Workplace Violence Risk Assessment Form

Foip Notification

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
Risk Identification
Have you considered bringing together a cross functional group to identify and assess the risks?:
Have you used brainstorming techniques to identify the risks impacting your workgroup?:
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)
b. Are you aware of violence that happens in workplaces similar to yours?
c. The conditions in which the work is done may increase the risk of employees encountering violence. Are there:
* Please check all conditions that apply.
d. The interactions that happen during work may increase the risk of employees encountering violence. Are employees:
* Please check all interactions that apply.
Risk Management

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 procedures
  • Clarity and effectiveness of emergency response
  • Physical security measures (Crime Prevention Through Environmental Design, access controls systems, electronic and natural surveillance, and physical barriers.
  • Regular training sessions

The 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?