Workplace Violence Prevention Plan

2026 

Piedmont Unified School District

760 Magnolia Ave.

Piedmont, CA 94611

(510) 594-2600

WORKPLACE VIOLENCE PREVENTION PLAN

Piedmont Unified School District

PROGRAM OBJECTIVES AND POLICY STATEMENT

As an employer subject to California Labor Code sections 6401.7 and 6401.9, and pursuant to California Senate Bill 553 (“SB 553”), Piedmont Unified School District  (“District”) established this Workplace Violence Prevention Plan (“WVPP” or “Plan”), which addresses the hazards known to be associated with the four types of workplace violence as defined by Labor Code section 6401.9.

The primary objective of the WVPP is to prevent and/or eliminate workplace violence as follows:

• Establish and maintain an effective WVPP;

• Provide a safe working environment;

• Establish policies, training, and communications to improve workplace violence prevention; and,

• Provide written records of workplace violence incidents and investigations, in accordance with the Plan.

The District hereby authorizes and ensures the establishment, implementation, and maintenance of this Plan and the documents/forms within this Plan.  The District is committed to ensuring the safety and well-being of its employees,  prohibits and will not tolerate any form of workplace violence by any employee or third party, including employees, vendors, visitors, parents, students, or others, on District property and at any District-sponsored events.

The WVPP shall be available at all times to employees, authorized employee representatives, representatives of the division, and Cal/OSHA.

Date of Last Review: N/A

Date of Last Revision(s): November, 2024

1. DEFINITION OF TERMS

1. Emergency: Unanticipated circumstances that can be life threatening or pose a risk of significant injuries to employees or other persons.

2. Engineering controls: An aspect of the built space or a device that removes a hazard from the workplace or creates a barrier between the employee and the hazard

3. Log: The violent incident log required by this Plan.

4. Plan: This workplace violence prevention plan required by Labor Code section 6401.9.

5. Serious injury or illness: Any injury or illness occurring in a place of employment or in connection with any employment that requires inpatient hospitalization for other than medical observation or diagnostic testing, or in which an employee suffers an amputation, the loss of an eye, or any serious degree of permanent disfigurement, but does not include any injury or illness or death caused by an accident on a public street or highway, unless the accident occurred in a construction zone.

6. Threat of violence: any verbal or written statement, including, but not limited to, texts, electronic messages, social media messages, or other online posts, or any behavioral or physical conduct, that conveys an intent, or that is reasonably perceived to convey an intent, to cause physical harm or to place someone in fear of physical harm, and that serves no legitimate purpose.

7. Workplace violence: any act of violence or threat of violence that occurs in a place of employment, including, but not limited to, the following: (i) the threat or use of physical force against an employee that results in, or has a high likelihood of resulting in, injury, psychological trauma, or stress, regardless of whether the employee sustains an injury; (ii) an incident involving a threat or use of a firearm or other dangerous weapon, including the use of common objects as weapons, regardless of whether the employee sustains an injury; and (iii) the following four types of workplace violence:

1. Type 1 violence: Workplace violence committed by a person who has no legitimate business at the worksite, and includes violent acts by anyone who enters the workplace or approaches employees with the intent to commit a crime.

2. Type 2 violence: Workplace violence directed at employees by students or visitors.

3. Type 3 violence: Workplace violence against an employee by a present or former employee, supervisor, or manager.

4. Type 4 violence: Workplace violence committed in the workplace by a person who does not work there, but has or is known to have had a personal relationship with an employee

Workplace violence does not include lawful acts of self-defense or defense of others.

8. Work practice controls: Procedures and rules which are used to effectively reduce workplace violence hazards.

9. Alarm: a mechanical, electrical, or electronic device that does not rely upon an employee’s vocalization in order to alert others.

10. Environmental risk factors: factors in the facility or area in which services or operations are conducted that may contribute to the likelihood or severity of a workplace violence incident, including, but not limited to, risk factors associated with the specific task being performed, such as the collection of money

2. RESPONSIBLE PERSONS

The WVPP Administrator, Ariel Dolowich, Assistant Superintendent, has the authority and responsibility for implementing and maintaining this Plan.  In the absence of the WVPP Administrator, the person with authority and responsibility for implementation of this Plan is the immediate supervisor of affected employee[s].

The WVPP Administrator will be accountable for implementation and maintenance of this program. School Site Principals and all supervisors within the district are responsible for implementing and maintaining the Plan in their areas of responsibility and will provide day-to-day program support, guidance and training to the individual employees regarding the District Plan.

A copy of the WVPP may be obtained from each manager, supervisor and/or principal.  All managers and supervisors are responsible for implementing and maintaining the WVPP in their work areas and for answering employee questions about the WVPP. 

3. EMPLOYEE ACTIVE INVOLVEMENT

The District shall obtain the active involvement of employees in developing and implementing the Plan, including their participation in: identifying, evaluating, and correcting workplace violence hazards; designing and implementing training; reporting and investigating workplace violence incidents; and, reviewing the Plan.  The District may carry out its responsibilities by the methods listed below:

1. Provide employees and authorized employee representatives with meaningful opportunities to participate in identifying, evaluating, and determining corrective measures to prevent and address workplace violence.

2. Hold periodic safety meetings with employees to discuss identification of workplace violence related concerns/hazards, evaluate those hazards and/or concerns, and how to correct them. These meetings may include brainstorming sessions, discussions of recent incidents, reviews of safety procedures, and updates to safety measures.

3. Maintain an online form where employees can provide suggestions, feedback or concerns regarding the Plan and/or violence at the District.

4. Prepare written records of workplace violence issues discussed at safety meetings, and make copies of the records available to all affected employees.

5. Communicate safety and health issues to each site/department and coordinate training.

6. Provide the Plan to employees.

REPORTING AND INVESTIGATING WORKPLACE VIOLENCE INCIDENTS

It is the duty of every employee to immediately or as soon as is practical report any incident or viable threat of workplace violence.  All reports shall be kept as confidential as possible under the circumstances. It is the duty of the WVPP Administrator to investigate reports made pursuant to this WVPP.

Those submitting reports pursuant to this WVPP shall be free from retaliation for reporting concerns regarding workplace violence.  (See District Board Policy (“BP”) and Administrative Regulation (“AR”) 4030, Non-Discrimination in Employment [Including Sexual Harassment], Intimidation, Bullying and Cyberbullying, for more information;.)

All employees will follow workplace violence prevention plan directives, policies, and procedures, and assist in maintaining a safe work environment.  The District has created and implemented several systems to ensure employees are capable of, and will, comply with WVPP directives.

4. EMPLOYEE COMPLIANCE

The District is committed to ensuring a safe and secure workplace. The District has developed a system to ensure that employees comply with the rules and work practices designed to promote and ensure a safe workplace.  Herein is a brief description of key measures that support the effective implementation and enforcement of this WVPP:

1. Train employees, supervisors, and managers in the provisions of this WVPP.
2. Develop and implement effective procedures to ensure that supervisory and nonsupervisory employees comply with the WVPP.
3. Provide retraining to employees whose safety performance is deficient with the WVPP.
4. Recognize employees who demonstrate safe work practices that promote the WVPP in the workplace by providing certificates of completion upon completion of key trainings, certificates of recognition for employees who promote the prevention of workplace violence, and by sending out company-wide messages to celebrate individuals going above and beyond to ensure a safe and secure workplace.
5. Discipline employees for failure to comply with the WVPP.

Under certain circumstances, failure to report a threat of violence and/or a job-related accident, or to follow other prescribed procedures relating to workplace safety, may result in an employee being subject to disciplinary measures.  (See District AR 4117.4, Dismissal; BP/AR 4118, Suspension/Disciplinary Action; AR 4216, Disciplinary Action/ Suspension/ Dismissal (Classified Employees); BP/AR 4218, Dismissal/Suspension/Disciplinary Action.)

No employee will be subject to any discipline, retaliation or reprisal for reporting or communicating regarding workplace violence or any injury resulting from workplace violence.

5. COMMUNICATION WITH EMPLOYEES

The District recognizes that open communication between administration, staff, and other employers, where applicable, regarding workplace violence is essential to a safe and productive workplace.  The District’s communication procedures are designed to encourage and facilitate a continuous flow of information between management, employees and other employers regarding any suggestions, concerns or information relating to health, safety or security issues, without fear of reprisal and in a form that is readily understandable by all affected employees.

The District will ensure that all workplace violence policies and procedures within this Plan are clearly communicated to and understood by all employees, including any revisions to the Plan.

All employees may communicate suggestions, concerns or information regarding workplace violence either directly to their supervisor or manager.

In addition to other communications required by this Plan, the District shall communicate with employees regarding:

1. How an employee can report a violent incident, threat, or other workplace violence concern to the District or law enforcement without fear of reprisal.  (Please see the “Reports of Workplace Violence” section of this Plan.)
2. How employee concerns will be investigated in a timely manner and how employees will be informed of the results of the investigation and any corrective actions to be taken, in accordance with the “Hazard Identification, Evaluation and Correction,” and “Investigation and Post Incident Response” sections of this Plan.

The District shall also communicate with employees regarding workplace violence matters using the following methods:

1. Hosting new employee orientation on workplace security policies, procedures, and work practices, including the Plan.
2. Ensuring WVPP Administrator, Principals, and/or Supervisors attend staff meetings throughout the District to obtain employee input.
3. Conducting regularly scheduled school safety committee meetings that address security issues and potential workplace violence hazards. All meetings should be documented, including, but not be limited to, signed attendance rosters, agenda for items discussed, and minutes of the meetings.
4. Communicating safety and health issues to each school or worksite.
5. Posting or distributing workplace safety and violence prevention information, including regarding any identified workplace violence hazards.
6. Maintaining an online form where employees can provide suggestions, feedback, or concerns regarding the Plan and/or violence at the District.
7. Communicating procedures for employees to inform the District about workplace security hazards, workplace violence, or threats of violence, including in accordance with the “Reports of Workplace Violence” section of this Plan.
8. Making the Plan available to all employees upon request at no cost.
9. Hosting training and re-training programs, as provided in the Plan.
10. Establishing and maintaining effective communication between employees and supervisors and managers about workplace violence concerns, including in accordance with the “Reports of Workplace Violence” and “Hazard Identification, Evaluation and Correction” sections of this Plan.

REPORTS OF WORKPLACE VIOLENCE

The District requires all employees to report workplace violence (including threats of violence), as described below.  The District requires completion of a Violent Incident Report Form (Attachment A) when workplace violence occurs, except as described below.  The affected employee or the person receiving the report may complete the Violent Incident Report Form.

In addition, employees may communicate suggestions, concerns or information regarding workplace violence either directly to their supervisor or manager or in accordance with this section and the “Communications” section of this Plan.

No District employee shall be subject to any discipline, retaliation or reprisal for reporting a concern regarding workplace violence, workplace violence or any injury resulting from workplace violence to the District or law enforcement.  Any employee, including any supervisor or manager, who retaliates against an employee for reporting a concern regarding workplace violence, workplace violence or any injury resulting from workplace violence is subject to discipline, up to and including termination. Depending on the nature of the incident and the content of any report made to law enforcement or the District, the District may provide an employee with counseling or training, as warranted, regarding appropriate circumstances to make a report of workplace violence.

Nothing in this policy shall prevent an employee from accessing the employee’s cellular telephone or other communication devices to seek emergency assistance, assess the safety of an emergency situation, or communicate with a person to verify their safety.

Incidents of workplace violence must be reported using either the following by completing the form in Attachment A or the link found in Attachment B.  Reports may be completed and submitted as follows:

1. To the WVPP Administrator, school site Principal or the employee’s supervisor.
2. Using an online form where employees can report workplace violence, threats or concerns.
3. To law enforcement, as appropriate.

Any person receiving a report of workplace violence shall forward it immediately to the WVPP Administrator.

The WVPP Administrator, Principal and/or Supervisor shall accept and respond to reports of workplace violence, as described in this Plan. In addition to reviewing the Violent Incident Report Form as described above, the WVPP Administrator, Principal and/or Supervisor is responsible for recording information relating to each occurrence of workplace violence in the Violent Incident Log.

If workplace violence results in an injury requiring the completion of other documents, such as a California Department of Industrial Relations Form 5020 (Employer’s Report of Occupational Injury or Illness), the Cal/OSHA Form 301 Injury and Illness Incident Report, and/or California Department of Industrial Relations, Division of Workers’ Compensation Form DWC-1 (Workers’ Compensation Claim Form), then no Violent Incident Report Form is required. All forms are processed and stored in accordance with the applicable laws and regulations relating to those forms. Even if no Violent Incident Report Form is completed, the information required by this Plan must still be recorded in the Violent Incident Log.

Employees may also report incidents of workplace violence to law enforcement, as appropriate.

Emergency Situations

During any emergency situation, any District personnel observing the situation should:

1.        Get to safety.

2.        Call 911 when safe to do so.

Non-Emergency Situations

Contact numbers for the District, local law enforcement and emergency services agencies may be available in every district or school site office. During any non-emergency situation, employees involved in a workplace violence incident must report it, as described above. The WVPP Administrator, Principal and/or Supervisor may then report the incident to law enforcement, if warranted.

Any employees who report workplace violence and believe they are being subjected to discipline, retaliation or reprisal should report it to Human Resources immediately.

1. RESPONSE TO WORKPLACE VIOLENCE EMERGENCIES

In addition to the other provisions of this Plan, the District shall respond to actual or potential workplace violence, including emergencies, by the methods described below:

1. Making this Plan available to employees.
2. Informing employees how to obtain help from the District and law enforcement.  Employees may contact law enforcement by dialing 911.  The contact information for local law enforcement is: Piedmont Police Department (510) 420-3000.
3. Establishing and using effective means to alert employees of the presence, location and nature of workplace violence emergencies by text message and email alerts.
4. Developing and informing employees of evacuation and sheltering plans that are appropriate and feasible for the employees’ worksite and when to implement those plans.

2. COORDINATION WITH OTHER EMPLOYERS

The District shall coordinate implementation of the Plan with all other employers whose employees (“third-party employers and/or employees”) provided services to the District on District property. The District may coordinate the implementation of the Plan with other employers by the following methods:

1. Providing all third-party employers a copy of the relevant worksite Plan and obtain copies of each third-party employer’s Plan.

2. Requiring all third-party employees to report all reportable incidents (as defined in this Plan) to the appropriate supervisor, manager or other designated person, and participate in any investigations, as required by this Plan and/or other District policies and procedures.

3. Coordinating procedures with third-party employers for reporting, investigating, and documenting workplace violence incidents.

3. WORKPLACE VIOLENCE INCIDENT REPORTING PROCEDURES

The District will implement procedures to ensure that:

1. All threats or acts of workplace violence shall be reported to an employee’s supervisor or manager, who will inform the WVPP administrator.  This will be accomplished, in part, by ensuring that the policies and procedures contained in the WVPP are appropriately communicated to District employees.

If reporting to a supervisor or manager is impractical or impossible, employees may report incidents directly to the WVPP Administrator, Ariel Dolowich.

2. Upon receiving a report pursuant to this WVPP, the District shall conduct a fair, thorough, and timely investigation into the report.  The investigation will be handled in as confidential a manner as possible, although complete confidentiality cannot always be guaranteed.  Investigations will provide all parties with an appropriate process for reporting concerns, and, when applicable, provide parties complained against whom there are allegations with an opportunity to be heard and to respond to such reports.
3. Depending on the specific circumstances surrounding the report, the underlying conduct that gave rise to the report, and with sensitivity to issues around confidentiality and safety, the District will provide updates on the status of investigations and corrective actions will be provided to employees through email and at safety meetings.
4. Under certain circumstances, employees may anonymously report a violent incident, threat, or other concerns around violence by either: (2) submitting an electronic report (link found in Attachment B), or (2) submitting in-person a written or printed copy of a report (found in Attachment A) to the attention of Ariel Dolowich at the Piedmont Unified School District district office at 760 Magnolia Ave. Piedmont, CA 94611.
5. The District has a strict no retaliation policy.  Any claims of retaliation shall be investigated.  (See District BP/AR 4030, Non-Discrimination in Employment [Including Sexual Harassment], Intimidation, Bullying and Cyberbullying, for more information.) Consistent with these policies, an employee who retaliates against a co-worker for reporting an incident may be subject to discipline, up to and including termination.

4. EMERGENCY RESPONSE PROCEDURES

The District has in place School Safety Plans that outline emergency response procedures including the following specific measures to handle actual or potential workplace violence emergencies:

6. Effective means to alert employees of the presence, location, and nature of workplace violence emergencies by the following: text, email, handheld radios, alarm systems, and PA announcements.
7. The District has evacuation and sheltering plans.  These plans include:

1. Maps of evacuation routes
2. Locations of emergency exits
3. Instructions for sheltering in place
4. Relevant contact information to obtain help from staff, and law enforcement
5. Procedures for activating the incident command system.
6. Calling 911 if there is immediate danger.

5. WORKPLACE VIOLENCE HAZARD IDENTIFICATION AND EVALUATION

The District will implement the following policies and procedures to identify and evaluate workplace violence hazards:

7. Review all submitted/reported concerns of potential hazards and/or actual incidents of workplace violence.  
8. Conduct inspections when the Plan is first established, after each workplace violence incident, and whenever the District is made aware of a new or previously unrecognized hazard.
9. Conduct periodic inspections of workplace violence hazards to identify unsafe conditions and work practices.  This may require assessment for more than one type of workplace violence.  Periodic Inspections shall be managed by Pete Palmer in conjunction with Keenan Loss Prevention Inspector and Piedmont Fire Marshal.
10. Conduct inspections for workplace violence hazards include assessing classrooms, office spaces, hallways, common spaces, gyms, theaters, multi-purpose rooms, and bathrooms.
11. Assess the following specific environmental risk factors:

1. Exterior and interior of the workplace for its accessibility and security.
2. Need for surveillance measures, such as mirrors and cameras.
3. Procedures for reporting suspicious persons or activities.
4. Location and functioning of emergency buttons and alarms.
5. Posting of telephone numbers for law enforcement, fire, and medical services.
6. Employee access to a telephone with an outside line; whether employees have effective escape routes from the workplace; and, whether employees have a designated safe area where they can go to in an emergency.
7. Adequacy of workplace security systems, such as door locks, entry codes or badge readers, security windows, physical barriers, and restraint systems.
8. Employees’ skill in safely handling threatening or hostile individuals.
9. Effectiveness of systems and procedures that warn others of actual or potential workplace violence danger or that summon assistance (e.g., alarms or panic buttons).
10. Availability of employee escape routes.
11. Access to and freedom of movement within the workplace by non-employees, including recently discharged employees or persons with whom one of our employees is having a dispute.
12. Frequency and severity of employees’ reports of threats of physical or verbal abuse by managers, supervisors, or other employees.
13. Any prior violent acts, threats of physical violence, verbal abuse, property damage or other signs of strain or pressure in the workplace.

6. WORKPLACE VIOLENCE HAZARD CORRECTION

Workplace violence hazards will be evaluated and corrected in a timely manner. The District will implement the following effective procedures to correct workplace violence hazards that are identified:

8. If an imminent workplace violence hazard exists that cannot be immediately abated without endangering employee(s), all endangered employee(s) will be removed from the situation except those necessary to correct the existing condition. Employees necessary to correct the hazardous condition will be provided with the necessary protection.
9. All corrective actions taken will be appropriately documented, communicated, and retained as sensitive records.
10. Corrective measures for workplace violence hazards will be specific to a given work area and will be identified through various means discussed throughout this plan: employee training, periodic inspections and safety meetings, communication with employees, and workplace violence hazard identification and evaluation. 

7. PROCEDURES FOR POST-INCIDENT RESPONSE AND INVESTIGATION

After a workplace violence incident, the WVPP Administrator or their designee will implement the following post-incident procedures:

11. Visit the scene of an incident as soon as safe and practicable.
12. Interview involved parties, such as employees, witnesses, law enforcement, and/or security personnel.
13. Review security footage of existing security cameras, if applicable.
14. Examine the workplace for security risk factors associated with the incident, including any previous reports of inappropriate behavior by the perpetrator.
15. Determine the cause of the incident.
16. Take corrective action to prevent similar incidents from occurring.
17. Record the findings and ensure corrective actions are taken.
18. Obtain any reports completed by law enforcement.
19. Input into the Violent Incident Log will every workplace violence incident and include information, such as:

