2434 – BluWater Security

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Section I

General Information

Location Name:

ACME Hospital East

Year founded:

1980

Address:

4309 Indian Deer Rd

suite 202

Hollywood

33040

General Contact Telephone Number:

555-555-1212

Security Contact Telephone Number:

555-555-1212

Senior Executive Responsible for the Facility:

John

Security Department Head or Personnel Assigned Security Responsibility:

Dan

Contract Security Leadership:

Big Security

Workplace Violence / Crime Prevention Committee Chairperson:

Ted

Workplace Violence / Crime Prevention Committee Vice Chair:

Sue

Facility Type:

building

Facility Size:

24,000 sq/f

All Units:

office space

Full-Time Employees:

Part-Time Employees:

100

Field Workers / Home Health:

Travel:

Temporary Employees:

Section 2

Workplace Violence Prevention Plan

Introduction:

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Statement by Senior Leadership:

Current Workplace Violence Program:

Overview of Patient, Client and Setting-Related Risk Factors:

Any Organizational Risk Factors:

Workplace Violence Prevention Training:

Supervisor and Management Training Courses:

Training of Security Staff:

Evaluation of Training:

Documentation:

Records Analysis and Tracking:

Job Hazard Analysis:

Employee Surveys:

Hazard Prevention and Control:

Administrative and Work Practice Controls:

Investigation of Incidents:

Recordkeeping and Program Evaluation:

Policies and procedures for obtaining medical care, trauma informed care, counseling, workers’ compensation, or legal assistance:

Section 3

Workplace violence probability table

Do employees have contact with the public?

Yes

Do they exchange money with the public?

Do they work alone?

Yes

Do they work late at night or during early morning hours?

Is the workplace often understaffed?

Yes

Is the workplace located in an area with a high crime rate?

Yes

Do employees enter areas with a high crime rate?

Do they have a mobile workplace (patrol vehicle, work van, etc.)?

Yes

Do they deliver passengers, goods, or services?

Do employees perform jobs that might put them in conflict with others?

Yes

Do they ever perform duties that could upset people (deny service, insurance benefits, etc.)?

Do they deal with people known or suspected of having a history of violence?

Do any employees or supervisors have a history of assault, verbal abuse, harassment, or other threatening behavior?

Yes

Other risk factors – please describe:

Yes