Get the free Workplace Violence Incident Report Form - NJ.gov

Health and SafetyViolent Incident Report Staff who have been subject to or witnessed a violent incident at work should complete this report as soon as possible. Upon completion, make 4 copies: 1 copy

How to fill out workplace violence incident report

How to fill out workplace violence incident report

1. To fill out a workplace violence incident report, follow these steps:
2. Begin by providing your contact information, including your name, job title, and department.
3. Identify the individuals involved in the incident, including the victim(s) and the perpetrator(s).
4. Specify the date, time, and location of the incident.
5. Write a detailed description of what occurred, including any physical, verbal, or psychological violence that took place.
6. Include any witnesses who were present during the incident and their contact information.
7. Attach any supporting evidence, such as photographs, videos, or documents related to the incident.
8. Describe any injuries or damages that resulted from the violence.
9. Indicate whether law enforcement or authorities were notified about the incident.
10. Sign and date the report to confirm its accuracy.
11. Submit the completed workplace violence incident report to the appropriate supervisor or HR department.

Who needs workplace violence incident report?

1. A workplace violence incident report is needed by employers, supervisors, and HR departments to document and address incidents of violence that occur within the workplace. It helps in investigating the incidents, implementing safety measures, and providing support to victims. Additionally, law enforcement agencies may also require these reports for legal purposes.

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What is workplace violence incident report?

A workplace violence incident report is a formal document that records incidents of violence occurring at a workplace, including details about the event, those involved, and any witnesses.

Who is required to file workplace violence incident report?

Typically, supervisors, managers, or human resources personnel are required to file workplace violence incident reports, but any employee involved in or witnessing an incident may also report it.

How to fill out workplace violence incident report?

To fill out a workplace violence incident report, gather all relevant information, including the date, time, location, a detailed description of the incident, the names of individuals involved, and any witnesses, and then complete the report form as required by your organization's policy.

What is the purpose of workplace violence incident report?

The purpose of a workplace violence incident report is to document incidents of violence for analysis, to improve workplace safety measures, and to comply with legal and regulatory requirements.

What information must be reported on workplace violence incident report?

The report must include the date and time of the incident, location, nature of the violence, description of the incident, names of individuals involved, witnesses, and any injuries sustained.