You are not required to use any of the examples of existing controls. There may be other controls that are more suitable to the circumstances of your workplace and to controlling the risks of workplace violence that you identify. Physical Environment / Recommended Controls / Person Responsible / Existing Controls Action Date of Completion Measures & Procedures 1. Are safe visit plans YES Safe visit plans are developed for each in place before NO worker who visits high risk or remote workers visit high risk N/A locations or remote locations? Supervisor reviews the safe plan visit with workers prior to visiting high risk or remote locations Safe visit plans are reviewed annually with workers to ensure plans are current 2. Can workers call for YES Equipment exists that can automatically immediate help when NO summons assistance required? N/A Emergency numbers available to all workers Two way radios with direct contact to a dispatcher or co-workers are used Internal code word(s) are in place to indicate that help is needed Procedures in place for contacting 911 3. Do workers work at YES Buddy system / minimizing number or times of increased NO employees working during higher-risk vulnerability, such as N/A times late at night or early Procedures for responding to high risk morning? 4. Are workers YES A risk assessment has been conducted provided with the NO to identify high crime areas or safest route to travel? N/A remote locations and the safest route to travel including parking, walking, public transportation, and hotel recommendations
You are not required to use any of the examples of existing controls. There may be other controls that are more suitable to the circumstances of your workplace and to controlling the risks of workplace violence that you identify. Physical Environment / Measures & Procedures Existing Controls Recommended Controls / Action Person Responsible / Date of Completion 1. Are safe visit plans in place before workers visit high risk or remote locations? YES NO N/A Safe visit plans are developed for each worker who visits high risk or remote locations Supervisor reviews the safe plan visit with workers prior to visiting high risk or remote locations Safe visit plans are reviewed annually with workers to ensure plans are current 2. Can workers call for immediate help when required? YES NO N/A Equipment exists that can automatically summons assistance Emergency numbers available to all workers Two way radios with direct contact to a dispatcher or co-workers are used Internal code word(s) are in place to indicate that help is needed Procedures in place for contacting 911 3. Do workers work at times of increased vulnerability, such as late at night or early morning? YES NO N/A Buddy system / minimizing number or employees working during higher-risk times Procedures for responding to high risk 4. Are workers provided with the safest route to travel? YES NO N/A A risk assessment has been conducted to identify high crime areas or remote locations and the safest route to travel including parking, walking, public transportation, and hotel recommendations
Violence-Prevention-Risk-Assessment-Template.docx