Workplace Violence Risk Assessment Form You must have JavaScript enabled to use this form. Foip Notification Foip Information The personal information requested on this form is collected under the authority of Section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act of Alberta. It will be used for the purpose of administering the University of Lethbridge’s hazard assessment program in accordance with Alberta Occupational Health and Safety legislation. Questions about this collection can be directed to the University’s FOIP Coordinator at 4401 University Drive, Lethbridge, AB T1K 3M4; foip@uleth.ca; 403-332-4620. General Information Faculty/Unit/Department Name: Assessment Date: Name of Assessor(s): Describe the department/work area that you are assessing: Number of Employees: Physical Location: Areas you are considering as the workplace for those employees who are your responsibility: Describe the types of activities/functions performed by employees in the department: Additional Details: Risk Identification Have you considered bringing together a cross functional group to identify and assess the risks?: Yes No Have you used brainstorming techniques to identify the risks impacting your workgroup?: Yes No Identifying the Risks a. Have there been any past violent incidents? This could range from employees having experienced physical violence to verbal abuse. (i.e. being shouted at, obscene language or phone calls, threats) Yes No Please list past violent incidents: b. Are you aware of violence that happens in workplaces similar to yours? Yes No Please provide examples: c. The conditions in which the work is done may increase the risk of employees encountering violence. Are there: employees working alone before, during and/or after regular working hours? (working alone is defined as when a person is working both out of sight and out of hearing of other employees) employees working with money or other valuable items? employees traveling for work to higher risk areas? (examples: remote locations, etc) potential issues with the physical location of the workplace and its layout? specific times when the risk could be higher; i.e.: evaluation, exams? employees delivering or collecting items of value? Other * Please check all conditions that apply. Please explain: Additional Details: d. The interactions that happen during work may increase the risk of employees encountering violence. Are employees: dealing with people under the influence of drugs and alcohol? dealing with people who are deeply troubled or distressed? dealing with people in difficult and emotionally charged situations? exercising control over others, or acting in a security function? monitoring or regulating the activity of others or carrying out procedures/making decisions that adversely affect others? involved in activities that may elicit a negative or confrontational response? Other * Please check all interactions that apply. Please explain: Additional Details: Describe each of the activities and/or features of the workplace that you believe may trigger violence and describe how frequently it happens: Risk Management Risk Management Information Risk management includes the things you are doing to reduce the probability of the violence risk that it will happen and mitigate the impact if it does. All of the significant risks identified and assessed (the red and orange ones) must be appropriately managed in order to comply with Occupational Health and Safety requirements. You must prepare and include in your report a violence prevention plan that covers each of the significant risks.Consider the following when preparing the violence prevention plan:Policies and proceduresClarity and effectiveness of emergency responsePhysical security measures (Crime Prevention Through Environmental Design, access controls systems, electronic and natural surveillance, and physical barriers.Regular training sessionsThe management activities should be monitored to ensure effectiveness. This assessment process should be repeated every five years unless a significant change creates new or increased risk in your area and before then and a copy of the final assessment report must be forwarded to Campus Safety. Based on the responses given to the assessment, please answer the following: Do you feel that all reasonable steps and precautions have been taken to prevent or to reduce the risk of violence occurring within the department/workplace? Yes No What additional steps would you recommend or suggest?: What type of assistance would be required to successfully accomplish the above steps?: Print Button
