Guide to Violence Prevention in the Work Place

Appendix B

The employee survey may be used to obtain basic information on employees' understanding of the violence prevention program in their work place. The survey is optional, and the responses are to be considered in light of the information and requirements in Part XX of the Canada Occupational Health and Safety Regulations.

Employee Survey

  1. My employer has a written violence prevention policy.
    • Yes
    • No
    • Not applicable
    • I don't know
  2. My work place has clearly established procedures and expectations for violence prevention.
    • Yes
    • No
    • Not applicable
    • I don't know
  3. My work place has the violence prevention policy posted in a place accessible to all employees.
    • Yes
    • No
    • Not applicable
    • I don't know
  4. I have received formal training in the area of work place violence.
    • Yes
    • No
    • Not applicable
    • I don't know
  5. I know what constitutes work place violence.
    • Yes
    • No
    • Not applicable
    • I don't know
  6. I know the factors that can contribute to violence in my work place.
    • Yes
    • No
    • Not applicable
    • I don't know
  7. I know the disciplinary action that can be taken against me if I cause a work place violence incident.
    • Yes
    • No
    • Not applicable
    • I don't know
  8. I know what to do when I witness or am involved in a work place violence incident.
    • Yes
    • No
    • Not applicable
    • I don't know
  9. I am aware of the controls and safety procedures implemented in the work place to protect me from work place violence.
    • Yes
    • No
    • Not applicable
    • I don't know
  10. If I am involved in a work place violence incident and I request assistance, it will be provided to me by the employer
    • Yes
    • No
    • Not applicable
    • I don't know
  11. Comments :

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Date Modified:
2012-04-19