Healthcare Workplace Violence Survey

This survey should take about 2 minutes to complete.

This anonymous, voluntary survey will help inform ourselves about safety and security issues in U.S. healthcare facilities. Full results will be shared with all participants and in subsequent publications.

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* 1. How many reported acts of violence has your facility experienced in the past year?

3 or more

We don’t have records

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* 2. What types of workplace violence has your facility experienced in the past year? Check all that apply.

Resident/patient against caregiver/staff

Resident/patient against resident/patient

Visitor/outsider against resident/patient

Visitor/outsider against caregiver/staff

Caregiver/staff against resident/patient or visitor

Caregiver/staff against another caregiver/staff

Other (please specify)

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* 3. Were weapons used in any of the attacks?

Yes

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* 4. What prevention/protection methods are used in your facility? Check all that apply.

Armed Guards

Unarmed Guards

Locked doors/limited access

Guests are greeted and required to sign in

Weapons exclusion policies

Secure parking facilities – lights fences and gates, buddy system

Other (please specify)

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* 5. Do you believe your physical facility properly protects your patients/residents and staff from violence?

Yes

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* 6. What mitigation methods are used in your facility? Please check all that apply.

Diffusion/confrontation skills training

Alarm systems/hot buttons

Electronic surveillance

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* 7. In your opinion, does inadequate staffing increase the threat of violence in your facility?

Yes

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* 8. During the past 12 months, how many hours of training specific to workplace violence prevention did EACH employee receive?

None

<2 hours

2 hours or more

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* 9. When is the last time you had a drill on workplace violence?

Last three months

Last year

Last 2 years

Longer ago than that/never

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* 10. In what type of setting do you work?

Hospital/Clinic/Surgery Center/In-patient Hospice

Assisted Living

Skilled Nursing/Long-term care

Home Health or Home-bound Hospice

Intermediate Care Facility (ICF/IID)

Other (please specify)

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* 11. What is your role within the organization?

Frontline, patient-facing

Middle level management

Senior leadership

Other (please specify)

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* 12. In what state is the facility located?

State

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* 13. If you would like to receive a copy of the survey results and additional information on violence in healthcare facilities, enter your name and email address here.

Name

Company

Email Address

Phone Number

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* 14. Thank you. If you wish to comment further, please do so here. For more information on healthcare preparedness, see our website at https://www.yourcrisisteam.com