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Workplace violence prevention plan template
A written workplace violence prevention plan for one workplace, filled in on a phone or computer and kept up to date. Its sections follow the elements California Labor Code section 6401.9 (SB 553) lists: the people responsible, employee involvement, coordination with other employers, reporting and no retaliation, communication, emergency response, training, identifying and correcting hazards, post-incident response and review. It also holds the records: hazard inspections for each work area with photos, training sessions, and a violent incident log with the fields the law lists and no names. Use it with the incident report template for injuries, and the security risk assessment for the building itself.
For store and branch managers, HR and safety leads, and owners of California businesses (retail, offices, warehouses, restaurants) who need a written plan specific to their workplace and somewhere to keep its records.
Built on California law. Outside California, federal OSHA states that there are currently no specific OSHA standards for workplace violence; the form still works as a written prevention plan, with hazard inspections and an incident log.
- Sections that follow the plan elements in Labor Code 6401.9(c)(2)
- Hazard inspection records for each work area, with the reason for each inspection and photos
- Violent incident log with the fields listed in 6401.9(d), and a warning to leave out names and other identifying details
- Training records with dates, contents, trainer and attendees
- Hazards needing correction and incomplete investigations counted on the actions page
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What must a California workplace violence prevention plan include?
A workplace violence prevention plan is useful when it is about this workplace: the counters, shifts and back doors where trouble actually starts, written with the people who work there. Each incident should lead to an inspection of that area and a change, and the log should show the pattern without naming anyone.
Last updated . Facts checked by the SiteSurvey team on 27 October 2026 against California Labor Code section 6401.9 (SB 553), California Legislative Information, Cal/OSHA, Workplace Violence Prevention for General Industry (Non-Health Care Settings) and OSHA, Workplace Violence.
How to write a workplace violence prevention plan
Write it with the people who do the work: the law asks for employee involvement in finding hazards, training and reviewing the plan.
Workplace and people
Enter the workplace, its work areas and operations, and where employees can read the plan. Name the people responsible and their roles, and how employees and other employers are involved.
Reporting and emergencies
Write how anyone reports an incident or concern without fear of reprisal, how reports are handled, how people are alerted in an emergency, and where they go.
Inspect for hazards
Walk each work area with employees. Record the date, the reason and each hazard, with photos, and how and when it will be corrected.
Train
Record each training session: date, contents, trainer and qualifications, and who attended.
Log incidents
Log every workplace violence incident with the date, time, location, type, a detailed description, who committed it, the circumstances and the response, without names. Record the investigation.
Review and sign
Review the plan with employees at least once a year, after an incident and when a problem shows up. Record the actions and sign.
What makes a workplace violence prevention plan useful
Violent incident log: description, circumstances, response and actions taken, with no names
9 Oct, 18:40, returns counter. Type 2. A customer refused a refund shouted, leaned over the counter and said he would wait for the associate in the parking lot. Circumstances: usual duties, low staffing, alone. Police called on the non-emergency line; customer gone on arrival. Actions: associate walked to their car at closing, second person on returns from 4 pm, hold-up button for the counter ordered.
Fictional example. Record the actual evidence and approved arrangements for your job.
A common recording mistake
Downloading a plan, filling in the company name and filing it, with no hazard inspection of the actual work areas and a log that names the employee and the customer.
What happens next
Inspect the area after every incident, train everyone on what changed, and review the plan with employees at least once a year.
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Every question in the workplace violence prevention plan template
A written workplace violence prevention plan for one workplace, built on the elements of California Labor Code section 6401.9 (SB 553): people responsible, employee involvement, coordination with other employers, reporting and no retaliation, communication, emergency response, training with training records, hazard inspection records for each work area, correcting hazards, the violent incident log with the fields the law lists and no personal identifying information, post-incident investigation, plan review, actions and sign-off. 8 sections and 111 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Workplace address: the site address, from the space or the project
- Owner or landlord: the project's customer
Workplace and plan
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Workplace addressShort answerFills in from the site address, from the space or the project
- Owner or landlordShort answerFills in from the project's customer
- Location (GPS)Short answer
- Plan date*Date
- Plan prepared by*Short answer
- Employer*Short answer
- Type of workplaceChoose one
- Retail store
- Office
- Warehouse or distribution
- Manufacturing
- Restaurant or hospitality
- School or college
- Construction site
- Other
- Work areas and operations covered*Notes
The plan is specific to the hazards of each work area and operation, for example sales floor, registers, stockroom, loading dock, parking lot, deliveries.
- Employees at this workplace*Number
- Open to the public?*Choose one
- Yes
- No
- How the plan is kept*Choose one
- Stand-alone section of the Injury and Illness Prevention Program (IIPP)
- Separate document
- Plan revisionShort answer
- Where employees can read the plan at any time*Short answer
For example break room binder and the staff app.
- GuidanceWhat this plan is for. California Labor Code section 6401.9 (SB 553), in force from 1 July 2024, asks covered employers to establish, implement and maintain an effective written workplace violence prevention plan, available to employees at all times and specific to the hazards and corrective measures for each work area and operation. It may be a stand-alone section of the IIPP or a separate document. The sections of this form follow the elements the law lists. Filling it in does not make an employer compliant: carrying it out does.
- CheckSome workplaces are exempt from 6401.9, for example health care settings covered by Title 8 section 3342, employees teleworking from a place of their choice not under the employer's control, and places with fewer than 10 employees at any time that are not open to the public and comply with the IIPP rule (section 3203). Read subdivision (b) before deciding.Shown only when the answers above make it relevant
- CheckCal/OSHA has been developing a workplace violence prevention standard, which the Standards Board is required to adopt by 31 December 2026. Check the Cal/OSHA workplace violence page for any new requirements before you rely on this plan.
- GuidanceOutside California: federal OSHA states that there are currently no specific OSHA standards for workplace violence. This form still works as a written prevention plan, and the California elements make a sound structure elsewhere.
Responsibility, involvement and coordination
- GuidanceThe plan names, by name or job title, the persons responsible for implementing it, and describes their roles if there are several (6401.9(c)(2)(A)). It sets out how employees and their authorised representatives are actively involved in identifying, evaluating and correcting hazards, designing and implementing training, and reporting and investigating incidents (B), and how supervisors and employees are made to comply (E).
- People responsible for the planRepeat for each person. Each one asks:
- Name or job title*Short answer
- Role in the plan*Notes
For example runs inspections, takes reports, leads investigations, arranges training.
- How employees and their representatives are involved*Notes
For example safety committee, store meetings, hazard walk-rounds with staff, input on training.
- How supervisors and employees are made to follow the plan*Notes
- Do employees of other employers work here (staffing agency, security, cleaning, contractors, shared site)?*Yes or No
- How the plan is coordinated with them*Notes
So everyone knows their role, is trained, and incidents involving any employee are reported, investigated and recorded (6401.9(c)(2)(C)).
Shown when “Do employees of other employers work here (staffing agency, security, cleaning, contractors, shared site)?” is Yes
Reporting, communication and emergencies
- GuidanceThe plan sets out how reports of workplace violence are accepted and responded to, and prohibits retaliation against anyone who reports (6401.9(c)(2)(D)); how an employee can report an incident, threat or concern to the employer or law enforcement without fear of reprisal, and how concerns are investigated and employees told the results and corrective actions (F).
- How to report an incident, threat or concern*Notes
Who to tell, by what means, and that anyone may call 911.
- How reports are received and responded to*Notes
- Written statement that retaliation for reporting is prohibited*Choose one
- In the plan and briefed
- In the plan, not yet briefed
- Not yet written
- How employees are told the results of investigations and corrective actions*Notes
- GuidanceThe plan has procedures to respond to actual or potential workplace violence emergencies: how employees are alerted to the presence, location and nature of the emergency, evacuation or sheltering plans that suit the worksite, and how to get help from assigned staff, security and law enforcement (6401.9(c)(2)(G)).
- How employees are alerted to an emergency, where it is and what it is*Notes
For example code phrase on the PA, panic button to the alarm company, group text.
- Evacuation or sheltering plan*Notes
Exits to use, a room that locks from the inside, who checks the stockroom and restrooms.
- How to get help from assigned staff, security and law enforcement*Notes
- Emergency contactsRepeat for each contact. Each one asks:
- Who*Short answer
For example store manager on duty, security contractor, police non-emergency.
- Phone or how to reach them*Short answer
Hazard inspections and correction
- GuidanceThe plan has procedures to identify and evaluate workplace violence hazards, including scheduled periodic inspections and employee reports and concerns. Inspections are done when the plan is first established, after each workplace violence incident, and whenever the employer learns of a new or previously unrecognized hazard (6401.9(c)(2)(I)). Hazards are corrected in a timely manner (J). Keep these records at least five years (6401.9(f)(1)). The checks below are prompts; add what fits each area.
- Scheduled inspection frequency (your choice)*Short answer
- How hazards are corrected and in what time*Notes
Who decides the fix, how urgent hazards are handled the same day, how the fix is checked.
