Policy 1430 - Attachment 3 - Violence Free Workplace Policy
Revision Date: 8/21/2002
Responsible Office: Human Resources Office
Reference: University of Louisiana System, Policy M-11, Board Rule Chapter 3, Section XIX
VIOLENCE INCIDENT STATEMENT
The contents of this document shall be kept confidential with its contents released only to individuals with a legitimate need to know or unless it becomes public record by virtue of an appeal to a court or other adjudicative body.
|Date of Incident||Place of Incident|
|Time Incident Began||Time Incident Ended|
|Name of Person Making Statement||Phone No.|
Detail description of incident answer the questions WHO, WHAT, WHEN, WHERE, HOW, and WHY. (If necessary, continue on plain paper; attach sheets.) Completed statement should be forwarded to appropriate personnel.