Workplace Violence Report Form Template

Purpose of the report form

The workplace violence report form is used when a certain conflict between two or more individuals leads to violence in the workplace of any organization thus harming the working environment which then becomes necessary to picture the event in order to avoid any future discrepancies.

The purpose of the report form is to investigate when and how the conflict had started in the first place? Who was involved in the conflict? In which department, site, or part of the organization did the conflict took place? The individuals who were involved in the conflict are in what specific position in the organization at present. All these details are collected in order to get a clear and better understanding of the violence that took place at the workplace.

Any eye witness of the incident is also mentioned in clear spellings and signatures. It is human nature that we do not easily adjust to others' needs and specifications. At times we tend to remain silent while at other moments we chose to retaliate in a wrong manner. At times it is the way you choose to communicate to the other person what you desire from him in a wrong manner that leads to conflicts. Differences then help create room for violence which is not good.

Aim of the report

The report form aims at minimizing the events which might result in creating a violent atmosphere. It examines the series which have certainly led to the violence and in the light of the details at hand a certain course of action is devised so as to avoid any mishaps in future.

Other specific details

Who initiated?

It is mentioned in the report with the name of the specific individual who had initiated the violence. What specific set of behavior led to the violence?


It is mentioned that if any individual sustained an injury in the process. If yes, then was it a serious injury or an injury that was easily handled by first aid.


The gender of the parties involved is disclosed. It is stated that whether they are male or females who have actually ended up quarreling.


The specific date when the incident took place is mentioned.

Course of action

The necessary course of action taken in the light of the incidence by the management is mentioned in the report form.


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