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Hospital Security July 2019

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* 1. Please select your employer

Central Coast Local Health District

Far West Local Health District

Hunter New England Local Health District

Illawarra Shoalhaven Local Health District

Mid North Coast Local Health District

Murrumbidgee Local Health District

Nepean Blue Mountains Local Health District

Northern NSW Local Health District

Northern Sydney Local Health District

South Eastern Sydney Local Health District

South Western Sydney Local Health District

Southern NSW Local Health District

Sydney Children's Hospital Network

Sydney Local Health District

Western NSW Local Health District

Western Sydney Local Health District

Other (please specify)

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* 2. Which health facility is your main place of employment?

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* 3. In the last 12 months at your workplace, how many times have you been subject to:

	0	1	2	3	4	5	6	7	8	9	10	More than 10
Threats, intimidation or verbal abuse	Threats, intimidation or verbal abuse 0	Threats, intimidation or verbal abuse 1	Threats, intimidation or verbal abuse 2	Threats, intimidation or verbal abuse 3	Threats, intimidation or verbal abuse 4	Threats, intimidation or verbal abuse 5	Threats, intimidation or verbal abuse 6	Threats, intimidation or verbal abuse 7	Threats, intimidation or verbal abuse 8	Threats, intimidation or verbal abuse 9	Threats, intimidation or verbal abuse 10	Threats, intimidation or verbal abuse More than 10
Spitting	Spitting 0	Spitting 1	Spitting 2	Spitting 3	Spitting 4	Spitting 5	Spitting 6	Spitting 7	Spitting 8	Spitting 9	Spitting 10	Spitting More than 10
Physical assault	Physical assault 0	Physical assault 1	Physical assault 2	Physical assault 3	Physical assault 4	Physical assault 5	Physical assault 6	Physical assault 7	Physical assault 8	Physical assault 9	Physical assault 10	Physical assault More than 10
Threats with a weapon	Threats with a weapon 0	Threats with a weapon 1	Threats with a weapon 2	Threats with a weapon 3	Threats with a weapon 4	Threats with a weapon 5	Threats with a weapon 6	Threats with a weapon 7	Threats with a weapon 8	Threats with a weapon 9	Threats with a weapon 10	Threats with a weapon More than 10
Assaults with a weapon	Assaults with a weapon 0	Assaults with a weapon 1	Assaults with a weapon 2	Assaults with a weapon 3	Assaults with a weapon 4	Assaults with a weapon 5	Assaults with a weapon 6	Assaults with a weapon 7	Assaults with a weapon 8	Assaults with a weapon 9	Assaults with a weapon 10	Assaults with a weapon More than 10

Question Title

* 4. How many times in the last 12 months have you witnessed a workmate experience:

	0	1	2	3	4	5	6	7	8	9	10	More than 10
Threats, intimidation or verbal abuse	Threats, intimidation or verbal abuse 0	Threats, intimidation or verbal abuse 1	Threats, intimidation or verbal abuse 2	Threats, intimidation or verbal abuse 3	Threats, intimidation or verbal abuse 4	Threats, intimidation or verbal abuse 5	Threats, intimidation or verbal abuse 6	Threats, intimidation or verbal abuse 7	Threats, intimidation or verbal abuse 8	Threats, intimidation or verbal abuse 9	Threats, intimidation or verbal abuse 10	Threats, intimidation or verbal abuse More than 10
Spitting	Spitting 0	Spitting 1	Spitting 2	Spitting 3	Spitting 4	Spitting 5	Spitting 6	Spitting 7	Spitting 8	Spitting 9	Spitting 10	Spitting More than 10
Physical assault	Physical assault 0	Physical assault 1	Physical assault 2	Physical assault 3	Physical assault 4	Physical assault 5	Physical assault 6	Physical assault 7	Physical assault 8	Physical assault 9	Physical assault 10	Physical assault More than 10
Threats with a weapon	Threats with a weapon 0	Threats with a weapon 1	Threats with a weapon 2	Threats with a weapon 3	Threats with a weapon 4	Threats with a weapon 5	Threats with a weapon 6	Threats with a weapon 7	Threats with a weapon 8	Threats with a weapon 9	Threats with a weapon 10	Threats with a weapon More than 10
Assaults with a weapon	Assaults with a weapon 0	Assaults with a weapon 1	Assaults with a weapon 2	Assaults with a weapon 3	Assaults with a weapon 4	Assaults with a weapon 5	Assaults with a weapon 6	Assaults with a weapon 7	Assaults with a weapon 8	Assaults with a weapon 9	Assaults with a weapon 10	Assaults with a weapon More than 10

Question Title

* 5. How many times in the last 12 months have you witnessed a patient or member of the public experience:

	0	1	2	3	4	5	6	7	8	9	10	More than 10
Threats, intimidation or verbal abuse	Threats, intimidation or verbal abuse 0	Threats, intimidation or verbal abuse 1	Threats, intimidation or verbal abuse 2	Threats, intimidation or verbal abuse 3	Threats, intimidation or verbal abuse 4	Threats, intimidation or verbal abuse 5	Threats, intimidation or verbal abuse 6	Threats, intimidation or verbal abuse 7	Threats, intimidation or verbal abuse 8	Threats, intimidation or verbal abuse 9	Threats, intimidation or verbal abuse 10	Threats, intimidation or verbal abuse More than 10
Spitting	Spitting 0	Spitting 1	Spitting 2	Spitting 3	Spitting 4	Spitting 5	Spitting 6	Spitting 7	Spitting 8	Spitting 9	Spitting 10	Spitting More than 10
Physical assault	Physical assault 0	Physical assault 1	Physical assault 2	Physical assault 3	Physical assault 4	Physical assault 5	Physical assault 6	Physical assault 7	Physical assault 8	Physical assault 9	Physical assault 10	Physical assault More than 10
Threats with a weapon	Threats with a weapon 0	Threats with a weapon 1	Threats with a weapon 2	Threats with a weapon 3	Threats with a weapon 4	Threats with a weapon 5	Threats with a weapon 6	Threats with a weapon 7	Threats with a weapon 8	Threats with a weapon 9	Threats with a weapon 10	Threats with a weapon More than 10
Assaults with a weapon	Assaults with a weapon 0	Assaults with a weapon 1	Assaults with a weapon 2	Assaults with a weapon 3	Assaults with a weapon 4	Assaults with a weapon 5	Assaults with a weapon 6	Assaults with a weapon 7	Assaults with a weapon 8	Assaults with a weapon 9	Assaults with a weapon 10	Assaults with a weapon More than 10

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* 6. If you have any comments, or would like to share details of your experience, please enter them here.

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* 7. Are you a member of the Health Services Union?

Yes

No

No, but I am interested in becoming a member

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* 8. If you would like someone from the HSU to contact you regarding becoming a member, or are happy to be contacted to supply further information about your workplace experiences, please enter your contact details.

Name

Email Address

Phone Number