Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by:
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Location
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Personnel
Workplace Violence Risk Factors:
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Do employees exchange money with the public?
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Do employees deliver passengers or goods?
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Do employees have contact with the public?
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Do employees work alone?
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Do employees work late at night or during early morning hours?
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Is the workplace often understaffed?
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Is the workplace located in an area with a high crime rate?
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Have neighboring facilities and businesses experienced violence or crime?
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Do employees enter areas with a high crime rate?
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Do employees operate from a mobile workplace (patrol vehicle, work van, etc...)?
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Do employees perform jobs that might put them in conflict with others?
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Do employees ever perform duties that could upset people (deny benefits, confiscate property, terminate child custody, etc...)?
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Do employees deal with people known or suspected of having a history of violence?
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Do any employees or supervisors have a history of assault, verbal abuse, harassment, or other threatening behavior?
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Other risk factors - please describe:
Risk Factor
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Add notes:
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Add media
Work Areas:
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Who is responsible for building security?
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Are workers told or can they identify who is responsible for security?
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Are name tags or ID badges required for for all employees (omitting personal information such as last name and home address)?
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Are authorized visitors to the building required to wear ID badges?
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Are visitors or clients escorted to offices for appointments?
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Are workers notified of past violent acts in the workplace?
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Are trained security personnel accessible to workers in a timely manner?
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Are trained counseling personnel accessible to workers in a timely manner?
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Do security and/or counseling personnel have sufficient authority to take all necessary action to ensure worker safety?
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Are bullet-resistant windows or similar barriers used when money is exchanged with the public?
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Is there an established liaison with local law enforcement, emergency services, and counseling agencies?
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Are areas where money is exchanged visible to others who could help in an emergency?
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Is a limited amount of cash kept on hand, with appropriate signs posted?
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Are employees given maps and clear directions in order to navigate the areas where they will be working?
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Are floor plans posted showing building entrances, exits, and location of security personnel?
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Are these floor plans visible only to staff and not outsiders?
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Is additional emergency information posted, such as telephone numbers?
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Are there enough exits and adequate routes of escape?
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Can exit doors be opened only from the inside to prevent unauthorized entry?
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Is the lighting adequate to see clearly in indoor areas?
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Are there employee-only work areas that are separate from public areas?
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Is access to work areas only through a reception area?
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Are reception and work areas designed to prevent unauthorized entry?
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Is public access to the building controlled?
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Could someone hear a worker who calls for help?
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Can employees observe patients or clients in waiting areas?
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Do areas used for patient or client interviews allow co-workers to observe any problems?
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Are waiting areas and work areas free of objects that could be used as weapons?
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Are chairs and furniture secured to prevent their use as weapons?
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Is furniture in waiting areas and work areas arranged to prevent entrapment of workers?
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Are patient or client waiting areas designed to maximize comfort and minimize stress?
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Are patients or clients in waiting areas clearly informed how to use the department's services to minimize frustration?
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Are waiting times for patient or client services kept short to minimize frustration?
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Are private, locked restrooms available for employees?
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Is there a secure place for workers to store personal belongings?
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Are special security measures taken to protect people who work late at night (escorts, locked entrances, etc...)?
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If weapons are on-site are they secured and stored in a location that is physically separated from patient or client access areas?
Exterior Building Areas:
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Do workers feel safe walking to and from the workplace?
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Are the entrances to the building clearly visible from the street?
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Is the area surrounding the building free of bushes or other hiding places?
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Is lighting bright and effective in outside areas?
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Are security personnel provided outside the building?
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Is video surveillance provided outside the building?
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Are remote areas secured during off shifts?
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Is a buddy escort system required during off shifts?
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Are all exterior walkways visible to security personnel or managers?
Parking Areas:
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Is there a nearby parking lot reserved for employees only?
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Is the parking lot attended or otherwise secured?
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Is the parking lot free of blind spots and is landscaping trimmed back to prevent hiding places?
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Is there enough lighting to see clearly in the parking lot and when walking to/from the building?
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Are security escorts available to employees walking to and from the parking lot?
Security Measures:
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Physical barriers (plexiglass partitions, bullet-resistant customer window, etc...)?
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Proximity card access?
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Security cameras or closed-circuit TV in high-risk areas?
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Panic buttons?
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Alarm systems?
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Metal detectors?
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Security Screening devices?
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Door locks?
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Perimeter door panic locks?
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Internal telephone system to contact emergency assistance?
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Telephone system with an outside line programmed for 911?
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Telephone system emergency intercom system in place?
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Two-way radios, pagers, or cellular telephones?
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Security mirrors (e.g., convex mirrors)?
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Secured entry (e.g., "buzzers")?
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Personal alarm devices?
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"Drop safes" to limit the amount of cash on hand?
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Fire alarm pulls?
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Broken windows repaired promptly?
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Security systems, locks, panic buttons, etc. tested on a regular basis and repaired promptly when necessary?
Training:
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Is a site specific Workplace Security/Violence Plan in place?
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Are there standard operating procedures in place to handle specific anticipated scenarios?
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Are workers trained in the emergency response plan (for example, escape routes, and notifying the proper authorities)?
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Are workers trained to report violent incidents or threats?
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Are workers trained in how to handle difficult clients or patients?
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Are workers trained in ways to prevent or defuse potentially violent situations?
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Are workers trained in personal safety?
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Are workers trained in self defense?
Field Work:
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Are field activities away from the office conducted?
Field Work - Staffing:
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Is assistance provided to workers in the field in a timely manner when requested?
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Are escorts or "buddies" provided for people who work in potentially dangerous situations?
Field Work - Training:
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Are workers briefed about the area in which they will be working (gang colors, neighborhood culture, language, drug activity, etc...)?
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Can workers effectively communicate with people they meet in the field (same language, etc...)
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Are people who work in the field late at night or early mornings advised about special precautions to take?
Field Work - Work Environment:
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Is there enough lighting to see clearly in all areas where workers must go?
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Are there safe places for workers to eat, use the restroom, store valuables, etc...?
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Are there safe places where workers can go for protection in an emergency?
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Is safe parking readily available for employees in the field?
Field Work - Security Measures:
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Are workers provided two-way radios, pagers, or cellular phones?
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Are workers provided with personal alarm devices or portable panic buttons?
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Are vehicle door and window locks controlled by the driver?
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Are vehicles equipped with physical barriers (plexiglass partitions, etc...)?
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Are workers using Fleet vehicles?
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Are Fleet vehicles equipped with GPS?
Field Work - Work Procedures:
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Are employees given maps and clear directions for covering the areas they will be working?
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Are employees given alternative routes to use in neighborhoods with a high crime rate?
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Does a policy exist to allow employees to refuse service to clients or customers (in the home, etc...) in a hazardous situation?
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Has a liaison with law enforcement been established?
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Do workers avoid carrying unnecessary items that someone could use as a weapon against them?
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Does the employer provide a safe vehicle or other transportation for use in the field?e
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Does the employer require workers to utilize Fleet vehicles for field use?
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Are vehicles used in the field routinely inspected and kept in good working condition?
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Is there always someone who knows where each field worker is?
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Is there a check in time system in use for field workers?
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Are name tags required for workers in the field (omitting personal information such as last name)?
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Are field workers notified of past violent acts by particular clients, patients, etc...?
Field Work - Are Special precautions taken when workers:
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Have to take something away from people (remove children from home)?
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Have contact with people who behave violently?
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Have contact with people with known medical issues?
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Use vehicles or wear clothing marked with the name of an organization that the public may strongly dislike?
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Perform duties inside people's homes?
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Have contact with dangerous animals
Activity Certification:
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Facility/Site Representitive(s):
Representitive:
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Title:
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Add signature
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Analyst(s):
Analyst:
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Title:
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Add signature
