Our establishment, [Employer Name] is committed to our employees’ safety and health. We refuse to tolerate any form of violence in the workplace and will make every effort to prevent violent incidents from occurring by implementing a Workplace Violence Prevention Program (WVPP). We will provide adequate authority and budgetary resources to responsible parties so that our goals and responsibilities can be met.

All managers, supervisors and employees are responsible for implementing and maintaining our WVPP Program. We encourage employee participation in designing and implementing our program. We require prompt and accurate reporting of all violent incidents whether or not physical injury has occurred. We will not discriminate against victims of workplace violence.

A copy of this policy statement and WVPP Plan is readily available to all employees and from each manager and supervisor.

Our plan ensures that all employees, including supervisors and managers, adhere to work practices that are designed to make the workplace more secure, and do not engage in verbal threats or physical actions which create a security hazard for others in the workplace.

All employees, including managers and supervisors, are responsible and accountable for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe and secure work environment.

The management of our establishment is responsible for ensuring that all safety and health policies and procedures involving workplace security are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.

The WVPP Plan will be reviewed and updated annually.

The Workplace Violence Prevention Program Administrator is [Program Administrator] and (he/she) has the authority and responsibility for implementing the provisions of this program for [Establishment Name]. All managers, supervisors and employees are responsible for implementing and maintaining the WVPP in their work areas and for answering employee questions about the program.

In addition, a WVPP Planning Group will be established to assess the vulnerability to workplace violence at our establishment and reach agreement on preventive actions to be taken. This group will be responsible for developing employee training programs in violence prevention and plans for responding to acts of violence. They will also audit our overall Workplace Violence Prevention Program.

The Workplace Violence Prevention Group will consist of:

Name:_________________________________ Title:___________________ Phone:______________

Name:_________________________________ Title:___________________ Phone:______________

Name:_________________________________ Title:___________________ Phone:______________

Name:_________________________________ Title:___________________ Phone:______________

Name:_________________________________ Title:___________________ Phone:______________

Section III: Compliance

All employees are responsible and will be held accountable for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe and secure work environment.

Managers, supervisors and employees will comply with work practices that are designed to make the workplace more secure, and will not engage in threats or physical actions which create a security hazard for others in the workplace. Managers and supervisors will:

• Inform employees, supervisors and managers about our Workplace Violence Prevention Program.
• Evaluate the performance of all employees in complying with our establishment’s workplace security measures.
• Recognize employees who perform work practices which promote security in the workplace.
• Provide training and/or counseling to employees who need to improve work practices designed to ensure workplace security.
• Discipline employees for failure to comply with workplace security practices.
• Follow established workplace security directives, policies and procedures.

Managers and supervisors will maintain an open, two-way communications system on all workplace safety, health and security issues. Our establishment has a communication system designed to encourage a continuous flow of safety, health and security information between management and our employees without fear of reprisal and in a form that is readily understandable. Our communication system consists of the following items: 

• New employee orientation on our establishment’s workplace security policies, procedures and work practices.
• Periodic review of our Workplace Violence Prevention Program with all personnel.
• Training programs designed to address specific aspects of workplace security unique to our establishment.
• Regularly scheduled safety meetings with all personnel that include workplace security discussions.
• A system to ensure that all employees, including managers and supervisors, understand the workplace security policies.
• Posted or distributed workplace security information.
• A system for employees to inform management about workplace security hazards or threats of violence.
• Procedures for protecting employees who report threats from retaliation by the person making the threats.
• Our establishment has fewer than ten employees and communicates with and instructs employees orally about general safe work practices with respect to workplace security.
• Other: ______________________________________________________________.

Hazard Assessment

The Workplace Violence Prevention Group will perform workplace hazard assessment for workplace security in the form of record keeping and review, periodic workplace security inspections, and a workplace survey. The assessment group will identify workplace violence and security issues and make recommendations to management and employees.

Note: Care must be taken to ensure appropriate confidentiality of medical and personnel records, as required by the ADA (Americans with Disabilities Act) and other applicable regulations or policies.

Periodic updates and reviews of the following workplace violence reports and records will be made:

• Occupational Safety and Health Administration (OSHA) 200 logs
• Workplace violence incident reports
• Information compiled for recording assault incidents or near-assault incidents (i.e. Threat & Assault Log)
• Insurance records
• Police reports
• Workplace survey
• Accident investigations
• Training records
• Grievances
• Inspection information
• Other relevant records or information

The records review will be performed on the following schedule: _______________.

Workplace Security Inspections

Periodic inspections to identify and evaluate workplace security hazards and threats of workplace violence will be performed by the following observer(s) in the following areas of our workplace:

Periodic inspections are performed according to the following schedule:

• ________________________ (Frequency ¾ weekly, monthly, etc.);
• When we initially established our Workplace Violence Prevention Program;
• When new, previously unidentified security hazards are recognized;
• When occupational injuries or threats of injury occur; and
• Whenever workplace security conditions warrant an inspection.

Periodic inspections for security hazards consist of identification and evaluation of workplace security hazards and changes in employee work practices, and may require assessing for more than one type of workplace violence. Our establishment performs inspections for each type of workplace violence by using the methods specified below to identify and evaluate workplace security hazards.

