Templates
Workplace violence incident report form

Workplace violence incident report form

This customizable template gives you a clear and organized way to document workplace violence incidents. Use it to capture key details and take action.

Use this template
or download pdf
Workplace violence incident report form

This customizable template gives you a clear and organized way to document workplace violence incidents. Use it to capture key details and take action.

Use this template
or download pdf

About the Workplace violence incident report form

Workplace violence can disrupt teams and pose serious safety concerns—and it’s important to document them meticulously to address them and prevent them from happening again. This workplace violence incident report is your go-to tool for capturing critical details quickly and accurately so your team can take consistent action. Whether you’re an HR team member or a safety officer, this template helps you standardize reporting, streamline follow-ups, and create a safer, more accountable workplace.

A step-by-step guide to using the workplace violence incident report form

Here’s how you can use this template to streamline the reporting process:

  1. Customize the template for your workplace. Tailor the report to fit your company’s policies or specific industry needs. You can edit sections in the app, such as adding extra fields for shift times or incident categories relevant to your business.
  2. Record the incident details immediately. Encourage team members to document incidents as soon as they happen. Use the mobile app to enter essential details like time, location, and the type of incident.
  3. Describe actions taken and any injuries sustained. Be thorough when noting any injuries, emotional impacts, or immediate steps taken to address the situation. This can include medical treatment provided, emergency measures, or de-escalation techniques used.
  4. Assign follow-up tasks if needed. After submission, use the app to assign action tasks like scheduling meetings, counseling, or updating safety protocols. This ensures accountability and keeps post-incident resolutions organized.
  5. Analyze data for trends and improvement. Regularly review completed reports to identify patterns or recurring issues. The template’s analytics feature helps you spot trends and make informed decisions to improve workplace safety and prevent future incidents.

Best practices for using the workplace violence incident report form

To improve accuracy and effectiveness, you can follow these best practices.

Record details as soon as possible after the incident occurs. Prompt documentation is critical to capturing the incident while memories are fresh and facts are clear. Encourage employees to use the template immediately, noting specifics like the time, location, and individuals involved.

Review completed reports for patterns. A single report is valuable, but trends across multiple incidents provide deeper insights. Use the collected data to identify repeat behaviors, high-risk areas, or recurring perpetrators. These patterns can inform proactive measures, such as policy changes or training sessions.

Include all relevant information, no matter how minor it seems. Even small details, such as body language or overheard remarks, could prove significant later. Make sure reports describe actions factually and in as much detail as possible.

Streamline reporting with Lumiform’s tools today

Keeping track of workplace incidents doesn’t have to be complicated. With this template, you’ll have a clear, structured way to document incidents accurately and consistently. From logging incident details to assigning follow-ups, the template is designed to help you act fast and stay organized.

Related categories

Preview of the template
Page 1
Incident Details
Date of Incident
Time of Incident
geolocation!!!
Type of Incident
Provide a detailed description of the incident, including any actions taken and injuries sustained.
Victim Information
Name of Victim
Job Title of Victim
Department of Victim
Describe any physical or emotional injuries sustained by the victim.
Medical Treatment Provided
Perpetrator Information
Name of Perpetrator (if known)
Relationship to Victim
Perpetrator's Actions
Weapons Involved
Reporting Information
Name of Person Reporting Incident
Job Title of Person Reporting
Date Reported
Time Reported
Describe any immediate actions taken in response to the incident.
Law Enforcement Notified

Frequently asked questions

What are examples of workplace violence?

Workplace violence includes a wide range of behaviors, from verbal threats and harassment to physical assaults and even stalking. Examples include an employee yelling threats during a disagreement, a customer physically assaulting a staff member, or repeated unwanted contact outside of work hours.

How can I encourage employees to report workplace violence incidents without fear?

Create a culture of openness by letting employees know that the company will take all reports seriously and get treated confidentially. Offer anonymous reporting options, such as an online form or suggestion box. Reassure employees that you won’t tolerate retaliation, and emphasize that reporting incidents contributes to a safer workplace.

What steps can I take to maintain confidentiality in incident reporting?

Limit access to incident reports to only those who need to know, like HR personnel. Use secure systems for collecting and storing reports, whether digital or physical. Avoid discussing details in open spaces, and when interviewing individuals, choose private locations to protect their privacy.

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.