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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.

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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 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

Track and document workplace violence incidents with this digital log template. Designed for HR professionals and safety managers, this form goes beyond basic incident recording by capturing detailed information about perpetrators, victims, emergency responses, and preventive recommendations.

For example, if customer confrontations escalate to threats against staff, you can record all relevant details for both internal investigation and potential legal proceedings. The US Centers for Disease Control and Prevention (CDC) reports that workplace violence affects thousands of workers every year, with healthcare workers experiencing trauma at six times the rate of other industries.

Related categories

  • Health and safety management templates
  • General templates
  • Incident management templates
Preview of the template
Entity
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.

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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

How can I use this workplace violence incident log to prevent future incidents?

Use the completed logs to identify patterns in location, timing, or circumstances where violence occurs. Review the “Contributing Factors” and “Lessons Learned” sections across multiple incidents to spot recurring issues. The “Corrective Actions” field helps track implemented solutions and their effectiveness. Regular analysis of these logs enables you to develop targeted prevention strategies, adjust security measures, and enhance training programs where most needed.

When should I complete this workplace violence incident log template?

Complete the log as soon as possible after an incident occurs, ideally within 24 hours when details are fresh in everyone’s mind. Even if you don’t have all information immediately, start the documentation process and update it as more facts become available. For serious incidents requiring immediate medical attention or police involvement, prioritize those responses first, then complete the log once the situation is stabilized.

Who should be responsible for filling out the workplace violence incident log in my organization?

The responsibility typically falls to the direct supervisor of the affected area, the safety manager, or an HR representative who was notified about the incident. Some organizations designate a workplace violence response team member to ensure consistent documentation. Regardless of who completes it, ensure they’ve been trained on proper documentation practices and understand the importance of factual, comprehensive reporting.

How do I determine if an incident qualifies as “workplace violence” for this log?

An incident qualifies as workplace violence if it involves any threatening behavior, verbal abuse, physical assault, or property damage that occurs in the workplace or is work-related. This includes threats, intimidation, harassment, assaults, or other actions that create fear or concern for personal safety. When in doubt, document the incident—it’s better to have too much documentation than too little when analyzing workplace safety trends.


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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