Anonymous Workplace Violence Report Form

The SCCOE is committed to providing a safe, secure workplace for our employees. We recognize that open communication about workplace violence issues is essential to a safe and productive workplace.

By completion of the below form, SCCOE employees can anonymously report a violent incident, threat, or other violence concerns.

PLEASE NOTE: Your email or any identifiable information will not be recorded or retained, unless you specify your contact information at the bottom of this form

Reports will investigated in a timely manner.

For additional information regarding SCCOE's Workplace Violence Prevention Plan, please refer to the Employee Compliance Handbook in the SCCOE Intranet.

EMERGENCIES: If this is an incident that may cause an imminent or ongoing threat, contact Emergency personnel (police/fire/paramedic) from any SCCOE phone by dialing 9-1-1.

Please describe what happened. Include any relevant information that will assist SCCOE investigate this incident. *

When did this happen?*

MonthDayYear

Where did this happen (location)?*

Are there any witnesses that should be contacted? If yes, please provide names and contact information, if known.

Do you want to be contacted about the incident? If yes, please provide your name and contact information.

Yes, please contact meNo

If yes, please provide your contact information.