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Workplace violence incident log template

Workplace violence incident log template

Document key details of a workplace violence incident with clarity. This template guides you through the key facts, people involved, actions taken, and follow-up steps.

Use this template
or download pdf
Workplace violence incident log template

Document key details of a workplace violence incident with clarity. This template guides you through the key facts, people involved, actions taken, and follow-up steps.

Use this template
or download pdf

About the Workplace violence incident log template

This workplace violence incident log template helps organizations consistently document, track, and respond to workplace incidents involving aggression or physical harm. It gives you a clear, systematic way to capture the full story: who was involved, what went down, how it was handled, and what needs to happen next. With this template, you can standardize reports and spot patterns faster before they repeat.

Streamline your incident documentation and keep records clear

This workplace violence incident log template guides every report through a reliable structure. You start with the basics, such as time, place, and people involved, then document the full incident, step by step. Nothing gets skipped, and no one has to guess what’s needed.

You can use the template to clearly separate details about the victim, perpetrator, and response actions. This makes reviews faster and patterns easier to track over time.

It’s available as a PDF, but you can also use it right on the Lumiform app so your team can fill it out right on-site, assign follow-ups, and export records instantly. This kind of structure also supports your legal documentation and compliance processes.

How to use the workplace violence incident log template

This step-by-step approach helps you take immediate action and maintain accurate records with the template:

  1. Customize the template to fit your environment. Start by tailoring the fields to your workplace setup. You can add specific job roles, location types, or contributing factors relevant to your company. Using Lumiform, it takes just minutes to edit and adapt the template in the app.
  2. Assign the template to the responsible person. Give clear ownership. Usually, this will be your site manager, safety officer, or HR lead—someone trained to gather incident details calmly and thoroughly.
  3. Fill it out immediately after an incident. Encourage staff to document while the situation is still fresh. The template helps the assigned person walk through the report systematically, from time and location to actions taken and follow-up steps.
  4. Attach photos and evidence directly in-app. Use the photo and text fields to upload any visual proof or documentation. This strengthens the record and helps future reviews.
  5. Track responses and spot trends. Review logs regularly to analyze recurring issues, areas of risk, or policy gaps. Lumiform’s dashboard lets you visualize patterns and supports your next safety steps.

Standardize how your team reports incidents

Download this template to put a reliable process in place for documenting workplace violence. It provides you with a definite structure your team can follow every time. From roles and timelines to injuries and follow-up actions, each report stays consistent and complete. Assign it to managers or team leads and make reviewing incidents more efficient.

Related categories

  • Health and safety management templates
  • General templates
  • Incident management templates
Preview of the template
entity_item!!!
Page 1
Incident Details
Date of Incident
Time of Incident
Location of Incident
Involved Parties
Incident Description
Perpetrator Information
Perpetrator Name
Perpetrator Role
Perpetrator Gender
Perpetrator Age
Perpetrator Relationship to Victim
Victim Information
Victim Name
Victim Role
Victim Gender
Victim Age
Victim Injuries
Incident Response
Was Emergency Response Called?
What Actions were Taken?
Was the Incident Reported to Authorities?
Was the Incident Reported Internally?
What Follow-up Actions are Planned?
Incident Assessment
Was this Incident Preventable?
What Factors Contributed to the Incident?
What Lessons were Learned?
What Corrective Actions are Recommended?

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

How to write an incident report: Your complete guideIncident management: A deep diveBehavior based safety: Your guide for improving workplace safety
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Template collections

See comprehensive collections of best practice templates related to this topic.

7 best free workplace violence prevention plan templates4 free workplace incident report templates6 must-use employee incident report templates for free
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Use cases

Check out how the Lumiform software can be utilized for related use cases.

Risk assessment softwareIncident management softwareIncident report softwareSafety Incident Reporting Software
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Other resources

Explore all the additional resources we offer to assist you in mastering this topic.

5 types of incident reports4 benefits of safety management and how to communicate themThe importance of personal protective equipment (PPE) in workplace safetyBridging the gap: How Lumiform connects managers and frontline teams

Frequently asked questions

Who is responsible for completing the incident log?

It’s usually the supervisor or safety lead on duty, but make sure this responsibility is clearly assigned in advance. You don’t want confusion when an incident occurs. Some companies even train select staff on how to write detailed, unbiased reports. Giving that person immediate access to the template makes a big difference, whether on their phone or as a printed copy.

Can you use workplace violence logs in legal cases?

Yes, they often are. Accurate, timely logs provide essential documentation in claims, lawsuits, or investigations. Be factual and avoid emotional language. Include dates, witness statements, and any physical evidence like photos or messages. A well-kept log can show a pattern of behavior or prove that your company took timely action.

How do you encourage employees to report incidents?

Make it clear that all reports are taken seriously and handled confidentially. You might also want to offer anonymous reporting options. If people see that action is actually taken when reports come in, they’re more likely to speak up. Train staff on when and how to use the log, even if they’re not the ones filling it out.


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.
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