaluation and assessments of the human resource department of the company.

The company’s plans and strategies for ensuring that the concerns of the victim will be met and that the incident will not occur again are the matters to be discussed in this section. However, the company management must not create decisions by themselves since they must also involve the victim of how they will be able to obtain a resolution. One of the most common requests of a victim demands the harasser to be presented with an employment contract termination. Nevertheless, the company must weigh the options to ensure that they are effectively addressing the issue.

Work Related Violence Abuse Incident Report Form

With the aforementioned steps of creating the report form, the human resource department of the company will be able to have an assurance that they will be collecting sufficient details and information that will help them pave a path toward a resolution. Nevertheless, other documents and forms, as well as materials that can be a piece of evidence or proof for the claims of the parties involved in the incident, must also be enclosed with the form such as photographs and video clips of the interaction between the victim and the harasser in the company’s premises.