Workplace Violence Prevention Plan Development Form

The company is dedicating to providing its employees with a safe working environment. To that end, the company encourages all employees to participate the development and implementation of the company’s Workplace Violence Prevention Plan (WVPP) by providing suggestions, feedback or other information regarding effective workplace violence practices and procedures.

Use this form to provide information on the specific topics below and submit it to the company’s WVPP administrator(s) or other individuals designated to receive such information under the company’s WVPP. Provide as much detail as possible. The company will consider and evaluate the information as it develops, implements and/or revises its WVPP.

Procedures to identify and evaluate potential workplace violence hazards

Based on your specific work area, operation or department, please provide suggestions for the efficient and timely identification and evaluation of potential workplace violence hazards. For example, depending on your work area or department’s circumstances, this could include periodic safety meetings, oral or written reports to your direct supervisor or WVPP administrator, or other methods.

Procedures to identify, evaluate and determine corrective measures to prevent workplace violence

Based on your specific work area, operation, or department, provide any suggestions you may have for efficient and timely ways to identify, evaluate and determine appropriate corrective measures to mitigate potential workplace violence hazards.

Design and implementation of workplace violence prevention training

Provide any suggestions you may have regarding the design and implementation of the company’s workplace violence prevention training.

Methods of reporting and investigating workplace violence incidents

Based on your specific work area, operation, or department, provide any suggestions you may have for efficient and timely methods of reporting and investigating workplace violence incidents.

Additional comments:

Provide any other information, suggestions, or comments in the box below.

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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.

Atech Logistics & Distribution Workplace Violence Prevention Plan Development Form