Get the free Violent Incident Log template
A printable Violent Incident Log for California employers covered by SB 553, with one entry page per incident and every field listed in Labor Code §6401.9(d)(2).
What you get
- An entry form for each incident, with a section per item in §6401.9(d)(2)(A)–(I) — date, time, and location; violence type; detailed description; and the who, where, and what classifications as checkboxes, using the statute's own categories
- A classification key explaining the four workplace violence types
- A cover page carrying the rules that trip people up: no personal identifying information in the log, five-year retention, and 15 calendar days to provide copies on request
- An entry index, so a specific incident can be found years later
It is a PDF, and it is free. No account, no card. The log is a starting structure: keeping it is one of SB 553's three requirements, alongside the written plan and annual training, and filling it in is not a determination that a program meets any requirement.
Where to send it
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