The Georgia Department of Human Services (DHS) does not tolerate acts or threats of violence towards its employees, customers/clients, or those contracted to provide services to the Department. DHS employees, 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. Download and take the appropriate steps in the Download this pdf file. OIG Workplace Acts or Threats of Violence Checklist  (save the completed checklist for your records). Upon completion of the Checklist, please submit the form below, which is sent to the DHS Office of Inspector General email, as soon as possible, but within 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 the incident occurred
Office Type
Method of notification, if anonymous
Is the perpetrator known to the agency?
Has law enforcement been notified?
Were trespass warnings issued?
Witness 1
Witness 2
Witness 3