VIOLENT INCIDENT LOG

VIOLENT INCIDENT LOG

Alameda County Electrical JATC
Date of Incident

MonthDayYear
Date
Hour MinutesAM/PM Option
Location of Incident
Approximate Location on Property
Who Committed the Violence (do not use their name):

Person not associated with the program or any employeeCurrent or former apprentice/vendor inviteeCurrent or former employeePerson with a personal relationship with an employee/apprentice
Against Whom was the Violence Committed:

EmployeeApprenticePerson not associated with the program or any employeeOther
If other, please describe without using their name:
Type of Violence:

Physical Attack or ThreatVerbal Attack or ThreatWeapon Used or Threatened to be UsedSexual AssaultOther
If a weapon was used, what type:
Corrective Actions Taken:
Was Law Enforcement Contacted:
Consequences of Incident:
NOTE: This form is to be retained for 5 years after the incident with personal identifying information redacted. Employees are entitled to view and copy the log within 15 calendar days of a request.
Should be Empty: