The following data collection tool has been developed by the Maine Hospital Association Workplace Violence Subcommittee to quantify the number of workplace violence incidents occurring in Maine hospitals. The data collection tool has been broken down into two sections: Phase I and Phase II. Phase I data collection are the essential elements that hospitals should collect from any employee impacted by workplace violence. These are the minimum data that can provide insight into the volume and impact of workplace violence. The collection of the information is critical to developing an appropriate response to violence in hospitals, which may include policy change, advocacy, education, and training. Phase II data collection are elements that allow hospitals to better understand contributing factors to violence and provides more detailed information around the specifics of the incident including those involved. Phase II data will assist MHA member hospitals in understanding the steps that will be necessary to help prevent future incidents and support victims through the short -term and long-term impact of these events. Phase II data collection would be completed upon further investigation of an initial report. Hospitals may choose to collect this information for each report or select a subset of the total reports to collect additional information. PHASE I DATA COLLECTION: Information about Location of Event and Individual Impacted: