• Depending on the severity of the risk, a combination of training programs may be used to keep management up to date on violence prevention.
• Keeping accurate records and performing evaluations of violence prevention programs are essential for determining effectiveness, identifying issues, and quickly applying needed changes.

Training topics may include management of assaultive behavior, professional/police assault-response training, or personal safety training on how to prevent and avoid assaults. A combination of training programs may be used, depending on the severity of the risk.

In general, training should cover the policies and procedures for a facility as well as de-escalation and self-defense techniques. Both de-escalation and self-defense training should include a hand-on component. The following provides a list of possible topics:

• A workplace violence prevention policy;
• Risk factors that cause or contribute to assaults;
• The location, operation, and coverage of safety devices, such as alarm systems, along with information about required maintenance schedules and procedures;
• Early recognition of escalating behavior or recognition of warning signs or situations that may lead to an assault;
• Ways to recognize and prevent/diffuse volatile situations or aggressive behavior;
• Ways to manage anger and appropriately use medications;
• Ways to deal with hostile customers;
• Proper use of safe rooms and areas where staff can find shelter from a violent incident;
• A standard response action plan for violent situations that includes knowing the availability of assistance, knowing how to respond to alarm systems, and knowing how to handle communication procedures;
• Self-defense procedures;
• Ways to protect oneself and coworkers, including the use of a “buddy system”;
• Policies and procedures for reporting and recordkeeping; and
• Policies and procedures for obtaining care, counseling, workers’ compensation, or legal assistance after a violent episode or injury.

Recordkeeping and program evaluation

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

Accurate records of injuries, illnesses, incidents, assaults, hazards, corrective actions, and training can help employers:

• Determine the severity of the problem;
• Identify any developing trends or patterns in particular locations, jobs, or departments;
• Evaluate methods of hazard control;
• Identify training needs; and
• Develop solutions for an effective program.

Key records include:

• The Occupational Safety and Health Administration (OSHA) Log of Work-Related Injuries and Illnesses (OSHA Form 300). Covered employers are required to prepare and maintain records of serious occupational injuries and illnesses using the OSHA 300 Log. As of January 2015, all employers must promptly report to OSHA:
  • All work-related fatalities within 8 hours, and
  • All work-related inpatient hospitalizations, all amputations, and all losses of an eye within 24 hours.

Injuries caused by assaults must be entered on the log if they meet the recording criteria:

• Medical reports of work injury, workers’ compensation reports, and supervisors’ reports for each recorded assault. These records should describe the type of assault — such as an unprovoked sudden attack or patient-to-patient altercation — who was assaulted, and all other circumstances of the incident. The records should include a description of the environment or location, lost work time that resulted, and the nature of injuries sustained. These medical records are confidential documents and should be kept in a locked location under the direct responsibility of a healthcare professional.
• Records of incidents of abuse, reports conducted by security personnel, and verbal attacks or aggressive behavior that may be threatening, such as pushing or shouting and acts of aggression. This may be kept as part of an assaultive incident report. Ensure that the affected department evaluates these records routinely.
• Documentation of minutes of safety meetings, records of hazard analyses, and corrective actions recommended and taken.
• Records of all training programs, attendees, and qualifications of trainers.