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Workplace Survey (Assessing Your Culture)
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VIOLENCE AT WORK: ASSESSING YOUR WORK CULTURE

Though we in the (fill in type of industry—insurance, banking, education, etc.) business may not think about the potential for violence within our organization, the truth is that violent acts can flare up in any company at any time. To help us gauge our level of risk, please offer your feedback by responding to the statements below. Thank you.

Rating Scale:

4=Strongly Agree
3=Agree
2=Disagree
1=Strongly Disagree


1. At (Company Name), I handle many face-to-face customer contacts.

4 3 2 1


2. I have participated in workplace drills, using panic alarm buttons, silent alarms, or personal electronic alarm systems for prompt security assistance.

4 3 2 1


3. I am familiar with (Company Name's) response plan for recognizing and managing hostile and/or escalating aggressive behaviors within the workplace (whether from employees or non-employees).

4 3 2 1


4. I am prepared to use (Company Name's) response plan for recognizing and managing hostile and/or escalating aggressive behaviors within the workplace (whether from employees or non-employees).

4 3 2 1


5. I find my supervisor approachable, supportive, resourceful, and committed to helping me when I voice concerns about hostile and/or escalating aggressive
behaviors in the workplace.

4 3 2 1


6. I know that (Company Name) buildings have adequate physical security, which restricts unauthorized access.

4 3 2 1


7. My coworkers and I enter the workplace from one central, well-lit, highly visible location.

4 3 2 1


8. I, or one of my coworkers, work alone at (Company Name) during daylight or evening hours.

4 3 2 1


9. I believe that the risks of injury or harm within this workplace have been accurately assessed with regard to workplace violence.

4 3 2 1


10. I know what counseling services and other resources are offered through (Human Resources, EAP, Wellness, or appropriate name) at (Company Name).

4 3 2 1


11. I have used, or would use, counseling services and other resources offered through (Human Resources, EAP, Wellness, or appropriate name) at (Company
Name).

4 3 2 1


12. If I were being threatened or harassed, I believe management at (Company Name) would address it appropriately.

4 3 2 1



13. If I were being threatened or harassed, I would know what to do to get help from appropriate sources at (Company Name).

4 3 2 1



14. I have had the impression that a coworker is being threatened or harassed at work by someone from outside the organization.

4 3 2 1



15. I am aware of our company policy regarding violence or threats of violence in the workplace.

4 3 2 1


16. I understand how to use our company policy regarding violence or threats of violence in the workplace.

4 3 2 1



17. I am currently being threatened or harassed by an employee, supervisor or customer here at (Company Name)*.

4 3 2 1



18. In the past, I have been threatened or harassed by an employee, supervisor or customer while working at (Company Name).

4 3 2 1



19. (Company Name) makes us aware of partner violence issues.

4 3 2 1



20. I have been provided an opportunity to attend training or a seminar on partner violence through my workplace.

4 3 2 1



21. I know that someone I work with has been involved in a partner violence situation while employed here at (Company Name).

4 3 2 1



22. I believe that one or more of my coworkers, employees, or managers have been absent from work because of family violence.

4 3 2 1


23. I know what to do here at (Company Name) if I am ever the victim of partner violence.

4 3 2 1



24. I know what to do here at (Company Name) if a coworker, employee, or manager is a victim of partner violence.

4 3 2 1



25. I have been personally involved in a partner violence situation while employed here at (Company Name).

4 3 2 1



26. I understand what happens in a partner violence situation—including why people stay in abusive relationships, the cycle of violence, and the types of abuse involved.

4 3 2 1



27. I would like to know more about partner violence and its impact on the workplace.

4 3 2 1


* If you are currently being threatened or harassed by a coworker or supervisor, manager, or any other person while at this workplace, please immediately report this situation to ________(Fill in the name of the appropriate department at your company-Human Resources, Security, etc.)
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