Please note that these are suggestions only.
Any assessment must consider violent experiences at the employer's workplace and other similar workplaces, as well as the presence of factors which may give rise to violence.
An assessment would normally be conducted:
(a) when a workplace is initially established;
(b) when there is a report of a new type of violence in similar workplaces;
(c) when a previously unanticipated factor arises in the workplace, and this factor significantly increases the likelihood that an employee will experience violence in the workplace;
(d) when ordered to do so by a Department of Labour occupational health and safety officer; or
(e) at least once every 5 years.
This form contains one version of an assessment. The Joint Occupational Health and Safety Committee or Health and Safety Representative, where they exist, must be consulted on the decision to use this or an alternative form.
Violence in the Workplace
Sample Hazard Assessment
To use this form:
1) Decide who will do the assessment, remembering that it must be done in consultation with the Joint Occupational Health and Safety Committee or Health and Safety Representative.
2) Enter the employer's name, assessment date and name of the assessor(s).
3) Describe the workplaces or tasks covered by this assessment.
(i) For smaller employers, such as corner stores, there may only be one workplace, and thus only one assessment.
(ii) Larger employers may wish to divide the operations into workplaces or tasks that have similar predictors of violence. For example, a debt collection operation may divide its staff into those who deal with customers personally and those who perform administrative support functions with no customer contact. In this way, the employer can focus its violence prevention efforts on those areas where it is most needed.
4) Check the boxes below as accurately as possible, being sure to put a mark opposite each question. If you are unsure of any point, you should answer "Yes."
5) If the answer to any of the questions is "Yes," the employer, in consultation with the workplace Joint Occupational Health and Safety Committee or Health and Safety Representative, should consider whether a Violence Prevention Plan is required.
Employer:
_____________________________________
Assessment Date:
_______________________________
Assessor's name(s):
______________________________
Workplace/Task:
________________________________
| Yes | No | Question |
|---|---|---|
| During hours when you are open to the public, are there times when only one employee is present? | ||
| Do any of your staff handle cash or other valuables? | ||
| Do any of your staff deal with troubled clients (crisis centre staff, emergency room staff)? | ||
| Do any of your staff provide a public service (benefits officers, taxi or bus drivers)? | ||
| Do any of your staff care for others (health care or community workers)? | ||
| Are any of your staff involved in disciplining others (teachers)? | ||
| Do any of your staff deliver or collect items of value? | ||
| Do any of your staff exercise control over others (enforcement officers, pub or bar staff [bouncers])? | ||
| Do any of your staff inspect other people's private property (planning inspectors, assessment officers, insurance claims adjusters)? | ||
| Do any of your staff exercise security functions (police, private guards)? | ||
| Do any of your staff sell or dispense drugs or alcohol? | ||
| Do any of your staff deal with or handle firearms or similar weapons? | ||
| Has this workplace or task experienced violence in the past? | ||
| Do you know of similar workplaces or tasks in other companies that experienced violence in the past? |
Decision and Rationale: _______________________________________________
_______________________________________________
_______________________________________________
Please note that these are suggestions only.