• Workplace Violence: any physical assault, threatening behavior, or verbal abuse occurring in the work setting
• Workplace: any location either permanent or temporary where an employee performs any work-related duty
  • includes, but is not limited to, the buildings and the surrounding perimeters, including the parking lots, field locations, clients’ homes and traveling to and from work assignments

EXAMPLES

• Verbal threats to inflict bodily harm; including vague or covert threats

• Attempting to cause physical harm; striking, pushing and other aggressive physical acts against another person

• Verbal harassment; abusive or offensive language, gestures or other discourteous conduct towards supervisors, fellow employees, or the public

• Disorderly conduct, such as shouting, throwing or pushing objects, punching walls, and slamming doors

• Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority

• Inappropriate remarks, such as making delusional statements

• Fascination with guns or other weapons, bringing weapons into the workplace

• Violence by strangers

• Violence by customers or clients

• Violence by co-workers

• Violence by personal relations

• Homicide is the third leading cause of death in the workplace

• In 2016, there were 500 homicides in America’s workplaces

• Assaults and threats of violence number almost 2 million a year

• Most common were simple assaults: 1.5 million a year

  • Aggravated assaults: 396,000

  • Rapes and sexual assaults: 51,000

  • Robberies: 84,000

• Prevalence of handguns and other weapons among patients, their families, or friends

• Increasing use of hospitals by the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals

• Increasing number of acute and chronically mentally ill patients being released from hospitals without follow-up care, who now have the right to refuse medicine and who can no longer be hospitalized involuntarily unless they pose a threat to themselves or others

• Availability of drugs and money at hospitals, clinics and pharmacies, making them likely robbery targets

• Unrestricted movement of the public in clinics and hospitals

• Presence of gang members, drug/alcohol abusers, trauma patients, distraught family members

• Low staffing levels during times of increased activity such as meal and visiting times, transporting of patients

• Isolated work with clients during exams or treatment

• Solo work, often in remote locations, high crime settings with no back-up or means of obtaining assistance such as communication devices or alarm systems

• Lack of training in recognizing and managing escalating hostile and aggressive behavior

• Poorly-lighted parking areas

OSHA has developed guidelines to provide information to assist employers in meeting their responsibilities under the OSH Act.

• Not a new standard or regulation

• Advisory in nature and informational in content

• Intended for use by employers who are seeking to provide a safe and healthful workplace through effective workplace violence programs

• Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm
• This includes the prevention and control of the hazard of workplace violence
• OSHA will rely on Section 5 (a)(1) of the OSH Act for enforcement authority

• Management Commitment and Employee Involvement

• Worksite Analysis

• Hazard Prevention and Control

• Training and Education

• Recordkeeping and Evaluation of Program

• Complementary and essential

• Management commitment provides the motivating force to deal effectively with workplace violence

• Employee involvement and feedback-enable workers to develop and express their commitment to safety and health

• Organizational concern for employee emotional and physical safety and health

• Equal commitment to worker safety and health and patient/client safety

• System of accountability for involved managers, and employees

• Create and disseminate a clear policy of zero tolerance for workplace violence

• Ensure no reprisals are taken against employees who report incidents

• Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks

• Outline a comprehensive plan for maintaining security in the workplace

• Assign responsibility and authority for program to individuals with appropriate training and skills

• Affirm management commitment to worker supportive environment

• Set up company briefings as part of the initial effort to address safety issues

• Understand and comply with the workplace violence prevention program and other safety and security measures

• Participate in employee complaints or suggestion procedures covering safety and security concerns

• Prompt and accurate reporting of violent incidents

• Step-by-step look at the workplace to find existing or potential hazards for workplace violence
• A “Threat assessment Team”, Patient Assault Team, or similar task force may assess the vulnerability to workplace violence and determine appropriate actions
• Recommended Program:

  • Analyzing and tracking records

  • Monitoring trends and analyzing incidents

  • Screening surveys

  • Analyzing workplace security

• Engineering controls and workplace adaptation

  • Alarm systems and other security devices

  • Metal detectors

  • Closed-circuit video recording for high-risk areas

  • Safe rooms for use during emergencies

  • Enclose nurses’ station, install deep service counters or bullet-resistant glass in reception area, triage, admitting

• Administrative and work practice controls

  • State clearly to patients, clients, and employees that violence will not be tolerated or permitted

  • Establish liaison with local police and state prosecutors

  • Require employees to report all assaults and threats

  • Set up trained response teams to respond to emergencies

• Post incident response

  • Provide comprehensive treatment for victimized employees and employees who may be traumatized by witnessing a workplace violence incident

  • Trauma-crisis counseling

  • Critical incident stress debriefing

  • Employee assistance programs to assist victims

• Ensure that all staff are aware of potential security hazards and ways of protecting themselves.

• Employees should understand concept of “Universal Precautions for Violence”, i.e., that violence should be expected but can be avoided or mitigated through preparation.

• Employees should be instructed to limit physical interventions in workplace altercations unless designated emergency response team or security personnel are available.

• Recordkeeping and evaluation of the violence prevention program are necessary to determine overall effectiveness and identify deficiencies or changes that should be made.
• Recordkeeping

  • OSHA Log of Injury and Illness (OSHA 300)

  • Medical reports of work injuries assaults

  • Incidents of abuse, verbal attacks, or aggressive behavior

  • Information on patients with history of violence

  • Minutes of safety meetings, records of hazard analyses, and corrective actions

  • Records of all training programs

• Evaluation

  • Establish uniform violence reporting system and regular review of reports

  • Review reports of minutes from staff meetings on safety issues

  • Analyze trends and rates in illness/injury or fatalities caused by violence

  • Measure improvement based on lowering frequency and severity of workplace violence

• OSHA Consultation Program

• OSHA Internet Site www.osha.gov

• NIOSH

• Public Safety Officials

• Trade Associations

• Unions and Insurers

• Human Resource and Employee Assistance Professionals