This form is completed/submitted online and is sent automatically to the TDSB Health and Safety Department and the appropriate ETT Health and Safety Officer.
Please include contact information on the form (e.g. email, personal phone number) so that the ETT Health and Safety Officer can follow up.
Print off a hard copy and submit to the Principal.
If the violent incident resulted in an injury to yourself, you need to also submit a copy of the Employee’s Report of Accident/Injury (ERA) and follow the steps outlined for this form because the injury could result in loss of work time/a WSIB claim.
It would benefit you to also fill out the Health and Safety Concern/Near Miss Form to ensure a written response from the Principal within 5 days (can include language such as: "I am concerned for my safety," "I have no BMS training (if you don’t)," There are ongoing incidents of violence with …).
Under the Occupational Health and Safety Act, an act of violence is:
- The exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker.
- An attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker.
- A statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker
TDSB Policy: P072 (Workplace Violence Prevention)
(4.1) The Board believes in the prevention of violence and is committed to promoting a violence-free workplace in which all people respect one another and work together to achieve common goals.
(4.4) The Board is committed to the implementation of measures and procedures for the reduction of violent incidents through the assessment of risk, by providing employees information related to risk of workplace violence of a person with a history of workplace violence and instruction on how to report, and how the employer will investigate. In conjunction with its responsibilities and duties as outlined in the Education Act, the Board will take every precaution reasonable in the circumstances for the protection of a worker.
Questions to the TDSB about this form can be directed to the Board’s Occupational Health and Safety Office at: 416-397-3213.
If you have any questions about this form, please contact your Executive Officer or the appropriate ETT Health and Safety Inspector.
Members are required to login to the TDSB website to access this document.