Complete this form in conjunction with the UConn Health Workplace Violence Prevention Policy 2026

1. Begin by clicking ‘Get Form’ to open it in our editor.
2. Fill in your personal information in the 'PERSON COMPLETING REPORT' section, including your name, title, department, phone number, email, and today's date.
3. In the 'INCIDENT INFORMATION' section, provide details about the incident such as the date, time, location, type of incident, and whether a weapon was involved. Be sure to specify if law enforcement responded.
4. List all individuals involved in the incident under 'INDIVIDUALS INVOLVED', including their names, titles, phone numbers, and emails. Use additional sheets if necessary.
5. Indicate the assailant's relationship to the victim(s) by checking the appropriate box.
6. Complete the 'BACKGROUND' section by checking any relevant factors that may have contributed to the incident.
7. Provide injury information if applicable and detail any medical care required.
8. In 'DISPOSITION AND FOLLOW UP ACTIONS', check all actions taken following the incident.
9. Finally, write a detailed description of the event in the provided space before submitting your completed form using our platform’s functions or emailing it as an attachment.

Engage with our platform today to streamline your document completion process for free!