GUIDELINES FOR IMPLEMENTING THE WORKPLACE VIOLENCE POLICY Appendix A WORKPLACE VIOLENCE RISK ASSESSMENT FORM Under the Occupational Health and Safety Act, an employer must assess the risk of workplace violence that may arise from the nature of the workplace, the type of work or conditions of work. The assessment must take into account the circumstances of the workplace and circumstances common to similar workplaces. The assessment should be reviewed at least annually and whenever there are significant changes in work operations that impact the potential for workplace violence. This form is intended as a tool to assist in assessing the types of workplace violence risks to which City employees may be exposed. It may be completed by work location (as may be most appropriate if the work performed by employees is conducted at a single fixed work location) or by work operation (as may be more appropriate if work is performed either in a mobile workplace and/or across a number of work locations). In either case, consideration must be given to the nature of the workplace(s), the type of work or the conditions of work. Divisions may choose to amend or add additional questions to this risk assessment, if needed, to further identify and assess workplace violence risks. If, in consultation with the JHSCs and/or OH&S representatives, a division identifies another risk assessment tool to be more appropriate for, or specific to, its work operations or workplaces, an alternative tool may be used to achieve compliance with the Occupational Health and Safety Act and the City s Workplace Violence Policy. Division: Location or Work Operation: Types of Functions Performed by Employees: Management Representative Completing Form: Date: REVIEW OF PAST INCIDENTS, EMPLOYEE CONCERNS AND JOINT HEALTH AND SAFETY COMMITTEE RECOMMENDATIONS 1. Have there been past incidents and investigations into workplace violence at this location or in this work operation? Yes If yes: The frequency of these incidents was: Approximately daily (Very frequent) Approximately monthly (Regularly) Approximately weekly (Frequent) Once a year or less (Infrequent) These incidents were (check all that apply): Verbal, in person Written Physical Verbal, by phone Threatening gestures May 2010 Page 1 of 8
The party responsible was a (check all that apply): Client Patient Stranger (Random member of the public) Resident Participant Co-worker or other City employee Other, specify The incident(s) took place in(check all that apply): City Office Client s Home Workplace Parking Lot Residence/Long Term Care Client s Business Location Office Lobby/Exit Interview/ Public Meeting Room Field/Mobile Operation 2. Have workers expressed safety concerns with respect to workplace violence at this location or in this work operation? Yes If yes, briefly describe the nature of worker concerns, the circumstances that caused these concerns and any resolutions reached. 3. Have JHSCs/OH&S representatives raised concerns respecting violence or made recommendations respecting violence at this location or in this work operation? Yes If yes, briefly describe the nature of JHSC/OH&S representative concerns, recommendations and any resolutions reached. 4. Has the division conducted an assessment of experiences with workplace violence at similar workplaces or in similar work operations? Yes If yes, summarize the information gathered through this process (e.g. examples, statistics). If no, seek sources of available information (e.g. other City divisions with similar work operations, other organizations with similar work operations, health and safety associations), follow up and summarize information received. May 2010 Page 2 of 8
INTERVIEWS OR SURVEYS WITH EMPLOYEES 5. Have interviews with employees or a survey been used to assess past incidents and concerns regarding workplace violence? Yes If no, a sample survey is available as Appendix B. This survey may be used as is or adapted to meet divisional needs. If yes, indicate when and briefly describe process used: Did employees indicate they have experienced verbal abuse? Yes Briefly describe: Did employees indicate they have experienced written threats? Yes Briefly describe: Did employees indicate they have been threatened with physical harm? Yes Briefly describe: Did employees indicate they have experienced a physical assault or attack while employed? Yes Briefly describe: If no, a sample survey is available as Appendix B. This survey may be used as is or adapted to meet divisional needs. WORK SITUATION ASSESSMENT 6. Employees handle money, valuables or prescription drugs Yes May 2010 Page 3 of 8
7. Employees deliver or collect items of value Yes 8. Employees carry out inspection or enforcement duties (e.g. enforces by-laws, policies and/or rules with clients or the public) Yes 9. Employees work in mobile workplaces with multiple work locations Yes 10. Employees provide service, care, advice or education to individuals who may be violent Yes 11. Employees work in residential care setting Yes 12. Employees deal with individuals who may be under the influence of drugs or alcohol Yes May 2010 Page 4 of 8
13. Employees work alone Yes 14. Employees work during late evening or early morning hours Yes 15. Employees conduct home visits Yes 16. Employees work in community-based settings Yes 17. Employees travel to other countries Yes 18. Employee s deal with activities that may result in a negative or confrontational response Yes May 2010 Page 5 of 8
19. Employees (specify other risk factor) Yes WORK LOCATION ASSESSMENT 20. Parking lot Entrances and exits well marked Yes Signs with security reminders (e.g. Lock your car) Yes Adequate lighting Yes Pass cards control access Yes After-hours parking Yes Vehicles have been stolen or broken into Yes Summarize any identified workplace violence risks associated with parking lots. 21. Building perimeter Proximity to buildings, businesses or activities at risk from violent crimes Yes Violent, criminal, drunk or drugged persons come into building Yes High crime area Yes Isolated from other buildings Yes Signs of vandalism, graffiti, etc Yes Adequate lighting Yes Possible hiding spaces Yes Video surveillance Yes Summarize any identified workplace violence risks associated with the building perimeter. 22. Security Systems Security system in place Yes Security system regularly tested Yes Security guards available Yes Signs that security system is in place Yes Security cameras and mirrors in place as deterrent Yes Access controlled by reception, coded cards or keys Yes Reception area continuously staffed Yes Receptionist works alone Yes May 2010 Page 6 of 8
Emergency call button at reception area Yes Visitor policy to identify and escort visitors Yes Means of summoning immediate assistance if workplace violence occurs Yes Summarize any identified security-related workplace violence risks. 23. Signage Signs identifying where to get emergency assistance Yes Visitor areas/ employee areas clearly marked Yes Exit signs Yes Rules for visitors clearly posted Yes Hours of operation clearly posted Yes Summarize any identified signage issues. 24. Areas where someone might hide Stairwells free of hiding spaces Yes Well lit stairwells Yes Empty rooms that should be locked are locked Yes Doorways are not recessed Yes Single or minimal points of entry Yes Good visibility in elevator before entry Yes Emergency phone or call button in elevators Yes Public uses different washroom than staff Yes Washrooms are checked before building is vacated Yes Summarize any workplace violence issues arising from potential hiding spaces 25. Service counters Barriers between employee and client (e.g. Plexiglas) Yes Adequate spacing across desk between employee and client Yes Other employees in close proximity Yes Area free of items that can be used as weapons Yes Summarize any service counter-related workplace violence issues 26. Interview and Meeting Rooms (where meetings with clients are held) Nature of work makes meeting/interview room potential risk area Yes Separate interview/meeting rooms Yes May 2010 Page 7 of 8
Other employees can see inside meeting/interview room Yes Furniture arranged to allow for emergency exits Yes Alarm system in place Yes Summarize any interview/meeting room issues 27. Individual offices or other discrete work area where workplace violence may be anticipated Certain employees at higher risk because of office layout or location Yes Furniture allows for minimum distance between employees and clients Yes Furniture allows for quick exit Yes Interior visible from outside Yes Objects that can be used as weapons removed Yes Summarize any issues related to individual offices/discrete work areas This assessment was completed in consultation with JHSC/H&S Rep Yes A copy of this assessment has been provided to JHSC/ H&S Rep Yes Date provided to JHSC/H&S Rep: May 2010 Page 8 of 8