1. Date, time, and location of the incident.
2. Workplace violence type, or types, involved in the incident, including, but not limited to, whether it involved any of the following:

1. Physical attack without a weapon, including, but not limited to, biting, choking, grabbing, hair pulling, kicking, punching, slapping, pushing, pulling, scratching, or spitting.
2. Attack with a weapon or object, including, but not limited to, a firearm, knife, or other object.
3. Threat of physical force or threat of the use of a weapon or other object.
4. Sexual assault or threat, including, but not limited to, rape, attempted rape, physical display, or unwanted verbal or physical sexual contact.
5. Animal attack.

3. A detailed description of the incident.
4. Description of who committed the violence, e.g., former employee, parent, etc.
5. Description of circumstances at the time of the incident, including, but not limited to, whether the employee was completing usual job duties, working in poorly lit areas, rushed, working during a low staffing level, isolated or alone, unable to get help or assistance, etc.
6. Description of where the incident occurred, such as in the workplace, parking lot or other area outside the workplace, or other area.
7. Consequences of the incident, including, but not limited to:

1. Whether security or law enforcement was contacted and their response.
2. Actions taken to protect employees from a continuing threat or from any other hazards identified as a result of the incident.

8. Information about the person completing the log, including their name, job title, and the date completed.

20. Review all previous incidents.

8. TRAINING AND INSTRUCTION

All employees, including managers and supervisors, will have training and instruction on general and job-specific workplace violence practices. These sessions could involve presentations, discussions, and practical exercises. Training will occur:

21. When the WVPP is first established.
22. Annually to ensure all employees understand and comply with the Plan.
23. Whenever a new or previously unrecognized workplace violence hazard has been identified and when changes are made to the plan. The additional training may be limited to addressing the new workplace violence hazard or changes to the plan.

Training will address or include:

24. Instruction on the definitions found throughout this plan and the requirements listed below.
25. Review of and access to this WVPP, how to obtain a copy of the Plan at no cost, and how to participate in development and implementation of the Plan.
26. Procedures for reporting workplace violence incidents or concerns to the employer or law enforcement without fear of reprisal.
27. Workplace violence hazards specific to the employees’ jobs, the corrective measures the District has implemented, how to seek assistance to prevent or respond to violence, and strategies to avoid physical harm.
28. The violent incident log and how to obtain copies of records pertaining to hazard identification, evaluation and correction, training records, and violent incident logs.
29. Opportunities for interactive questions and answers with a person knowledgeable about the District operations.
30. Strategies to avoid/prevent workplace violence and physical harm, such as:

1. How to recognize workplace violence hazards including the risk factors associated with the four types of workplace violence.
2. Ways to defuse hostile or threatening situations.
3. How to recognize alerts, alarms, or other warnings about emergency conditions and how to use identified escape routes or locations for sheltering.

31. Emergency medical care provided in the event of any violent act upon an employee.

9. EMPLOYEE ACCESS TO THE WRITTEN WVPP

The District ensures that the WVPP plan shall be in writing and shall be available and easily accessible to employees, authorized employee representatives if applicable, and representatives of Cal/OSHA at all times.  This will be accomplished by:

32. The District will provide a printed and/or electronic copy of the WVPP if it is requested by an employee.
33. The District will also provide unobstructed access through KnowledgeBase which allows an employee to review, print, and email the current version of the written WVPP.

10. RECORDKEEPING

The District will:

34. Create and maintain records of workplace violence hazard identification, evaluation, and correction, for a minimum of five (5) years.
35. Create and maintain training records for a minimum of one (1) year and include the following:

1. Training dates.
2. Contents or a summary of the training sessions.
3. Names and qualifications of persons conducting the training.
4. Names and job titles of all persons attending the training sessions.

36. Maintain violent incident logs for a minimum of five (5) years.
37. Maintain records of workplace violence incident investigations for a minimum of five (5) years.  (The records shall not contain medical information per subdivision (j) of section 56.05 of the Civil Code.)
38. All records of workplace violence hazard identification, evaluation, and correction; training, incident logs and workplace violence incident investigations required by Labor Code section 6401.9(f), shall be made available to Cal/OSHA upon request for examination and copying.

11. EMPLOYEE ACCESS TO RECORDS

The following records shall be made available to employees and their representatives, upon request and without cost, for examination and copying within 15 calendar days of a request:

39. Records of workplace violence hazard identification, evaluation, and correction.
40. Training records.
41. Violent incident logs.

12. REVIEW OF AND REVISION TO THE WVPP

1. The District’s WVPP will be reviewed for effectiveness:

1. At least annually.
2. When a deficiency is observed or becomes apparent.
3. After a workplace violence incident.
4. As needed.

2. Review and revision of the WVPP will include the procedures listed in various sections of this WVPP, as well as the following procedures to obtain the active involvement of employees in reviewing the plan’s effectiveness.  Review of the District’s WVPP should include, but is not limited to:

1. Review of incident investigations and the violent incident log.
2. Assessment of the effectiveness of security systems, including alarms, and emergency response.

3. Ensure that violence risks are being properly identified, evaluated, and corrected. Any necessary revisions are made promptly and communicated to all employees. Revisions may involve changes to procedures, updates to contact information, and additions to training materials.

13. EMPLOYER REPORTING RESPONSIBILITIES

As required by California Code of Regulations (CCR), Title 8, Section 342(a), “Reporting Work-Connected Fatalities and Serious Injuries,” the District will immediately report to Cal/OSHA any serious injury or illness (as defined by CCR, Title 8, Section 330(h)), or death (including any due to Workplace Violence) of an employee occurring in a place of employment or in connection with any employment.

STATEMENT OF AUTHORIZATION

[“I, Ariel Dolowich, Assistant Superintendent of the Piedmont Unified School District, hereby authorize and ensure, the establishment, implementation, and maintenance of this written workplace violence prevention plan and the documents/forms within this written plan. I am committed to ensuring the safety and well-being of our employees and believe that these policies and procedures will help us achieve that goal.”]

______________________________________        ______________________________________

Name of Authorizing Person                        Title

______________________________________        ______________________________________

Signature                                                 Date

ATTACHMENT A

Violent Incident Reporting Form

Check which of the following describes the type(s) of incident, and explain in detail:

• Physical attack without a weapon (e.g., biting, choking, grabbing, hair pulling, kicking, punching, slapping, pushing, pulling, scratching, or spitting)

• Attack with a weapon or object (e.g., firearm, knife, other object)

• Threat of physical  force or threat of the use of a weapon or other object

• Sexual assault or threat (e.g., rape, attempted  rape, physical display, or unwanted verbal or physical sexual contact)

• Verbal harassment

• Animal attack

• Other

Detailed description of the incident and any additional information on the violence incident type and what it included:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Circumstances  at the time of the incident (e.g., victim performing usual job duties, poor lighting, rushed, working during low staffing level, isolated/alone,  unable to get help/assistance, working in unfamiliar/new location, other):

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Location of Incident  (e.g., office, classroom,  hallway, bathroom,  parking lot, playground,  etc.):

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Consequences  of the incident,  including,  but not limited to:

• Whether  law enforcement  was contacted  and their response.

• Actions  taken to protect employees  from a continuing  threat or from any other hazards  identified as a result of the incident.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Were there any injuries?  Select.  Please explain:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Were emergency  medical responders,  other than law enforcement  contacted,  such as a Fire Department, Paramedics,  On-site First-aid certified personnel?  Select.  If yes, explain below:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Did the severity of the injuries require reporting to Cal/OSHA?  If yes, document  the date and time this was done, along with the name of the Cal/OSHA representative contacted.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A copy of this violent incident log needs to be provided to the District.  Indicate date/time it was provided  and to whom (name/title). ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

This violent incident log was completed  by:

NAME: __________________________________

TITLE: __________________________________

SIGNATURE:         __________________________________        DATE:  ____________________

ATTACHMENT B

Link to Online Feedback and Reporting Form

https://forms.gle/9Ny3pA6wXKi8vmkL8

ATTACHMENT B

Link to Violent Incident Log

https://forms.gle/KzQxLDx1p9AMfEP26