Worksite Analysis based on Workplace Violence Prevention Program

Title Page

Site conducted
Location of Workplace
Prepared on
Prepared by

Initial Questions

Why is this workplace violence risk assessment needed? (Other than being legally required)
How could this workplace violence risk assessment help the business and its employees?
What is the intended result, effect, or output of this workplace violence risk assessment?
What's included in this workplace violence risk assessment?
What's not included in this workplace violence risk assessment?
Who will be involved in this workplace violence risk assessment and what level of responsibility or participation do they have?
When will this workplace violence risk assessment be performed?
Where (specific room, site, facility, building, or area) will this workplace violence risk assessment be performed?

Identify the hazards

Gather information about the hazards in your workplace.
Ask your employees and safety representatives about their experiences and what they think.
Look back at your injury and illness health records.
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

For areas that involve counseling/mental wellness:
Disagreements between staff and/or patients
Create action -Study hazard- by selecting the "Action" icon. Set a due date.
What risk would this hazard possibly lead to?
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using this risk matrix:
What is the risk level?
High-level risks must be prioritized.
Patients being intoxicated
Create action -Study hazard- by selecting the "Action" icon. Set a due date.
What risk would this hazard possibly lead to?
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using this risk matrix:
What is the risk level?
High-level risks must be prioritized.
Patients/Staff using illegal drugs
Create action -Study hazard- by selecting the "Action" icon. Set a due date.
What risk would this hazard possibly lead to?
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using this risk matrix:
What is the risk level?
High-level risks must be prioritized.
For Clinical/Non-clinical/Ancillary Support:
Unpredictable behavior of patients/staff/customers
Create action -Study hazard- by selecting the "Action" icon. Set a due date.
What risk would this hazard possibly lead to?
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using this risk matrix:
What is the risk level?
High-level risks must be prioritized.
Verbal abuse (usually more common than physical violence)
Create action -Study hazard- by selecting the "Action" icon. Set a due date.
What risk would this hazard possibly lead to?
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using this risk matrix:
What is the risk level?
High-level risks must be prioritized.

Who might be harmed and how?

Work out whether and how violence, or the fear of violence, could affect staff in your workplace.
Identify which groups of people in your hospital could be harmed by physical assaults, threats, intimidation, or verbal abuse.
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

Please specify if these risk factors are present or absent in the workplace:
Staff has face-to-face contact with patients/customers
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace operates in the evening or late at night
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Staff deals with patient/customer complaints or disputes
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace has lone workers or small numbers of staff
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace stores high-value goods such as medications, equipment and supplies
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Staff is under extreme pressure due to exceptional workloads and/or staff shortages
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Staff regularly faces inadequate stocks, delays, and long wait times, leading to patient dissatisfaction and/or hostility to be directed at them
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Patients have a history of violence
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Patients are likely to be under the influence of drink or drugs
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace has had a previous experience of assault, threats, or theft
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace is isolated or does not have many patients/customers
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace has easy access/escape routes that can be taken advantage of
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace layout is poor (emergency egress is obstructed, etc.)
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace lighting is poor (low visibility, etc.)
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.
Workplace does not have any obvious or highly visible security measures
What is a possible consequence of this risk?
How likely is it for this possible consequence to actually occur?
Identify the risk level using the risk matrix below:
What is the risk level?
High-level risks must be prioritized.

Record your findings and implement them

Consult staff about their opinions on the risk factors present in the workplace and their ideas for controlling workplace violence risks
Ask staff to share on-the-job experiences to help other employees recognize and respond to violence as safely as possible
Ask staff to participate in the evaluation of any control measures
Work out what you are already doing, whether your control measures are working properly and if there is anything else you need to do
Are new control measures needed?

Develop risk control measures

Ask staff to participate in developing and devising procedures to minimize risk
Can more than one measure be used?
Can a mix of both short and long-term measures that result in both 'quick wins' and longer-term effectiveness be used?
Describe the proposed control measure/s:
How will staff react to these measures (or measure)?
How can you or the employer demonstrate the value of such measure/s?
What are the potential negative aspects of the measure/s (such as dress codes, searches, strict return policies)?
How will these interventions (or intervention) cost in comparison to their/its effectiveness?
Are/Is the measure/s realistic?
Has everyone (staff, employer, management) agreed to these measures (or measure)?
How will you effectively and consistently inform, instruct and train staff in these measures (or measure)?
Have specific timescales or deadlines been set for these measures (or measure)?
What are the actions involved in these measures (or measure)?
How will these actions be implemented? Include details on who will do each action and by when.
Appoint a responsible person to ensure that actions are carried out.
How will the implementation of such actions be communicated to the staff?

Review your risk assessment and update if necessary

You should review your workplace violence risk assessment regularly in case the hazard, risk factors or the control measures needed have changed.
Create action -Review workplace violence risk assessment- by selecting the "Action" icon.
Select "Update action details" Then, change "Due" date to approx. 1 year from today.
Review workplace violence risk assessments at least annually.
Review workplace violence risk assessments at least annually.
Name and Signature of Employer
Name and Signature of Person Appointed by Employer (if applicable)