Workplace Violence Prevention Form

Your safety and well-being are our top priorities. This form is designed to allow you to report any incidents of workplace violence anonymously. Whether you've experienced or witnessed violence, your input is crucial in helping us maintain a safe and respectful work environment. Please provide as much detail as possible so that we can take appropriate action to prevent future incidents. Your anonymity and confidentiality are guaranteed, and there will be no retaliation for submitting this form. Thank you for helping us create a safer workplace.

MM slash DD slash YYYY
Please provide a detailed account of the incident. Include relevant information such as: What happened before, during, and after the incident? Any specific actions, words, or behaviors that were involved. The sequence of events as you remember them. Any objects or weapons used. The physical and emotional impact on those involved. Your detailed description helps us understand the context and take appropriate actions to address and prevent future incidents.

Additional Information (Optional)

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