WORKPLACE VIOLENCE QUESTIONNAIRE
The university’s zero tolerance
policy on acts or threats of violence to employees, students
and visitors was developed for the protection of the university
community. Workplace violence includes, but is not limited
to the following definition:
- any act which is physically assaultive
- any substantial threat to harm or to endanger the safety
of others
- behaviors or actions interpreted by a reasonable person
as carrying the potential for violence and/or acts of aggression
- any substantial threat to destroy property
- possession on campus of any weapon or dangerous instrument
(i.e., firearms, certain knives, brass or metal knuckles,
etc)
The university has an obligation
to provide awareness training on this subject and alert the
campus community to the potential for violence when a department
requests the training. This questionnaire will be used
to determine what level of vulnerability and awareness your
department has concerning workplace violence. It will be
used to develop a training session specifically geared toward
your concerns.
PLEASE PRINT, FILL OUT, AND RETURN TO EH&IS, T-1475
DEPARTMENT: ______________________________________________________
Have you experienced an incident of workplace violence while
here at CSUF? Please describe:
__________________________________________________________________
__________________________________________________________________
Do you feel you are adequately trained in what to do in these
situations? _______
If not, what type of information would improve your awareness?
__________________________________________________________________
__________________________________________________________________
Do you have concerns about your work environment that you
feel could be improved to increase your safety from workplace
violence? What suggestions would you make?
__________________________________________________________________
__________________________________________________________________
Does your department have a system in place for alerting
University Police when help is needed? (i.e. use of key word(s)
such "tuffy titan" to alert others in the office of a problem)
YES or NO
Additional Comments:
__________________________________________________________________
wvquestionnaire 7/08
Revised: 7/22/2008 TW