- Hazard inspection recordsRepeat for each area. Each one asks:
- Work area*Short answer
For example Sales floor and registers, Returns counter, Stockroom, Parking lot.
- Inspected on*Date
- Why inspected*Choose one
- Plan first established
- Scheduled periodic inspection
- After a workplace violence incident
- New or previously unrecognized hazard
- Employee report or concern
- Inspected by (name or job title)*Short answer
- Employees who took partShort answer
- Lighting inside and outside the area, including entrances and parkingChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Sight lines: staff can see and be seen, nothing blocks the view from the street or officeChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Cash handling: limits kept, drop safe used, counted out of public viewChoose one
Mark Not applicable where no cash is handled.
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Staffing at opening, closing and late hours; nobody left alone where that raises the riskChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Entrances, back doors and stockroom doors controlled; deliveries checkedChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Way to call for help from this area (phone, radio, panic button) worksChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Escape route and a place to shelter that can be securedChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Objects that could be used as weapons secured or out of reachChoose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Other hazards found in this areaNotes
- This area: hazards needing correctionWorked out by the form
- Not checkedWorked out by the form
- Photos of hazards foundPhotos
- Areas inspectedWorked out by the form
- Hazards needing correctionWorked out by the form
- Not checkedWorked out by the form
Training
- GuidanceInitial training when the plan is first established and annually after that, covering: the plan, how to get a copy at no cost and how to take part; the definitions and requirements of 6401.9; how to report without fear of reprisal; the hazards of each job, the corrective measures, how to get help and how to avoid harm; the violent incident log and how to get copies of records; and a chance for questions and answers with someone who knows the plan (6401.9(e)(2)). Add training for a new or previously unrecognized hazard and when the plan changes (e)(3). Training records include dates, contents or a summary, the trainers' names and qualifications, and attendees' names and job titles, kept at least one year (f)(2).
- How training is developed and given*Notes
Language and reading level used, who runs it, how new hires are covered.
- Training recordsRepeat for each session. Each one asks:
- Training date*Date
- Training*Choose one
- Initial
- Annual
- New or previously unrecognized hazard
- Plan changed
- Contents or summary*Notes
- Trainer name and qualifications*Short answer
- Names and job titles of attendees*Notes
- Number attendingNumber
- Sessions recordedWorked out by the form
Violent incident log and post-incident response
- GuidanceRecord every workplace violence incident in the violent incident log, with the information listed in 6401.9(d)(2), and omit personal identifying information (d)(1)(B). Review the log at each plan review. Keep logs and investigation records at least five years (f)(3) and (f)(4). Employees and their representatives may ask for these records and get them free within 15 calendar days (f)(6). Report any serious injury, illness or death to Cal/OSHA immediately.
- Post-incident response and investigation procedure*Notes
First aid and medical help, who is told, who investigates, how employees are supported, how the area is inspected afterwards (6401.9(c)(2)(K)).
- Violent incident logRepeat for each incident. Each one asks:
- WarningDo not write anyone's name, address, email, phone number, social security number or anything else that would identify a person involved. The person completing the log gives their own name below.
- Date of incident*Date
- Time*Time
- Location*Short answer
For example returns counter, sales floor.
- Workplace violence type*Tick all that apply
- Type 1: person with no legitimate business at the worksite
- Type 2: customer, client, patient, student, inmate or visitor
- Type 3: present or former employee, supervisor or manager
- Type 4: person with a personal relationship with an employee
- Detailed description*Notes
From the employees who experienced it, witness statements and the investigation, with no identifying details.
- Who committed the violence*Choose one
- Client or customer
- Family or friend of a client or customer
- Stranger with criminal intent
- Coworker
- Supervisor or manager
- Partner or spouse
- Parent or relative
- Other
- Where it happened*Choose one
- In the workplace
- Parking lot or other area outside the workplace
- Other area
- Circumstances at the time*Tick all that apply
- Completing usual job duties
- Working in a poorly lit area
- Rushed
- Working during low staffing
- Isolated or alone
- Unable to get help or assistance
- Working in a community setting
- Working in an unfamiliar or new location
- Other
- Type of incident*Tick all that apply
- Physical attack without a weapon
- Attack with a weapon or object
- Threat of physical force or of a weapon or object
- Sexual assault or threat
- Animal attack
- Other
- Was security or law enforcement contacted?*Yes or No
- Their responseNotesShown when “Was security or law enforcement contacted?” is Yes
- Actions taken to protect employees from a continuing threat or other hazards found*Notes
- Post-incident investigation*Choose one
- Complete
- In progress
- Not started
- Investigation findings and corrective actionsNotes
Keep medical information out of investigation records.
