The Georgia Department of Human Services (DHS) does not tolerate act or threats of violence towards its employees, customers/clients, or those contracted to provide services to the department. Employees of the department regardless of their position, are expected to report such acts or threats of violence to their (supervisor, manager, etc.) immediately and then document the incident on this form. Please submit this form to the DHS Office of Inspector General at email [email protected] as soon as possible but not more than three (3) business days of the incident.

Note: This form should not be used to report employee vs. employee violence or threats. Please refer to the DHS Office of Human Resources Policy 110. 

Address where incident occurred
Office Type
Is the perpetrator known to the agency?
Has law enforcement been notified?
Trespass warning issued?
Witness 1
Witness 2
Witness 3