Workplace Violence Hazard Identification Form

As part of its efforts to mitigate and prevent workplace violence, the company encourages all employees to identify and report potential workplace violence hazards to be evaluated and addressed under the company’s Workplace Violence Prevention Plan (WVPP).

Use this form to identify potential workplace violence hazards specific to your work area, operation, or department. Additionally, identify potential corrective measures the company should consider to address the potential hazard. Provide as much detail as possible. Use additional pages if necessary. Submit this form to the company’s WVPP administrator(s) or other individuals designated to receive such information under the company’s WVPP.

You may submit this form anonymously if preferred. The company will not retaliate against anyone for submitting information concerning workplace violence, including reporting a workplace violence incident, nor will it tolerate or permit retaliation by management, employees, or coworkers for submitting such information. Should you choose to submit anonymously, please print the hard copy of this form on the Company Intranet Page, complete it, and drop it into the HR mailbox at each facility.