Template library · Assessments & screeners
Violence Risk Assessment template
Evaluate historical and current factors associated with violence risk.
Structured assessment of risk for violence toward others
- 19 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Risk Factors
- History of violenceTick box
- Access to weaponsTick box
- Specific threats madeTick box
- Named target(s) identifiedTick box
- Escalating anger or agitationTick box
- Substance useTick box
- History of impulsivityTick box
- Recent triggering stressorTick box
Formulation & Plan
- Clinical formulation of risk levelText
- Duty-to-warn / notification considerationsText
- Safety and management planText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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