Inspections for workplace security hazards from violence by strangers (Type 1) include assessing:

• The exterior and interior of the workplace for its attractiveness to robbers.
• The need for security surveillance measures, such as mirrors or cameras.
• Posting of signs notifying the public that limited cash is kept on the premises.
• Procedures for employee response during a robbery or other criminal act.
• Procedures for reporting suspicious persons or activities.
• Posting of emergency telephone numbers for law enforcement, fire and medical services where employees have access to a telephone with an outside line.
• Limiting the amount of cash on hand and using time access safes for large bills.
• Staffing levels during evening hours of operation and at other high risk times.
• The use of work practices such as "buddy" systems, as appropriate, for identified risks (e.g., walking employees to their cars or mass transit stops at the end of the work day).
• Adequacy of lighting and security for designated parking lots or areas.
• Other: ______________________________________________________

Inspections for workplace security hazards from violence by customers or clients (Type 2) include assessing:

• Access to, and freedom of movement within, the workplace.
• Adequacy of workplace security systems, such as door locks, security windows, physical barriers and restraint systems.
• Frequency and severity of threatening or hostile situations that may lead to violent acts by persons who are service recipients of our establishment.
• Employees’ skill in safely handling threatening or hostile service recipients.
• Effectiveness of systems and procedures to warn others of a security danger or to summon assistance, e.g. alarms or panic buttons.
• The use of work practices such as "buddy" systems, as appropriate, for identified risks (e.g., walking employees to their cars or mass transit stops at the end of the work day).
• Adequacy of lighting and security for designated parking lots or areas.
• The availability of employee escape routes.
• Other: _______________________________________________________

Inspections for workplace security hazards from violence by co-workers (Type 3)
include assessing:

• How well our establishment’s anti-violence policy has been communicated to employees, supervisors and managers.
• How well our establishment’s management and employees communicate with each other.
• How well our employees, supervisors and managers know the warning signs of potential workplace violence.
• Access to, and freedom of movement within, the workplace by non-employees, specifically recently discharged employees.
• Frequency and severity of employee-reported threats of physical or verbal abuse by managers, supervisors or other employees.
• Any prior violent acts, threats of physical violence, verbal abuse, property damage or other signs of strain or pressure in the workplace.
• Employee disciplinary and discharge procedures.
• Other: _____________________________________________________

Inspection for workplace security hazards from violence by personal relations include assessing:

• Access to, and freedom of movement within, the workplace by non-employees, specifically personal relations with whom one of our employee’s is having a dispute.
• Frequency and severity of employee-reported threats of physical or verbal abuse which may lead to violent acts by a personal relation.
• Adequacy of workplace security systems, such as door locks, security windows, and physical barriers.
• Any prior violent acts, threats of physical violence, verbal abuse, property damage or other signs.
• The use of work practices such as "buddy" systems, as appropriate, for identified risks (e.g., walking employees to their cars or mass transit stops at the end of the work day).
• Adequacy of lighting and security for designated parking lots or areas.
• Warnings or police involvement to remove personal relations of employees from the worksite and effectiveness of restraining orders.

Under the direction of the Workplace Violence Prevention Administrator & Group, we distributed a survey among all of our employees to identify any additional issues that were not noted in the records review or the security inspection.

Based on the records review, workplace security inspections and workplace survey, the Workplace Violence Prevention Group has identified the following issues that need to be addressed:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Workplace Hazard Control and Prevention

In order to reduce the risk of workplace violence, the following measures have been recommended:

Engineering Controls and Building or Work Area Design:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Workplace Practices:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Management has instituted the following as a result of the workplace violence hazard assessment and the recommendations made by the Workplace Violence Prevention Group:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

These changes were completed on (date).

Policies and procedures developed as a result of the Workplace Violence Prevention Group’s recommendations:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

We have established the following policy on training all employees with respect to workplace violence and security.

All employees, including managers and supervisors, shall have training and instruction on general and job-specific workplace security practices. Training and instruction shall be provided when the Workplace Violence Prevention Program is first established and periodically thereafter. Training shall be provided to all new employees and to other employees for whom training has not previously been provided. It shall also be provided to all employees, supervisors, and managers given new job Exercises for which specific workplace security training for the job Exercise has not previously been provided. Additional training and instruction will be provided to all personnel whenever the employer is made aware of new or previously unrecognized security hazards.

General workplace violence and security training and instruction includes, but is not limited to, the following: 

• Explanation of the Workplace Violence Prevention Program including measures for reporting any violent acts or threats of violence.
• Recognition of workplace security hazards including the risk factors associated with the four types of violence.
• Measures to prevent workplace violence, including procedures for reporting workplace security hazards or threats to managers and supervisors.
• Ways to defuse hostile or threatening situations.
• Measures to summon others for assistance.
• Employee routes of escape.
• Notification of law enforcement authorities when a criminal act may have occurred.
• Emergency medical care provided in the event of any violent act upon an employee.
• Post-event trauma counseling for those employees desiring such assistance.

In addition, we provide specific instructions to all employees regarding workplace security hazards unique to their job Exercise, to the extent that such information was not already covered in other training.

We have chosen the following items for training and instruction for managers, supervisors and employees:

• Crime awareness.
• Location and operation of alarm systems, panic buttons and other protective devices.
• Communication procedures.
• Proper work practices for specific workplace activities, occupations or Exercises, such as late night retail sales, taxi-cab driver, security guard, law enforcement, health care, public transportation, etc.
• Self-protection.
• Dealing with angry, hostile or threatening individuals.
• Using the "buddy" system or other assistance from co-employees.
• Awareness of indicators that lead to violent acts by service recipients.
• Employee assistance programs.
• Review of anti-violence policy and procedures.
• Managing with respect and consideration for employee well-being.
• Pre-employment screening practices.
• Role playing a violent incident.
•  

Our procedures for investigating incidents of workplace violence—threats and physical injury—include: 

• Reviewing all previous incidents.
• Visiting the scene of an incident as soon as possible.
• Interviewing threatened or injured employees and witnesses.
• Examining the workplace for security risk factors associated with the incident, including any previous reports of inappropriate behavior by the perpetrator.
• Determining the cause of the incident.
• Taking corrective action to prevent the incident from recurring.
• Recording the findings and corrective actions taken.
• Other: