Workplace Violence Hazard Identification Form

As part of its efforts to mitigate and prevent workplace violence, The Museum School encourages all employees to identify and report potential workplace violence hazards to the company to be evaluated and addressed under the company’s Workplace Violence Prevention Plan (WVPP).

Use this form to identify potential workplace violence hazards specific to your work area, operation, or department. Additionally, identify potential corrective measures that the school should consider in addressing the potential hazard. Provide as much detail as possible. Use additional pages if necessary.

You may submit this form anonymously if preferred. The Museum School will not retaliate against anyone for submitting information concerning workplace violence, including reporting a workplace violence incident, nor will it tolerate or permit retaliation by management, employees, or coworkers for submitting such information.


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Date *
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Name (Optional)
Job Title (Optional)
Please identify any potential workplace violence hazards that may be present in your specific work area, operation, or department. Please be as specific as possible when describing the hazard.
*
Please identify and describe corrective measures for The Museum School to consider when addressing the potential workplace violence hazard identified above.
*
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