Sample Threat and Assault Log

This type of log can help summarize and characterize reports of threats and assaults in your company over the course of a year. This information may prove helpful to your workplace violence prevention group (or administrator) when considering the need for additional hazard assessment, prevention measures or training.

Threat and Assault Log Year____________

Threat & Assault Information

January - June

July - December

Total

Number of Threats & Assaults      
Type of Threat or Assault # Threats # Assaults # Threats # Assaults # Threats # Assaults
Type 1 / Threat or assault by stranger            
Type 2 / Threat or assault by customers/clients            
Type 3 / Threat or assault by co-workers            
Type 4 / Threat or assault by personal relations            
Gender of Victims and Pepetrators # Threats # Assaults # Threats # Assaults # Threats # Assaults
Number of female victims            
Number of male victims            
Number of female perpetrators            
Number of male perpetrators            
Time of Threats & Assaults # Threats # Assaults # Threats # Assaults # Threats # Assaults
Day shift            
Evening shift            
Night shift            
On weekend            
Location of Threats & Assaults # Threats # Assaults # Threats # Assaults # Threats # Assaults
On work premises            
Parking lot            
Other duty station            
Other Considerations # Threats # Assaults # Threats # Assaults # Threats # Assaults
Threats and assaults involving firearms            
Threats and assaults involving other weapons (not firearms)            
Number of cases where the victim was working in isolation            
Result of Threats & Assaults
Death      
Physical injury      
Stress/psychological impairment      
No injury      

Adapted from: Workplace Violence: Awareness and Prevention for Employers and Employees, Washington State Department of Labor and Industries

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