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2. Purpose of this assessment: This guide is provided by the Blue Ridge Partnership for Workplace Violence Prevention (BRPWVP) as an initial resource for evaluating concerning information/incidents and suggesting appropriate courses-of-action. This guide is separate from, yet complimentary to, more thorough analyses used by the BRPWVP, internal risk-management mechanisms, and/or other similar resources.
   
   This form is intended to serve as a recommended guide for determining the most appropriate course-of-action an organization may take upon receiving information concerning a possible threat of violence or harm towards that organization or its employees.
   
   This form is NOT a directive by any person, group, or agency, public or private, and does not assert any legal authority over any party.
   
   The courses-of-action included in this form are not exhaustive, nor are the criteria used to tabulate those recommended actions. Regardless of the recommended course-of-action indicated through completing this form, if there exists an imminent concern for the safety of any party or an active incident requiring immediate assistance, contact 911 immediately.
   
   Using this assessment: Upon receipt of information which could possibly concern the safety of an organization or one of its employees from harm or violence, identify any of the pre-selected criteria on the following page which may apply. If any of those criteria apply to the situation being evaluated refer to the corresponding suggested course-of-action for next-step guidance. If multiple criteria apply in more than one category, refer to the category of more serious concern.
   
   If none of the pre-selected criteria apply to the situation being evaluated and/or additional consultation is desired, please e-mail your inquiries to the BRPWVP.
   
   Please complete all applicable fields based on all available information. All reports must include the name of the report submitter and valid contact information (phone number or e-mail address) for the BRPWVP to follow-up with.
   
   Anonymous submissions will not be accepted. Works best in Google Chrome.
4. Date Received*
   Date Received
5. Time Received*
   Time Received
6. Method of Threat Delivery*
   Email, spoken threat, letter, etc.
8. Threat Received By:*
   Name of person that received the threat.
9. Report Submitted By:*
   Person completing this online form.
11. Submitter's First Name*
12. Submitter's Last Name*
14. Submitter's Phone*
15. Submitter's Email Address*
17. Target of Threat*
18. Threat Suspect/Originator*
22. Tier 1: IMMINENT THREAT
    If ANY of the criteria apply, IMMEDIATELY CALL 9-1-1 and request police response.
24. Tier 1 Criteria

    1. Threat involved specific language to kill, bomb, burn, shoot or otherwise cause great harm.
    2. Threatening suspect is currently on-scene and causing disturbance / escalating volatile behavior.
    3. Threat involved specific use of weapons (guns, knives, bombs, etc.).
    4. Threat involved specific & quickly-approaching timeline for harmful action.
    5. Other threat or action resulting in IMMEDIATE concern for potential harm or violence.
28. Tier 2: CREDIBLE THREAT OF PHYSICAL HARM - NOT IMMINENT
    If ANY of the criteria below apply, contact the BRPWVP representative as soon as possible.
30. Tier 2 Criteria

    1. Multiple documented incidents of escalating hostile / violent behaviors within or outside of the workplace, accumulated over a reasonable amount of time.
    2. Concerning writings, internet postings, reported discussions with co-workers/supervisors, and/or other corroborated reports of violent/threatening behavior (bearing some connection to the workplace).
    3. Behavior of an employee’s spouse or other third party which raises concerns for targeted violence/retaliation towards employee while at the workplace.
    4. Verbalized threat to harm (with violence) the organization, an employee, supervisor/administrator beyond flippant/casual/in-jest consideration (consider the context in which the statement was made).
    5. Other articulable and/or documented concerns of possible workplace violence the organization is not able to confidently or sufficiently address internally.
34. Tier 3: THREAT OF HARM NOT CREDIBLE / THREAT OF WORKPLACE DISRUPTION ONLY
    If ONLY these criteria apply incident should be assessed further through the organization's internal mechanisms (internal threat assessment team, management / administration, or human resources).
36. Tier 3 Criteria

    1. Concerning employee attitude or behaviors WITHOUT indicators of violence or desire to do harm.
    2. Noticeable decline in employee morale or work performance.
    3. Unsubstantiated rumors of anger or hostility towards other employees.
    4. Unsubstantiated rumors or concerns regarding employee’s actions/behaviors outside of workplace.
    5. Isolated displays of anger not resulting in harm or threats to harm others.
    6. Routine matters of discipline.
40. Law Enforcement Agency to Receive This Information

    Please select an agency below to receive your complaint. This agency will investigate your complaint for further action or recommendations.

    1. Roanoke County Police
    2. Roanoke City Police
    3. Salem City Police

    1. Virginia Western Community College
    2. Town of Vinton Police
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42. 1. Receive an email copy of this form.
43. Email address

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