Templates
Cal/OSHA workplace violence template

Cal/OSHA workplace violence template

Create an organized, compliant plan to meet California’s workplace violence prevention requirements. Document incidents and response actions clearly with this template.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
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Cal/OSHA workplace violence template

Create an organized, compliant plan to meet California’s workplace violence prevention requirements. Document incidents and response actions clearly with this template.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

This Cal/OSHA workplace violence template aids you in meeting California’s SB 553 requirements with a comprehensive risk assessment framework. You’ll document potential violence hazards, evaluate existing prevention measures, and develop an effective response plan.

Research rom ASIS International found that 14% of companies have no comprehensive plan for active-assailant incidents and no intention of creating one, while another 25% lack a plan but want to develop one. This template guides you through identifying workplace-specific risks and implementing appropriate controls, helping you avoid potential penalties while creating a safer work environment.

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Preview of the template
Entity
Page 1
Workplace Violence Risk Assessment
Describe the potential for violence in your workplace
Have there been any violent incidents in the past year?
If yes, provide details on the type and frequency of incidents
Do you have a process for employees to report concerns about workplace violence?
Describe the reporting process and how it is communicated to employees
Workplace Violence Prevention Measures
Do you have a written workplace violence prevention policy?
Describe the key elements of your workplace violence prevention policy
Have you provided training to employees on workplace violence prevention?
If yes, describe the training content and who receives it
Do you have security measures in place to prevent workplace violence?
Describe the security measures you have implemented
Workplace Violence Response Plan
Do you have a plan for responding to workplace violence incidents?
Describe the key elements of your workplace violence response plan
Have you provided training to employees on the response plan?
If yes, describe the training content and who receives it
Do you have a process for investigating workplace violence incidents?
Describe your incident investigation process

Frequently asked questions

What information should I include when documenting past violent incidents in my workplace?

Focus on factual details without personal identifiers: date, location, type of violence (customer, employee, stranger), any weapons involved, and resulting actions taken. Include patterns or common factors across incidents. This information helps identify prevention opportunities and demonstrates your commitment to analyzing trends for your Cal OSHA plan.

What should my workplace violence response plan include to meet Cal OSHA requirements?

Your response plan should outline immediate actions during an incident (evacuation routes, shelter locations, communication protocols), notification procedures, medical response, and post-incident support. Cal OSHA expects plans to be workplace-specific and practiced regularly. Use this template to document these elements and how you’ve communicated them to all employees.

How should I involve employees in completing this workplace violence assessment?

Gather input through safety committee meetings, anonymous surveys, or direct interviews about perceived threats and security concerns. Document this involvement directly in the template. Cal OSHA specifically requires employee participation in plan development, so note how worker feedback shaped your prevention strategies and how you’ve communicated the final plan back to them.

How can this template help me prioritize workplace violence prevention measures?

Use the assessment sections to score risk factors based on likelihood and potential severity. This helps identify your most urgent vulnerabilities first. Cal OSHA expects employers to address the most serious hazards promptly. By documenting both existing controls and planned improvements in this template, you create an action plan that demonstrates your commitment to continuous safety improvement.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.