Workplace Violence Form

If you witness a violent incident at work, please complete this form to let your Union Rep know. The more they know, the more they can do to improve your safety at work.

Did the incident happen to you or someone else?(Required)

What time of day was it?(Required)

What was the type of incident?(Required)

Was medical help required?(Required)
Did you contact Workplace Safety and Health?(Required)
Did you contact the Workers Compensation Board?(Required)


Your Union Rep is below

Once you click Submit, they will receive this form, and a copy will be sent back to you. Your Union Rep will reach out to you shortly to discuss this incident.

Reminder: If someone is being violent or stealing, DO NOT INTERVENE. It is not your job and you can risk injury and your employment by stepping in.