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Course 720 - Preventing Workplace Violence

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Sample Employee Survey on Hazard Assessment

Periodically surveying employees on workplace violence can be a valuable tool for evaluating your workplace violence prevention efforts and gathering suggestions for improving your program. Some employees may prefer not to have their names identified on a survey; making the name "optional" may increase the amount of feedback you receive.

Name (Optional) _______________________________________________________________

Department/Unit ______________________________ Date __________________________

Work Location (if at alternate worksite) _________________________________________

Please assess your department/unit over the last year. Circle TRUE (T), FALSE (F) or DON’T KNOW (?). Thank you for your honest assessment.

Management Commitment and Employee Involvement
T F ?
  1. Violence/threats are not accepted as "part of the job" by managers, supervisors and/or employees.
T F ?
  • Employees communicate information about potentially assaultive/threatening clients or visitors to appropriate staff.
T F ?
  • Management communicates information to employees about incidents of workplace violence.
T F ?
  • Employees feel they are treated with dignity and respect by other employees and management.
T F ?
  • Employees are basically satisfied with their jobs.
T F ?
  • Employees are basically satisfied with management.
T F ?
  • Employees are basically satisfied with the organization (i.e., mission, vision, goals).
T F ?
  • Employees generally feel "safe" when they are at work.
T F ?
  • Employees are familiar with the department’s/unit’s violence prevention policy.
Potential Risk Factors
T F ?
  1. Employees do not work in high-crime areas.
T F ?
  • Employees do not work with drugs.
T F ?
  • Employees do not work with cash.
T F ?
  • Employees do not work with patients or clients who have a history of violent behavior or behavior disorders.
T F ?
  • Employees do not work in isolated work areas.
Hazard Prevention and Control
T F ?
  • The department/unit has adequate lighting to, from and within the worksite.
T F ?
  • The employee parking garage is secure when arriving, leaving and during changes of shift.
T F ?
  • Access and freedom of movement within the workplace are restricted to those persons who have a legitimate reason for being there.
T F ?
  • Alarm systems such as panic alarm buttons, silent alarms, or personal electronic alarm systems are being used for prompt security assistance.
T F ?
  • Employees know to use security escort service after hours.
T F ?
  • After hours, the building is locked down with only one access point.
T F ?
  • Visitors are signed in and out.
Hazard Prevention and Control (continued)
T F ?
  • Exits are accessible and clearly marked.
T F ?
  • Employees are able to locate emergency equipment such as fire alarm boxes or emergency generator outlets.
T F ?
  • Emergency equipment is accessible and free from obstruction.
T F ?
  • Employees are able to locate cellular phones, power-failure phones and/or radios for emergency communication.
T F ?
  • Employees know proper procedures if a bomb threat is announced.
T F ?
  • Employee emergency call-back list is up-to-date and available.
T F ?
  • Employees provide privacy to reflect sensitivity and respect for clients and visitors.
T F ?
  • Employees use the "buddy system" to work together if problems arise.
T F ?
  • Employees working in the field have cellular phones or other communication devices to enable them to request aid.
T F ?
  • Staffing levels are appropriate for department/unit functions.
T F ?
  • Reference manuals are up-to-date and available to employees.
T F ?
  • There is a grievance policy available to employees.
T F ?
  • There is a Safety Committee available as a resource to staff for any hazard concern.
Training
     
  1. Employees have received training on the company’s workplace violence prevention program.
T F ?
  • Employees know how to ask for assistance by phone or by alerting other staff.
T F ?
  • Employees have been trained to recognize and handle threatening, aggressive, or violent behavior.
T F ?
  • Employees have been trained in verbal de-escalation techniques.
T F ?
  • Employees have been trained in self-defense/restraint procedures.
Incidents and Reporting
T F ?
  • This work unit/department has not experienced violent behavior and assaults or threats from strangers.
T F ?
  • This work unit/department has not experienced violent behavior and assaults or threats from clients or customers.
T F ?
  • This work unit/department has not experienced violent behavior and assaults or threats from others employed in the organization.
T F ?
  • This work unit/department has not experienced domestic violence issues.
T F ?
  • Employees are required to report incidents or threats of violence, regardless of injury or severity; the reporting system is clear.
T F ?
  • Medical and psychological counseling services were offered to employees who have been assaulted or threatened.

Adapted from: Workplace Violence: Awareness and Prevention for Employers and Employees, Washington State Department of Labor and Industries