Welcome and Thank You for taking the time to complete our survey

Even if you only answer a couple of questions, please hit the "submit" button.

Partially complete surveys are better than nothing at all.

This survey is about workplace related violence. Workplace related violence includes actual violent incidents that occur in the workplace, at company events, or outside of work but as a result of people and situations in the workplace.

The purpose of this survey is twofold.

One is to learn where to better focus our educational and advocacy efforts.

The second is to give people a safe venue in which to make their opinions heard and counted.

This is anonymous unless you choose otherwise.

We will not ask for, nor keep, publicize, or otherwise share anyone's personal information.

We will not contact you unless you ask us to do so.

If you want to speak with us directly you can email us, call us, or leave us your email address.

1. Your Location
In what country do you live and work?

2. In what field of work are you? (e.g. sales, nursing, manufacturing, retail, etc)

3. Impact
Whether or not you have been directly victimized by workplace related violence, do you think that the issue of workplace violence has an impact on you?

	Yes
	No

4. Direct Experience
Have you witnessed, been a victim of, or personally know someone who has been a victim of workplace related violence? Check as many boxes as apply.

	No
	Yes, I was a victim of workplace related violence
	Yes, I witnessed an incident of workplace related violence
	Someone I know witnessed an incident
	Someone I know was a victim of workplace-related violence
	That stuff doesn't happen

5. Policy
Does your workplace have policies related to:

	No	Not officially, but they deal with the issues	I don't know	Yes, but they don't enforce them	Yes, and they do enforce them
Harassment(based on gender, race, disabilty, et. al.)
Bullying
Workplace Violence
Security of Employees

6. Employer Response to Workplace Violence Prevention Concerns
Is your employer responsive to the issue of preventing workplace-related violence? You may give a simply yes or no answer if you wish, or elaborate.

7. Employee Awareness Workplace Violence Prevention Concerns
As an employee, are you responsive to the issue of preventing workplace-related violence? Do you know what the warning signs are and what to do? You may give a simply yes or no answer if you wish, or elaborate.

8. Employer Response to Workplace Violence Prevention Concerns
If your employer would do just one thing in respect to workplace related violence and/or prevention, what do you think it should be?

9. Employee Response to Workplace Violence Prevention Concerns
If your employees would do just one thing in respect to workplace related violence and/or prevention, what do you think it should be?

10. Your Comments: