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Workplace Violence Incident Survey
Here at Home Trust we want to ensure that all our employees feel safe, therefore we are currently gathering data on workplace violence incidents in order to continue our efforts of preventing violence against employees in the workplace. Information in this survey is confidential and will only be used for the purpose of collecting data on the occurrences of violence in the workplace.
Based on Bill 168, workplace violence is defined as any physical force by a person with the intent or consequence of bodily harm, statement or behaviour that is reasonable for a worker to interpret as a threat to exercise physical force, or using any verbal comments or conduct against a worker which includes bullying, intimidating, offensive jokes or innuendos, displaying or circulating offensive pictures or materials, or offensive or intimidating phone calls.
 
Please use the below survey to provide information about any incidences of workplace violence you have experienced.
Thank you
 
 
 
During my time here at Home Trust, I have experienced or observed workplace violence:
 
Within the past month
 
Within the past 6 months
 
Within the past year
 
Over a year ago
 
Never
 
 
 
Please select from the below options the type(s) of workplace violence that best describes what you experienced or observed:
 
Unwanted sexual advances
 
Domestic Violence
 
Verbal Assault
 
Stalking
 
Threats (verbal or through phone, email)
 
Racial slurs
 
Rape
 
Destruction of property
 
Sexual Assault
 
Having your work sabotaged
 
Physical Assault
 
Other: Please specify
 
 
 







Have you experienced verbal abuse (swearing, insults, teasing, or bullying) while an employee of this company?


 
Yes
 
No
 
 
 
Have you experienced verbal or written threats (e.g. “If you don’t get off my case, you’ll regret it!”) while an employee of this company?
 
Yes
 
No
 
 
 
Have you been threatened with physical harm (e.g. shaking a fist, throwing objects, committing vandalism) while an employee of this company?
 
Yes
 
No
 
 
 
Have you experienced a physical assault or attack while an employee of this company?
 
Yes
 
No
 
 
 
If yes to any of the above, did you report the incident(s)?
 
Yes
 
No
 
 
 
If yes, did you report the incident(s)
 
Orally
 
In Writing
 
 
 
How did you feel that the situation was dealt with?
 
Very Good
 
Good
 
Ok
 
Bad
 
Very Bad
 
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