ABOUT THE REPORT

A record of what happened.

ViolenceReport.com provides a voluntary way for nurses and nursing staff to document workplace violence, threats, harassment, and their impact.

When to use this form

Complete it after the scene is safe. You can report an encounter you experienced, witnessed, or responded to. Select the answers that best match what you know and leave optional details blank when they do not apply.

Keep identifying details out

Do not include patient names, staff names, medical record numbers, room numbers, contact information, exact addresses, or other identifying details. Describe behaviors, working conditions, and the response without identifying the people involved.

Continue your usual reporting

This form is not an emergency service, an official facility incident report, an HR filing, or a police report. Submitting here does not notify your employer, security, law enforcement, or emergency services. Follow your facility’s reporting procedures separately.

If there is immediate danger, contact emergency services or your facility’s emergency response team.