Shown only when the answers above make it relevant - Multiemployer worksite: copy given to the controlling employer?Yes or No
- Log completed by (name)*Short answer
- Job title*Short answer
- Date completed*Date
- Incidents loggedWorked out by the form
- Investigations not completeWorked out by the form
Plan review and records
- GuidanceReview the plan's effectiveness and revise it as needed, with employees and their representatives taking part, at least annually, when a deficiency is observed or becomes apparent, and after a workplace violence incident (6401.9(c)(2)(L)).
- Last review dateDate
- Reason for the last reviewChoose one
- Annual review
- Deficiency found
- After an incident
- Plan first written
- What the review found and what changedNotes
- Employees and representatives who took partShort answer
- Next annual review dueDate
- Where hazard, training, log and investigation records are kept*Short answer
Actions and sign-off
- Items needing actionWorked out by the form
- ResultWorked out by the form
- ActionsRepeat for each action. Each one asks:
- Action*Notes
- PriorityChoose one
- Immediately
- This week
- This month
- At the next review
- Who will do it*Short answer
- Due byDate
- Status*Choose one
- Open
- In progress
- Done, checked
- Photo when donePhotosShown when “Status” is “Done, checked”
- Actions still openWorked out by the form
- Decision*Choose one
- Plan in effect
- In effect: finish the listed actions
- Not ready: review before issue
- Next check or re-inspection dateDate
- retaliation_actionWorked out by the form
- Summary for the clientNotes
- Plan prepared by nameShort answer
- Plan prepared by signature*Signature
- Person responsible for the plan nameShort answer
- Person responsible for the plan signatureSignature
See it filled in
A completed workplace violence prevention plan report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
Workplace violence prevention plan FAQs
Which California employers need a workplace violence prevention plan?
Section 6401.9 applies to all employers, employees, places of employment and employer-provided housing, with exemptions. They include health care settings covered by Title 8 section 3342, employees teleworking from a place of their choice not under the employer's control, and places with fewer than 10 employees at any time that are not open to the public and comply with the IIPP rule (section 3203). The requirements have applied since 1 July 2024.
Sources: California Labor Code section 6401.9 (SB 553), California Legislative Information and Cal/OSHA, Workplace Violence Prevention for General Industry (Non-Health Care Settings).
What goes in the violent incident log?
For every incident: the date, time and location; the workplace violence type (1 to 4); a detailed description; who committed it (for example customer, stranger with criminal intent, coworker); the circumstances, such as working alone or during low staffing; where it happened; the type of incident; whether security or law enforcement were contacted and their response; actions taken to protect employees; and the name and job title of the person completing the log and the date. Leave out anything that would identify a person involved.
Source: California Labor Code section 6401.9 (SB 553), California Legislative Information.
How long do we keep the records?
Section 6401.9(f) asks for hazard identification, evaluation and correction records, violent incident logs and incident investigation records to be kept for at least five years, and training records for at least one year. Investigation records must not contain medical information. Employees and their representatives can ask for the hazard, training and log records and get them free within 15 calendar days.
Source: California Labor Code section 6401.9 (SB 553), California Legislative Information.
How often is workplace violence training required?
Initial training when the plan is first established and then every year, covering the plan, the law's definitions and requirements, how to report without fear of reprisal, the hazards of each job and how to get help, the incident log and how to get records, and a chance to ask questions. Extra training is needed when a new hazard is found or the plan changes. The form keeps a record of each session.
Source: California Labor Code section 6401.9 (SB 553), California Legislative Information.
Is there a federal OSHA workplace violence standard?
OSHA's workplace violence page states that there are currently no specific OSHA standards for workplace violence. California's rule comes from state law, and Cal/OSHA has been developing a standard that the Standards Board is required to adopt by 31 December 2026, so check Cal/OSHA's page for changes. Outside California, check your own state's rules; the form still works as a written plan.
Sources: OSHA, Workplace Violence and Cal/OSHA, Workplace Violence Prevention for General Industry (Non-Health Care Settings).
Does using this template make us compliant with SB 553?
No. The law asks for a plan that is effective and carried out: employees involved, hazards found and corrected, training given, incidents logged and investigated. The template gives you the structure and keeps the records in one place, with photos and a PDF report. Whether you comply depends on what you do, and on any Cal/OSHA standard adopted after this page was checked.
Source: Cal/OSHA, Workplace Violence Prevention for General Industry (Non-Health Care Settings).
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