Free Workplace Violence Incident Report Template
Workplace Violence Incident Report
I. Incident Description
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Date and Time of Incident: May 15, 2054, 2:30 PM
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Location of Incident: Breakroom
Description: The incident involved a physical altercation between two female employees in the breakroom. On May 15, 2054, at 2:30 PM, Sarah Johnson, a sales associate, was involved in an aggressive confrontation with Emily Thompson, a customer service representative, resulting in a physical altercation. The altercation was witnessed by several employees, and security personnel were immediately notified to intervene.
II. Involved Parties
A. Complainant
Statement: The complainant reports that they were involved in a verbal altercation with another individual that escalated into a physical confrontation.
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Name: Sarah Johnson
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Position: Sales Associate
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Contact Information: 022-111-3334
B. Accused
Statement: The accused acknowledges their involvement in the altercation and provides their perspective on the incident.
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Name: Emily Thompson
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Position: Customer Service Representative
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Contact Information: 111-222-2343
III. Witnesses
A. Witness 1
Statement: "As a witness to the altercation, I observed the events leading up to and during the altercation, providing my account of what transpired."
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Name: Lily Adams
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Position: Marketing Coordinator
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Contact Information: 555-123-4567
B. Witness 2
Statement: "As an observer of the altercation, I provided my perspective on the incident, including any actions taken to intervene or assist."
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Name: Sophia Lee
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Position: Human Resources Assistant
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Contact Information: 444-222-4344
IV. Preventive Measures
A. Immediate Actions Taken
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Security Intervention |
Security personnel intervened and separated the complainant and the accused. |
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Temporary Leave |
The complainant and the Accused were escorted to separate areas and placed on temporary leave pending further investigation. |
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Medical Assistance |
Medical assistance was offered to both employees to address any injuries sustained during the altercation. |
B. Planned Actions
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Investigation |
HR will conduct a thorough investigation into the incident, including interviews with witnesses and involved parties. |
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Counseling Sessions |
Counseling and conflict resolution sessions will be provided to both employees to address underlying issues and prevent future incidents. |
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Security Measures |
Enhanced security measures will be implemented in the workplace to prevent similar occurrences. |
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Responsible Person: Jane Doe, HR Manager
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Contact Information: 222-333-4444
V. Conclusion
The incident report concludes the documentation of the workplace violence incident involving the complainant and the accused. Immediate actions were taken to address the situation and ensure the safety of all employees. Planned actions will focus on investigating the incident further, providing support and counseling to the involved parties, and implementing preventive measures to mitigate the risk of similar incidents in the future.
VI. Report Submission
Report Created By: [Your Name]
Role: [Your Role]
Date: May 17, 2054
Phone: [Your Company Number]
Company Email: [Your Company Email]
Company Address: [Your Company Address]
