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Reporting of Workplace Violence Incidents

The agency must develop and maintain a workplace violence incident report, in any format, that contains at a minimum:

• Workplace location where incident occurred
• Time of day/shift when incident occurred
• Detailed description of the incident, including events leading up to the incident, and how the incident was resolved
• Names and titles of employee(s) involved
• Name or other identifier of others involved
• Nature and extent of injuries arising from the incident
• Names of witnesses

The DOS Workplace Violence Incident Report is posted to the DOSNET intranet site within the Directory of Policies and Procedures.

Copyright 2015
New York State Governor's Office of Employee Relations
New York State Department of State
Human Resources Management Training & Development