Workplace Harassment Risk Assessment Form
Help us identify risk factors for workplace harassment by assessing conditions, behaviors, awareness, and support needs.
How safe do you feel in your workplace environment?
*
Not safe at all
1
2
3
4
Completely safe
5
1 is Not safe at all, 5 is Completely safe
How often have you observed or experienced inappropriate comments or jokes at work in the past 6 months?
*
Never
Rarely
Sometimes
Often
Very often
How aware are you of the procedures for reporting workplace harassment?
*
Not aware at all
1
2
3
4
Very aware
5
1 is Not aware at all, 5 is Very aware
If you witnessed harassment, how comfortable would you feel reporting it?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Please rate your agreement with the following statements about your workplace.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Management takes harassment seriously
1
2
3
4
5
There are clear policies against harassment
6
7
8
9
10
Employees are encouraged to speak up
11
12
13
14
15
Have you attended any workplace harassment prevention training in the past year?
*
Yes
No
Not sure
Which types of harassment do you believe are most prevalent in your workplace? (Select all that apply)
*
Verbal harassment
Physical harassment
Sexual harassment
Bullying or intimidation
None
Other
Do you know whom to contact if you need support regarding workplace harassment?
*
Yes
No
Not sure
How confident are you that your workplace would respond appropriately to a harassment report?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Submit Assessment
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