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Wilfrid Laurier University Safety, Health, Environment & Risk Management
November 1, 2014

Canadian Excellence

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Safety, Health, Environment & Risk Management

WORKPLACE VIOLENCE RISK ASSESSMENT


Managers/Supervisors:

Please review the risk factors provided below and determine if any are associated with positions under your area of responsibility.

Submit a risk assessment form for positions that have one or more risk factor(s) associated with their duties. One form may be completed for a group of positions possessing similar duties and comparable risks i.e. faculty members, parking attendants, administrative assistants.

If you wish to submit additional information to support this form, please forward it to:

Safety, Health, Environment & Risk Management
232 King Street, #K101
(include your name, department and the position the violence risk assessment was completed for)

For further information, refer to the Workplace Violence Prevention Program or contact SHERM.

ALL INFORMATION RECEIVED REGARDING PAST OCCURRENCES OF VIOLENCE WILL BE KEPT CONFIDENTIAL.


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Is this position(s) required to work alone (not directly supervised and emergency assistance is not readily available. Not nearby or within shouting distance of another person)?:
Is this position(s) required to travel to remote locations or hazardous regions (remote area: secluded/isolated from emergency services, hazardous regions: identifed by police services or the Government of Canada as having possible safety concerns)?:
Does this position(s) deal with highly sensitive or controversial personal matters or make decisions that impact academic or employment status?:
Is this position(s) required to provide services directly to members of the public?:
Is this position(s) required to handle, secure or protect cash or other tangible valuables including narcotics or other drugs?:
Is this position(s) required to patrol and respond to security conditions and provide protective services?:
Is this position(s) required to deal with unstable/volatile individuals?:
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updated June 21/13