Additional information and follow up is required for incidents of violence perpetrated on staff members (including for "near misses")
Name of Staff Victim *
Type of Violence/Assault *
- Select - Verbal abuse/Assault Threats Punching/Striking Scratching Pushing Kicking Biting Spitting Sexual touching/Assault Other (please specify)
Was medical attention/first aid administered? *
- Select - Yes No Not Sure
Was the staff member informed of the right to consult a physician? *
- Select - Yes No Not Sure
Has the incident been reported to the victim's supervisor? *
- Select - Yes No Not Sure
Have the required WorkSafe BC Forms been completed? *
- Select - Yes No Not Sure
Has the required investigation been conducted? *
- Select - Yes No Not Sure
Please describe the incident follow-up conducted and any recommendations to avoid future incidents of violence