Workplace Violence Risk Assessment Form

Foip Notification

The personal information requested on this form is collected under the authority of Section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act of Alberta.  It will be used for the purpose of administering the University of Lethbridge’s hazard assessment program in accordance with Alberta Occupational Health and Safety legislation.  Questions about this collection can be directed to the University’s FOIP Coordinator at 4401 University Drive, Lethbridge, AB T1K 3M4;; 403-332-4620.

General Information
Risk Identification
Identifying the Risks
Risk Assessment

To properly perform the Risk Assessment, enter the position(s) title at risk of Workplace Violence and specify the type of violence, for example: robbery, assault, etc.  Then, examine the following charts and assess by selecting the appropriate option in the drop down boxes provided.

  • the probability of the Violence Risk occurring
  • the most serious, *reasonably possible outcome (as opposed to the "most likely" outcome) for each violence risk and position

* If the consequence has happened even once, it is reasonably possible

 Position:Violence Risk:Risk Probability:Risk Impact:
Risk 1
Risk 2
Risk 3
Risk 4
Risk Assessment Legend
Risk LikelihoodNameCharacterization
AAlmost CertainHighly likely to occur, expected to occur in most circumstances.
BLikelyLikely to happen, will probably occur.
CPossibleMay occur at some time
DUnlikelyUnlikely to occur but possible
ERareHighly unlikely that this will occur, not expected
Risk ImpactNameCharacterization
1InsignificantNo Injury
2MinorMinor Injury; Possible first aid.

Moderate non-life threatening injuries;
Injury requiring medical attention;
Possible Emergency care;
Possible Short term Disability;
Possible injury related absence from work

4MajorExtensive Injuries;
Emergency care;
Injury related absence from work.
5CatastrophicLong term disability;
Extended hospitalization;
Campus Safety Risk Matrix
Likelihood\Impact1 - Insignificant
2 - Minor3 - Moderate4 - Major5 - Catastrophic
AAlmost CertainModerate

Interpretation of Risk

Extreme:Unacceptable Risks. Address immediately through a violence prevention plan.
High:Significant Risks. Include these risks in a violence prevention plan.
Moderate:Not considered to be significant for the purposes of requiring a violence prevention plan. These risks should be addressed through standard health and safety measures.
Low:Not considered to be significant for the purposes of requiring a violence prevention plan. However, wherever possible consistent efforts should be made to eliminate or reduce the risks completely.
Risk Management

Risk management includes the things you are doing to reduce the probability of the violence risk that it will happen and mitigate the impact if it does.  All of the significant risks identified and assessed (the red and orange ones) must be appropriately managed in order to comply with Occupational Health and Safety requirements.  You must prepare and include in your report a violence prevention plan that covers each of the significant risks.

  • Consider the following when preparing the violence prevention plan:
  • Policies and procedures
  • Clarity and effectiveness of emergency response
  • Physical security measures (Crime Prevention Through Environmental Design, access controls systems, electronic and natural surveillance, and physical barriers.
  • Regular training sessions

The management activities should be monitored to ensure effectiveness. This assessment process should be repeated every five years unless a significant change creates new or increased risk in your area and before then and a copy of the final assessment report must be forwarded to Campus Safety.   

Based on the responses given to the assessment, please answer the following: