close
lumiform
Lumiform Mobile audits & inspections
Get App Get App

Workplace Harassment and Violence Risk Assessment Checklist Template

This workplace harassment and violence risk assessment checklist template is just one example that you will need to customize to meet your organization's needs using Lumiform's form builder. As an employer, you may need to assess other workplace conditions with specific hazards that are not included in this checklist.


The designated employer representative must conduct this assessment in collaboration with the appropriate partner in the company, such as the policy committee. If there is no such committee, the employer representative must conduct the assessment in conjunction with the workplace committee or health and safety representative.


Together, they should repeat the assessment within the time frame required by law. Alternatively, they must conduct workplace threat risk assessments whenever risk factors within the organization change and require re-assessment.


Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Register for free on lumiformapp.com and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra

Workplace Harassment and Violence Risk Assessment Checklist Template

General Information

Name

Site Name

Date

Indicate with a checkmark if this is the initial assessment or a reassessment. Indicate when you conducted the last assessment (if applicable) and when you are planning to conduct the next assessment.

Initial Assessment Date

Reassessment Date

Previous Assessment Date

Next Planned Reassessment Date

Information to Answer the Questions

Answer each question in the workplace risk assessment based on its content. For example, when you read the 39 questions below, ask yourself the following: 1. Do I have it? a. If Yes (I do have it), do I need to review it? i. if Yes (I need to review it), and do I need to modify it? 1. if Yes (I need to modify it), then describe the existing controls and list any action items. 2. if No (I do not need to modify it), then no further action is required. ii. if No (I do not need to review it), then no further action is required. b. If No (I do not have it), do I need to develop one? i. if Yes (I need to develop one), then describe the existing controls and/or list any action items. ii. if No (I do not need to develop one), then no further action is required.

Prevention Policy

Does the employer have a policy addressing workplace harassment and violence, including sexual harassment and domestic violence, containing all elements required by the Work Place Harassment and Violence Prevention Regulations (the Regulations) that is readily available to all employees?

Does the employer communicate to its employees the contents of the harassment and violence prevention policy?

Does the employer ensure by policy and in practice that there is no disciplinary or punitive action against an employee for filing a notice of an occurrence of harassment and violence?

Does the employer require by policy and/or practice that employees report any occurrences of harassment and violence in the workplace?

Emergency Procedures

Does the employer have readily available emergency procedures to address an occurrence that poses or threatens to pose an immediate danger to the health and safety of an employee (for example, a bomb threat, riot, highjack, active shooter, armed threat, robbery, employee distress/ threat of self-harm)?

Training

Are all management and non-management employees trained on the prevention of all forms of workplace harassment and violence, including harassment and violence based on the prohibited grounds under the Canadian Human Rights Act?

Are employers and designated recipients trained on responding to occurrences of harassment and violence?

Are all management and non-management employees trained on civility and respect in the workplace?

Are all management and non-management employees provided training on how to recognize the difference between workplace conflict and harassment and violence?

Are all management employees provided training on how to coach and mitigate workplace conflict that may become harassment and violence, if left unmanaged?

Resolution Process

Does the employer ensure by policy and/or practice that notices of occurrences of harassment and violence can be submitted anonymously?

Does the employer have a designated recipient that has received training before assuming their duties under the Regulations?

Are there alternative avenues for submitting a notice of an occurrence of harassment and violence when the designated recipient is the principal or responding party in the occurrence?

Does the employer respond to all notices of occurrences of harassment and violence?

Does the employer have a formal process to inquire into occurrences of harassment and violence that happen outside of the workplace (for example, cyberbullying outside of work hours)?

Is there a process in place to make the option of conciliation available?

Are the investigators appointed to harassment and violence investigations chosen in accordance with the Regulations?

Physical Work Environment

Is the workplace located in a low-crime area?

Is public access to the workplace restricted?

Are access doors locked or secured after hours?

Is video surveillance and/or security services used to monitor entrances, exits and the surroundings of the workplace?

Is there adequate lighting at all times (or at least during working hours) inside and outside the workplace?

Does the employer have well-lit and secure parking lots available for its employees?

Is there a secure place (such as, a locked area or `personnel access only' area) for employees to safely store their personal belongings?

For all work-related activities occurring outside company premises or outside regular working hours, are there security protocols in place that are shared with employees to mitigate risk?

Are there processes in place to address security gaps?

Type of Work

Is the work free from handling cash and/or other valuables?

Does the work involve transporting people or goods?

Is the work free from direct (such as, in-person) contact with clients?

Are employees trained on procedures to manage angry or aggressive clients (for example, de-escalating techniques)?

Are employees trained on safety precautions to take and procedures to follow when working alone or in small numbers to protect themselves from harassment and violence?

Are employees trained on safety precautions to take and procedures to follow when going onto sites (commercial or residential) where the environment is unknown?

Are employees trained on emergency procedures to be implemented where an occurrence poses an immediate danger or there is a threat of an occurrence posing an immediate danger to the health and safety of an employee?

Psychological Protection

Do management employees receive training on their role to support psychological health?

Does the employer have internal resources available to provide support to employees who experience psychological or emotional stress stemming either from the workplace or their personal lives?

Does the employer periodically survey employees on their satisfaction with the work environment?

Are there specific preventative measures in place to protect employees when they work during times of increased psychological vulnerability, such as under high-stress conditions (for example, seasonal demands, exceptional circumstances, etc.)?

Are there clear lines of reporting to minimize conflicting demands on employees?

Share this template:

Similiar templates