Guidelines for Implementing the Workplace Violence Policy

GUIDELINES FOR IMPLEMENTING THE WORKPLACE VIOLENCE POLICY

Appendix A

/ WORKPLACE VIOLENCE RISK ASSESSMENT FORM /
Under the Occupational Health and Safety Act, an employer must assess the risk of workplace violence that may arise from the nature of the workplace, the type of work or conditions of work. The assessment must take into account the circumstances of the workplace and circumstances common to similar workplaces. The assessment should be reviewed at least annually and whenever there are significant changes in work operations that impact the potential for workplace violence.
This form is intended as a tool to assist in assessing the types of workplace violence risks to which City employees may be exposed. It may be completed by work location (as may be most appropriate if the work performed by employees is conducted at a single fixed work location) or by work operation (as may be more appropriate if work is performed either in a mobile workplace and/or across a number of work locations). In either case, consideration must be given to the nature of the workplace(s), the type of work or the conditions of work.
Divisions may choose to amend or add additional questions to this risk assessment, if needed, to further identify and assess workplace violence risks. If, in consultation with the JHSCs and/or OH&S representatives, a division identifies another risk assessment tool to be more appropriate for, or specific to, its work operations or workplaces, an alternative tool may be used to achieve compliance with the Occupational Health and Safety Act and the City’s Workplace Violence Policy.
Division:
Location or Work Operation: _____
Types of Functions Performed by Employees:
Management Representative Completing Form: ______
Date:
REVIEW OF PAST INCIDENTS, EMPLOYEE CONCERNS AND JOINT HEALTH AND SAFETY COMMITTEE RECOMMENDATIONS
1. Have there been past incidents and investigations into workplace
violence at this location or in this work operation? r Yes r No
If yes:
The frequency of these incidents was:
r Approximately daily (Very frequent) r Approximately weekly (Frequent)
r Approximately monthly (Regularly) r Once a year or less (Infrequent)
These incidents were (check all that apply):
r Verbal, in person r Verbal, by phone
r  Written r Threatening gestures
r  Physical
The party responsible was a (check all that apply):
r Client r Patient r Stranger (Random member of the public)
r Resident r Participant r Co-worker or other City employee
r  Other, specify
The incident(s) took place in(check all that apply):
r City Office r Client’s Business Location r Client’s Home r Office Lobby/Exit
r Workplace Parking Lot r Interview/ Public Meeting Room r Residence/Long Term Care r Field/Mobile Operation
2. Have workers expressed safety concerns with respect to
workplace violence at this location or in this work operation? r Yes r No
If yes, briefly describe the nature of worker concerns, the circumstances that caused these concerns and any resolutions reached.
______
3. Have JHSCs/OH&S representatives raised concerns respecting
violence or made recommendations respecting violence at this location
or in this work operation? r Yes r No
If yes, briefly describe the nature of JHSC/OH&S representative concerns, recommendations and any resolutions reached.
4. Has the division conducted an assessment of experiences with
workplace violence at similar workplaces or in similar work operations?
r Yes r No
If yes, summarize the information gathered through this process (e.g. examples, statistics).
If no, seek sources of available information (e.g. other City divisions with similar work operations, other organizations with similar work operations, health and safety associations), follow up and summarize information received.
INTERVIEWS OR SURVEYS WITH EMPLOYEES
5. Have interviews with employees or a survey been used to
assess past incidents and concerns regarding workplace violence? r Yes r No
If no, a sample survey is available as Appendix B. This survey may be used as is or adapted to meet divisional needs.
If yes, indicate when and briefly describe process used:
Did employees indicate they have experienced verbal abuse?
r Yes r No
Briefly describe:
Did employees indicate they have experienced written threats? r Yes r No
Briefly describe:
Did employees indicate they have been threatened with physical harm?
r Yes r No
Briefly describe:
Did employees indicate they have experienced a physical assault or
attack while employed? r Yes r No
Briefly describe:
If no, a sample survey is available as Appendix B. This survey may be used as is or adapted to meet divisional needs.
WORK SITUATION ASSESSMENT
6. Employees handle money, valuables or prescription drugs r Yes r No
Describe circumstances and potential workplace violence risks:
7. Employees deliver or collect items of value r Yes r No
Describe circumstances and potential workplace violence risks:
8.  Employees carry out inspection or enforcement duties
(e.g. enforces by-laws, policies and/or rules with clients or the public)
r Yes r No
Describe circumstances and potential workplace violence risks:
9.  Employees work in mobile workplaces with multiple work
