Hastings Prince Edward Teacher Local

VIOLENT INCIDENT REPORT

IDENTIFYING INFORMATION

First and Last Name

INCIDENT AND INJURY INFORMATION

mm/dd/yyyy
Time

TYPE OF VIOLENCE

The Occupational Health and Safety Act defines workplace violence as:
♦ The exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker;
♦ An attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker;
♦ A statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker
mm/dd/yyyy
Please contact the Health and Safety Chair at healthandsafety.etfohp@gmail.com once you have received follow-up information from your Administrator.

OTHER INFORMATION

Procedure 379 (excerpt from page 5)

Part 3: Principal Responsibilities

Principals are ultimately responsible for the safety of students and employees at the school. The principal is required to conduct an investigation into all potential and reported incidents of unsafe conditions and establish a plan to alleviate the safety concern. In addition, the principal is responsible for establishing and communicating clear processes for the development, review and communication of Safety Plans.

c) Investigation of incidents

iv) Debriefing all individuals impacted by the incident following the incident (e.g. how are you feeling, how can I support, what happened, what might be considered next time, TCI Life Space Interview, etc.)

v) Following any serious incident, working with the established in-school team and others as appropriate to review the Safety Plan and making necessary revisions and communicating the revised Safety Plan to employees working regularly and directly with the student.

HELPFUL RESOURCES:

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ETFO LOCAL OFFICE

Federation House

114 Victoria Avenue

Belleville, ON K8N2A8

P: 613.968.3707

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Affiliated with the

Elementary Teachers' Federation of Ontario