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Workplace Violence Documentation
Person reporting:
Location of event:
Date of event:
Time of event:
Define behaviors, acts, or actions (who, what, when, where, how):
Who was involved? (names, positions, job titles)
Who witnessed the action?
What were the consequences of the action to you? To others?
What action did you take?
Who did you notify? When?
What efforts did you make to document the incident and where is the documentation located?
If you confronted the person taking action, what occurred during the interaction?