IF1

INCIDENT / ASSAULT REPORT	

To be completed by DWP staff on the day the incident / assault occurs.

1. OFFICE NAME & ADDRESS (written not stamped)

Official office name

Postcode 

Region

Telephone number
	
     

     

     

        Fax number       

	
Type of office
		
Jobcentre Plus

Contact centre     	 

	Social security office  

Other (specify)              	

	Jobcentre		
      
2. ASSAILANT DETAILS (if known)

Name       

NINO        

Age           

Male       Female  

Currently marked PV?   Yes        No  

Address

	
     

     

     

     

	

Please read the guidance notes to help you fill in this form

3. CUSTOMER DETAILS    (if different from the assailant)

Name                                        NINO         

Relationship to assailant (e.g. partner)            

4. YOUR DETAILS

Name           

Age              	
Staff / pay number      

Male                Female  	

5. ABOUT YOUR CURRENT JOB

To which business do you belong?

Jobcentre Plus               The Pension Service               Child Support Agency  

The Appeals Service                Debt Management                Disability & Carers  
                                                                                                       Service

Security Guard                     Other   (please state)               

Length of time in current Business:         years            months

Length of time in current job:                   years             months

Have you received training in handling difficult customers / situations?

Do you agree to your personal details being disclosed to the TUS?	
Yes       No             

Yes       No  	

6. TIME OF THE INCIDENT
	
Day:          
	Date:          	Time:          	

7.	TYPE OF INCIDENT

7a	Did the incident take place in a screened area?		YES		NO   

7b	If you were not touched in any way, pick one of the following:  

		1.  Verbal abuse (face to face)

		2.  Verbal abuse (telephone)

		3.  Abusive written correspondence

       4.   Threatening you either face to face or over the telephone (e.g. 
threats to follow you, ‘get you outside’, ‘don’t send anyone near my house’, intimidation, harassment (including sexual or racial), waving objects around but not aimed at you)

       5.  Small items (papers, pens, etc) aimed or thrown at you but missed

	6.  Large items aimed or thrown at you but missed 

	7.  Assailant lunged at you or attempted to hit you but missed

	8.  Spitting aimed at you but missed

	9.  Thumping the security screen

	10. Hitting or kicking furniture, slamming/kicking doors (but not damaged) 

7c	If you were touched in any way, pick one of the following:

		11. Spitting

		12. Small items thrown at you and hit you (e.g. papers, pens etc)
	
	13. Large items were thrown at you and hit you (e.g. furniture, office equipment etc)

	14. Struck by assailant (includes touching, holding, kicking, head butting)

		15. Struck with a weapon owned by the assailant

		16. Struck with a weapon found on the premises

7d	Other circumstances (tick as appropriate)

	1. Damage to property (e.g. office equipment damaged, windows 
broken)
	
	2. Customers fighting each other

8. AFTERMATH  complete (a), (b) and (c):
	
a) Injury (tick one)	(b) Shock/distress (tick one)	c) Medical treatment (tick one)	

1. No physical injury

1. No shock/distress experienced

1. No medical treatment required	
	2. Cuts and bruises		2. Shock / distress at time, now recovered		2. Required local first aid

	
3. More than cuts and bruises (give details)	

3. Shock / distress continuing (give details)	

3. Required medical treatment (give details)	
Details of injury/shock/medical treatment:     	

9.   EVENTS LEADING UP TO INCIDENT (select up to 3 items)

	
	1	Enforcement of business rules (e.g. failure to provide evidence or information on time, availability, actively seeking, Jobseeker’s directions, mandatory programme, DNA testing, presumption of parentage etc)
	
	2	Benefit/money/maintenance/fares etc stopped/reduced/disallowed, closure of claim
	
	3	Social Fund/Hardship payment dispute (e.g. eligibility, delays, demands)
	
	4a	Refusal to replace lost/delayed GIRO/payment
	
	4b	Refusal of advance payment request
	
	5	Payment/GIRO late
	
	6a	Long waiting time to be seen/sign
	
	6b	Long waiting time for counter payment
	
	6c	Long delay in telephone being answered
	
	7	Customer appointment problems (e.g. notification of interview, signing late, attending    late for appointment, failure to attend, attending on wrong day, etc)
	
	8	Non specific hostility to staff/no apparent issues leading up to incident
	
	9	Assailant appeared to be under the influence of alcohol/drugs
	
	10	Assailant behaviour unstable, erratic, odd	
	11	Office error, clerical error
	
	12	Forcing or attempting forced entry; issues around access and office opening times
	
	13	Issues affecting partner of customer
	
	14	Notification of visit
	
	15	Issues surrounding fraud and other investigations e.g. interviews under caution
	
	16	Other* (Please give details)	*Only use this box if none of the above apply

     	

10.	LOCATION (tick one)		                           11.	 OFFICE CONDITIONS 
                     (only tick if applicable) 

	
1. Initial reception	 
	
Office crowded	

2. Public waiting area	
	
Temperature uncomfortable	
	
3. Public contact/interview areas including tribunal suites and medical boards		Staffing levels less than usual	

4. Private interview rooms		Office noisier than usual	

5. Non public (staff/restricted areas)		

6. Stairs		

7. Entrance/doorways		
	
8. Outside office (e.g. car park, on street, staff home)					
	
9. During visit (e.g. to customer’s home, NRP, Employers premises etc)		

10. Telephone/correspondence		

11. Outreach location (e.g. CAB)		

12.     EMPLOYEE ASSISTANCE SERVICE 

 

       I will seek / have sought support from Employee Assistance Service 

       I will not seek support from Employee Assistance Service 

13.    ACCOUNT OF INCIDENT (Please write clearly)

	
Briefly outline what happened, noting what led up to the incident, what was said or done, who was involved, role of the security guard if appropriate. Where possible please record exact words used (even if this is unpleasant) and avoid jargon or abbreviations. To comply with the Data Protection Act information must be accurate, factual and relevant, so stick to the facts and try to avoid making assumptions. Use a separate sheet if necessary.  
	
     	

Name any witnesses to the incident       

Signature  .....................................……
	
Print Name       	

Date form completed and passed to line manager