Workplace Violence Incident Report Sheet
Incident Information
Date of Incident
Time of Incident
Location of Incident
Person Reporting
Name
Department
Contact Information
People Involved
Alleged Aggressor(s)
Victim(s)
Witness(es)
Incident Description
Describe the incident (include actions, words, events, injuries, etc.)
Action Taken
Immediate action taken
Reported to (manager, HR, police, etc.)
Additional Notes
Signature
Signature
Date