​Online, Anonymous Violent Incident Report Form (Appendix 5)
    Parents’ Place

    ​Type 1 violence - Workplace violence committed by a person who has no legitimate business at the worksite, and includes
    violent acts by anyone who enters the workplace or approaches employees with the intent to commit a crime.
    Type 2 violence - Workplace violence directed at employees by customers, clients, patients, students, inmates, or visitors.
    Type 3 violence - Workplace violence against an employee by a present or former employee, supervisor, or manager.
    Type 4 violence - Workplace violence committed in the workplace by a person who does not work there, but has or is
    known to have had a personal relationship with an employee.
    ​Check which of the following describes the type(s) of incident, and explain in detail:
    Note: It’s important to understand that “Workplace Violence Type” and “Type of Incident” have separate requirements. For
    this part of the log, “Type of Incident” specifically refers to the nature or characteristics of the incident being logged. It
    does not refer to the type of workplace violence.
     Physical attack without a weapon, including, but not limited to, biting, choking, grabbing, hair pulling, kicking, punching,
    slapping, pushing, pulling, scratching, or spitting.
     Attack with a weapon or object, including, but not limited to, a firearm, knife, or other object.
     Threat of physical force or threat of the use of a weapon or other object.
     Sexual assault or threat, including, but not limited to, rape, attempted rape, physical display, or unwanted verbal or
    physical sexual contact.
     Animal attack.
     Other.
    Explain: Provide a detailed description of the incident and any additional information on the violence incident type and
    what it included, and names of witnesses, if any.
    Was the person being violent a client or customer, family or friend of a client or customer, stranger with criminal intent,
    coworker, supervisor or manager, partner or spouse, parent or relative, or someone else. 
    ​Circumstances at the time of the incident: what was happening at the time of the incident, including, but not limited to,
    whether the employee was completing usual job duties, working in poorly lit areas, rushed, working during a low staffing
    level, isolated or alone, unable to get help or assistance, working in a community setting, or working in an unfamiliar or
    new location.