Instructions: the appropriate response under the physical environment/measures & procedures statement Check and/or enter existing controls already in place Enter the recommended controls or actions required who is responsible and date for the recommended control or action to be completed. 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. Does the public YES Counters and/or barriers prevent have direct physical NO physical access to non-public areas access to the N/A Equipment is in place to notify workplace? workers when someone enters the workplace Reception areas are visible to other workers Signs are posted for worker-only areas Non-workers are accompanied in restricted areas 2. Can workers call YES Equipment exists that can for immediate help NO automatically summons assistance when required? N/A Phones are pre-programmed to dial emergency numbers Emergency numbers are posted by all phones Internal code word(s) are in place to indicate that help is needed 3. Are there objects YES Public counters are free of equipment or equipment on NO and clutter counters in public N/A Sharp and dangerous items are stored areas that could be so that only workers have access to used to hurt people? them 4. Are there YES Meeting room interior is visible to designated rooms for NO other workers meeting with clients? N/A
Instructions: the appropriate response under the physical environment/measures & procedures statement Check and/or enter existing controls already in place Enter the recommended controls or actions required who is responsible and date for the recommended control or action to be completed. 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. Does the public have direct physical access to the workplace? YES NO N/A Counters and/or barriers prevent physical access to non-public areas Equipment is in place to notify workers when someone enters the workplace Reception areas are visible to other workers Signs are posted for worker-only areas Non-workers are accompanied in restricted areas 2. Can workers call for immediate help when required? YES NO N/A Equipment exists that can automatically summons assistance Phones are pre-programmed to dial emergency numbers Emergency numbers are posted by all phones Internal code word(s) are in place to indicate that help is needed 3. Are there objects or equipment on counters in public areas that could be used to hurt people? YES NO N/A Public counters are free of equipment and clutter Sharp and dangerous items are stored so that only workers have access to them 4. Are there designated rooms for meeting with clients? YES NO N/A Meeting room interior is visible to other workers
Violence-Prevention-Risk-Assessment-Template.docx