ER SAFE Employers
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Wisconsin's Department of Workforce Development Safe Access For Employees (S.A.F.E.) Employer Application
Your First Name
Your Last Name
Your Phone Number
Name of Company / Business
Your Position in Company/Businness
Please enter a other position text.
Company Address Line 1
Company Address Line 2
District of Columbia
Certification Questions (Checking Box Indicates the Statement is True):
1. Your company / business currently has a policy regarding domestic abuse and sexual violence.
2. Your company / business prohibits job discrimination based on an employee's status as a victim of domestic abuse or sexual violence.
3. Your company treats any reports by employees of domestic abuse or sexual violence as private and confidential.
4. Your company provides employees who are dealing with domestic abuse or sexual violence time off work to take care of needs related to domestic abuse or sexual violence, such as seeking legal assistance, attending court proceedings, or relocation.
a. Describe what time off is made available.
5. How are your employees notified of your domestic abuse and sexual violence policy within their first three months of employment?
At least one option must be checked for Question 5.
New Employee Orientation
6. Is your policy published for employees to view on request?
a. Where is your policy published?
b. How do employees know where to find the policy?
7. Does your company / business provide any other type of assistance for victims of domestic abuse or sexual violence?
8. Please attach a copy of the relevant policy/policies as .pdf, .doc.