Bystander Intervention Training Compliance Checklist Form
Use this form to document completion and compliance with bystander intervention training and related follow-up requirements.
Participant Full Name
*
First Name
Last Name
Employee ID or Participant Number
*
Date of Training Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Training Completion Status
*
Completed
Partially Completed
Not Completed
Checklist of Core Training Components
*
Rows
Completed
Recognizing inappropriate behaviors
1
Safe intervention strategies
2
Reporting procedures
3
Understanding company policy
4
Resources for support
5
Were all required follow-up actions completed?
*
Yes
No
Not Applicable
Describe any follow-up actions taken (if applicable)
Supervisor/Trainer Name
*
Supervisor/Trainer Email
*
example@example.com
Submit Compliance Checklist
Should be Empty: