Hospital Workplace Violence Survey Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Email Question Title * 4. Workplace Question Title * 5. How long have you worked at your current hospital? Less than a year 1-3 years 4-9 years 10 years or more Question Title * 6. Classification Question Title * 7. Do you know who your Joint Health & Safety Committee (JHSC) Representative is at your workplace? Yes No My workplace does not have a JHSC Representative Question Title * 8. Are you currently or formerly a JHSC Representative? Yes No Question Title * 9. If you responded yes, is workplace violence a topic that can be addressed at JHSC meetings? Yes No I don’t know Not applicable, I’ve never been a JHSC representative Question Title * 10. How frequently do you experience the following types of workplace violence? Most days Most weeks Most months A couple times a year Almost never Never Physical aggression Physical aggression Most days Physical aggression Most weeks Physical aggression Most months Physical aggression A couple times a year Physical aggression Almost never Physical aggression Never Verbal abuse Verbal abuse Most days Verbal abuse Most weeks Verbal abuse Most months Verbal abuse A couple times a year Verbal abuse Almost never Verbal abuse Never Racism/discrimination Racism/discrimination Most days Racism/discrimination Most weeks Racism/discrimination Most months Racism/discrimination A couple times a year Racism/discrimination Almost never Racism/discrimination Never Sexual harassment/assault Sexual harassment/assault Most days Sexual harassment/assault Most weeks Sexual harassment/assault Most months Sexual harassment/assault A couple times a year Sexual harassment/assault Almost never Sexual harassment/assault Never Use of a weapon or harmful object Use of a weapon or harmful object Most days Use of a weapon or harmful object Most weeks Use of a weapon or harmful object Most months Use of a weapon or harmful object A couple times a year Use of a weapon or harmful object Almost never Use of a weapon or harmful object Never Question Title * 11. Who have you experienced violence from? Check all that apply. Management Residents Co-workers Residents’ Families Other (please specify) Question Title * 12. In the past 6 months, how often has short staffing made it harder to prevent or respond to resident aggression or workplace violence? Daily Weekly Monthly Rarely Never Not sure Question Title * 13. When workplace violence happens, is there usually enough staff available to respond safely? Always Often Sometimes Rarely Never Question Title * 14. Do you feel you are more at risk to workplace violence when working alone? Yes No Not sure Question Title * 15. Have you ever suffered an injury while at work? Yes No Not sure Question Title * 16. If you feel comfortable, please describe the situation and injury(ies) you’ve experienced while performing your job. Question Title * 17. Have you ever missed time due to a workplace injury? Yes No I don’t know Question Title * 18. What is the most common type of workplace injury experienced at your workplace? Question Title * 19. Does your workplace have a policy around violence and harassment? Yes No I don’t know Question Title * 20. Does your home have a policy to prevent racism and discrimination? Yes No I don’t know Question Title * 21. Have you ever seen a patient refuse care from a worker because of their race? Yes No I’m not sure Question Title * 22. Has your Employer arranged a workplace violence training for you and your coworkers? Yes No I don’t know Question Title * 23. If you responded yes, please describe what training you’ve received from your employer, or outside organization. Question Title * 24. How prepared do you feel to de-escalate a potentially violent situation at work? Very prepared Somewhat prepared Neither prepared nor unprepared Somewhat unprepared Very unprepared Question Title * 25. Are there any flaws in the de-escalation training you’ve received that impacts your ability to remain safe at work? Question Title * 26. Which of the following are provided to you for your protection at work? Select all that apply. Whistles Radios Personal Alarms Resident flagging Secured furniture Seclusion rooms Other (please describe) Question Title * 27. Does your hospital have dedicated security staff? Yes No I’m not sure Question Title * 28. If they do, do the security staff intervene if there is a potentially violent incident? Never Rarely Sometimes Always My workplace does not have dedicated security staff Question Title * 29. In your opinion, rank the following causes of workplace violence. Question Title * 30. Have you ever called 911 due to a violent incident at your workplace? Yes No Question Title * 31. How would you generally describe police response? Helpful Unhelpful It depends I’ve never had to call the police Question Title * 32. How safe do you feel working at your hospital? Very Safe Somewhat safe Somewhat unsafe Very unsafe Question Title * 33. Do you have the right to refuse work due to fear of violence? Yes No I don’t know Question Title * 34. How comfortable do you feel reporting workplace violence and/or an unsafe work environment to your manager/supervisor? Very comfortable Somewhat comfortable Uncomfortable Afraid to report workplace violence/unsafe work Question Title * 35. How supported are you by your manager/supervisor in dealing with health and safety matters and workplace violence? I feel very supported I feel somewhat supported I do not feel supported Question Title * 36. On a scale of 1 to 10, with 10 feeling very mentally healthy, how would you rate your mental well-being while working at your retirement home? Not Healthy Mentally Very Healthy Mentally Not Healthy Mentally Very Healthy Mentally Question Title * 37. Do you agree with the following statement: “My manager/supervisor prioritizes the needs of residents over my own safety and wellbeing?” Strongly Agree Agree Disagree Strongly Disagree Question Title * 38. Has your manager ever blamed you as the reason for experiencing violence or abuse at work? Yes No I’m not sure Question Title * 39. If you could make one change at your workplace to prevent workplace violence, what would it be? Question Title * 40. Gender: Man Woman Non-binary Other Prefer not to answer Question Title * 41. How old are you? 18-29 30-39 40-49 50-59 60-69 70+ Prefer not to answer Question Title * 42. Which, if any, equity-deserving group(s) do you identify with? Please select all that apply. Black people Indigenous people Asian or Pacific Islander Racialized people/People of Colour LGTBQ+ people Persons with disabilities Women or gender minorities Religious minorities Other Prefer not to answer Question Title * 43. What is your immigration status? Citizen Permanent resident On a temporary work permit Undocumented worker I would rather not say Done