Title Page
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Site conducted
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Location of Workplace
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Prepared on
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Prepared by
Initial Questions
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Why is this workplace violence risk assessment needed? (Other than being legally required)
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How could this workplace violence risk assessment help the business and its employees?
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What is the intended result, effect, or output of this workplace violence risk assessment?
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What's included in this workplace violence risk assessment?
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What's not included in this workplace violence risk assessment?
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Who will be involved in this workplace violence risk assessment and what level of responsibility or participation do they have?
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When will this workplace violence risk assessment be performed?
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Where (specific room, site, facility, building, or area) will this workplace violence risk assessment be performed?
Identify the hazards
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Gather information about the hazards in your workplace.
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Ask your employees and safety representatives about their experiences and what they think.
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Look back at your injury and illness health records.
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List the workplace violence hazards you have observed and/or experienced as well as those you suspect are happening in the workplace:
Common Workplace Violence Hazards
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For areas that involve counseling/mental wellness:
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Disagreements between staff and/or patients
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Create action -Study hazard- by selecting the "Action" icon. Set a due date.
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What risk would this hazard possibly lead to?
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using this risk matrix:
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What is the risk level?
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High-level risks must be prioritized.
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Patients being intoxicated
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Create action -Study hazard- by selecting the "Action" icon. Set a due date.
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What risk would this hazard possibly lead to?
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using this risk matrix:
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What is the risk level?
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High-level risks must be prioritized.
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Patients/Staff using illegal drugs
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Create action -Study hazard- by selecting the "Action" icon. Set a due date.
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What risk would this hazard possibly lead to?
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using this risk matrix:
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What is the risk level?
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High-level risks must be prioritized.
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For Clinical/Non-clinical/Ancillary Support:
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Unpredictable behavior of patients/staff/customers
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Create action -Study hazard- by selecting the "Action" icon. Set a due date.
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What risk would this hazard possibly lead to?
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using this risk matrix:
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What is the risk level?
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High-level risks must be prioritized.
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Verbal abuse (usually more common than physical violence)
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Create action -Study hazard- by selecting the "Action" icon. Set a due date.
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What risk would this hazard possibly lead to?
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using this risk matrix:
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What is the risk level?
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High-level risks must be prioritized.
Who might be harmed and how?
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Work out whether and how violence, or the fear of violence, could affect staff in your workplace.
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Identify which groups of people in your hospital could be harmed by physical assaults, threats, intimidation, or verbal abuse.
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Talk to staff about the situations where they feel threatened, as well as situations that might pose a risk, EVEN IF they do not cause concern to staff at the moment.
Evaluate the risks and decide on precautions
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Please specify if these risk factors are present or absent in the workplace:
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Staff has face-to-face contact with patients/customers
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace operates in the evening or late at night
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Staff deals with patient/customer complaints or disputes
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace has lone workers or small numbers of staff
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace stores high-value goods such as medications, equipment and supplies
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Staff is under extreme pressure due to exceptional workloads and/or staff shortages
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Staff regularly faces inadequate stocks, delays, and long wait times, leading to patient dissatisfaction and/or hostility to be directed at them
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Patients have a history of violence
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Patients are likely to be under the influence of drink or drugs
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace has had a previous experience of assault, threats, or theft
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace is isolated or does not have many patients/customers
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace has easy access/escape routes that can be taken advantage of
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace layout is poor (emergency egress is obstructed, etc.)
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace lighting is poor (low visibility, etc.)
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
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Workplace does not have any obvious or highly visible security measures
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What is a possible consequence of this risk?
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How likely is it for this possible consequence to actually occur?
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Identify the risk level using the risk matrix below:
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What is the risk level?
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High-level risks must be prioritized.
Record your findings and implement them
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Consult staff about their opinions on the risk factors present in the workplace and their ideas for controlling workplace violence risks
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Ask staff to share on-the-job experiences to help other employees recognize and respond to violence as safely as possible
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Ask staff to participate in the evaluation of any control measures
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Work out what you are already doing, whether your control measures are working properly and if there is anything else you need to do
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Are new control measures needed?
Develop risk control measures
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Ask staff to participate in developing and devising procedures to minimize risk
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Can more than one measure be used?
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Can a mix of both short and long-term measures that result in both 'quick wins' and longer-term effectiveness be used?
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Describe the proposed control measure/s:
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How will staff react to these measures (or measure)?
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How can you or the employer demonstrate the value of such measure/s?
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What are the potential negative aspects of the measure/s (such as dress codes, searches, strict return policies)?
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How will these interventions (or intervention) cost in comparison to their/its effectiveness?
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Are/Is the measure/s realistic?
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Has everyone (staff, employer, management) agreed to these measures (or measure)?
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How will you effectively and consistently inform, instruct and train staff in these measures (or measure)?
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Have specific timescales or deadlines been set for these measures (or measure)?
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What are the actions involved in these measures (or measure)?
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How will these actions be implemented? Include details on who will do each action and by when.
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Appoint a responsible person to ensure that actions are carried out.
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How will the implementation of such actions be communicated to the staff?
Review your risk assessment and update if necessary
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You should review your workplace violence risk assessment regularly in case the hazard, risk factors or the control measures needed have changed.
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Create action -Review workplace violence risk assessment- by selecting the "Action" icon.
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Select "Update action details" Then, change "Due" date to approx. 1 year from today.
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Review workplace violence risk assessments at least annually.
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Review workplace violence risk assessments at least annually.
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Name and Signature of Employer
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Name and Signature of Person Appointed by Employer (if applicable)