locations r Yes r No
Describe circumstances and potential workplace violence risks:
10.  Employees provide service, care, advice or education to
individuals who may be violent r Yes r No
Describe circumstances and potential workplace violence risks:
11. Employees work in residential care setting r Yes r No
Describe circumstances and potential workplace violence risks:
12. Employees deal with individuals who may be under the
influence of drugs or alcohol r Yes r No
Describe circumstances and potential workplace violence risks:
13. Employees work alone r Yes r No
Describe circumstances and potential workplace violence risks:
14.  Employees work during late evening or early morning hours
r Yes r No
Describe circumstances and potential workplace violence risks:
15. Employees conduct home visits r Yes r No
Describe circumstances and potential workplace violence risks:
16. Employees work in community-based settings r Yes r No
Describe circumstances and potential workplace violence risks:
17. Employees travel to other countries r Yes r No
Describe circumstances and potential workplace violence risks:
18.  Employee’s deal with activities that may result in a negative or
confrontational response r Yes r No
Describe circumstances and potential workplace violence risks:
19. Employees (specify other risk factor) r Yes r No
Describe circumstances and potential workplace violence risks:
WORK LOCATION ASSESSMENT
20.  Parking lot
Entrances and exits well marked r Yes r No
Signs with security reminders (e.g. Lock your car) r Yes r No
Adequate lighting r Yes r No
Pass cards control access r Yes r No
After-hours parking r Yes r No
Vehicles have been stolen or broken into r Yes r No
Summarize any identified workplace violence risks associated with parking lots.
21. Building perimeter
Proximity to buildings, businesses or activities at risk
from violent crimes r Yes r No
Violent, criminal, drunk or drugged persons come
into building r Yes r No
High crime area r Yes r No
Isolated from other buildings r Yes r No
Signs of vandalism, graffiti, etc r Yes r No
Adequate lighting r Yes r No
Possible hiding spaces r Yes r No
Video surveillance r Yes r No
Summarize any identified workplace violence risks associated with the building perimeter.
22.  Security Systems
Security system in place r Yes r No
Security system regularly tested r Yes r No
Security guards available r Yes r No
Signs that security system is in place r Yes r No
Security cameras and mirrors in place as deterrent r Yes r No
Access controlled by reception, coded cards or keys r Yes r No
Reception area continuously staffed r Yes r No
Receptionist works alone r Yes r No
Emergency call button at reception area r Yes r No
Visitor policy to identify and escort visitors r Yes r No
Means of summoning immediate assistance if
workplace violence occurs r Yes r No
Summarize any identified security-related workplace violence risks.
23.  Signage
Signs identifying where to get emergency assistance r Yes r No
Visitor areas/ employee areas clearly marked r Yes r No
Exit signs r Yes r No
Rules for visitors clearly posted r Yes r No
Hours of operation clearly posted r Yes r No
Summarize any identified signage issues.
24.  Areas where someone might hide
Stairwells free of hiding spaces r Yes r No
Well lit stairwells r Yes r No
Empty rooms that should be locked are locked r Yes r No
Doorways are not recessed r Yes r No
Single or minimal points of entry r Yes r No
Good visibility in elevator before entry r Yes r No
Emergency phone or call button in elevators r Yes r No
Public uses different washroom than staff r Yes r No
Washrooms are checked before building is vacated r Yes r No
Summarize any workplace violence issues arising from potential hiding spaces
25.  Service counters
Barriers between employee and client (e.g. Plexiglas) r Yes r No
Adequate spacing across desk between employee and client r Yes r No
Other employees in close proximity r Yes r No
Area free of items that can be used as weapons r Yes r No
Summarize any service counter-related workplace violence issues
26.  Interview and Meeting Rooms (where meetings with clients are held)
Nature of work makes meeting/interview room potential
risk area r Yes r No
Separate interview/meeting rooms r Yes r No
Other employees can see inside meeting/interview room r Yes r No
Furniture arranged to allow for emergency exits r Yes r No
Alarm system in place r Yes r No
Summarize any interview/meeting room issues
27.  Individual offices or other discrete work area where workplace violence may be anticipated
Certain employees at higher risk because of office
layout or location r Yes r No
Furniture allows for minimum distance between
employees and clients r Yes r No
Furniture allows for quick exit r Yes r No
Interior visible from outside r Yes r No
Objects that can be used as weapons removed r Yes r No
Summarize any issues related to individual offices/discrete work areas
This assessment was completed in consultation with JHSC/H&S Rep
r Yes r No
A copy of this assessment has been provided to JHSC/ H&S Rep
r Yes r No
Date provided to JHSC/H&S Rep:

Guidelines for Implementing the Workplace Violence Policy Appendix A

May 2010 Page 8 of 8