OSHA guidance on workplace violence

Potential abatement methods

The employer may use any one or combination of the following abatement methods to materially reduce or eliminate the hazard of workplace violence. Other references should also be reviewed to determine the most effective methods applicable to the workplace.

General recommendations for all industries and administrative workplaces:

Conduct a workplace violence hazard analysis (this includes analyzing vehicles used to transport clients).

Assess any plans for new construction or physical changes to the facility or workplace to eliminate or reduce security hazards.

Provide employees with training on workplace violence.

Implement Engineering Controls, such as:

• Install and regularly maintain alarm systems and other security devices, panic buttons, hand-held alarms or noise devices, cellular phones and private channel radios where risk is apparent or may be anticipated. Arrange for a reliable response system when an alarm is triggered.
• Provide metal detectors-installed or hand-held, where appropriate-to detect guns, knives or other weapons, according to the recommendations of security consultants.
• Use a closed-circuit recording on a 24-hour basis for high-risk areas.
• Place curved mirrors at hallway intersections or concealed areas.
• Lock all unused doors to limit access, in accordance with local fire codes.
• Install bright, effective lighting, both indoors and outdoors.
• Replace burned-out lights and broken windows and locks.
• Keep automobiles well maintained if they are used in the field.
• Lock automobiles at all times.

Implement Administrative Controls-to change work practices and management policies in order to reduce exposure to hazards. Such controls include:

• Establish liaisons with local police and state prosecutors. Report all incidents of violence. Give police physical layouts of facilities to expedite investigations.
• Require employees to report all assaults or threats to a supervisor or manager (in addition, address concerns where the perpetrator is the manager). Keep log books and reports of such incidents to help determine any necessary actions to prevent recurrences.
• Advise employees of company procedures for requesting police assistance or filing charges when assaulted and help them do so, if necessary.

Provide management support during emergencies. Respond promptly to all complaints.

Set up a trained response team to respond to emergencies.

Use properly trained security officers to deal with aggressive behavior. Follow written security procedures.

Develop a written, comprehensive workplace violence prevention program, which should include:

A policy statement regarding potential violence in the workplace and assignment of oversight and prevention responsibilities.

A workplace violence hazard assessment and security analysis, including a list of the risk factors identified in the assessment and how the employer will address the specific hazards identified.

Development of workplace violence controls, including implementation of engineering and administrative controls and methods used to prevent potential workplace violence incidents.

A recordkeeping system designed to report any violent incidents. Additionally, the employer shall address each specific hazard identified in the workplace evaluation. The reports must be in writing and maintained for review after each incident and at least annually to analyze incident trends.

Development of a workplace violence training program that includes a written outline or lesson plan.

Annual review of the workplace violence prevention program, which should be updated as necessary. Such review and updates shall set forth any mitigating steps taken in response to any workplace violence incidents.

Development of procedures and responsibilities to be taken in the event of a violent incident in the workplace.

Development of a response team responsible for immediate care of victims, reestablishment of work areas and processes and providing debriefing sessions with victims and coworkers. Employee assistance programs, human resource professionals and local mental health and emergency service personnel should be contacted for input in developing these strategies.

Additional Considerations for Retail Industry

See OSHA publication 3153.

Minimizing Risk through Engineering Controls and Workplace Adaptations

Limit window signs to low or high locations and keep shelving low so that workers can see incoming customers and so that police can observe what is occurring from the outside of the store.

Ensure that the customer service and cash register areas are visible from outside of the establishment.

Install video surveillance equipment and closed-circuit TV to increase the likelihood of identification of perpetrators.

Use door detectors so that workers are alerted when someone enters the store.

Have height markers on exit doors to help witnesses provide more accurate descriptions of assailants.

Install fences and other structures to direct the flow of customer traffic into and around the store.

Control access to the store with door entry (buzzer) systems.

Install physical barriers between customers and workers, such as bullet-resistant enclosures with pass-through windows.

Use drop safes to limit the availability of cash to cashiers and post signs stating that cashiers have limited access to cash.

Use a panic button and responsive staff or other system that can be used to call for backup assistance, when needed in an emergency.

Use an x-ray or other security screening to detect and prevent weapons from being brought into the facility.

Minimizing Risk through Administrative and Work Practice Controls

Integrate violence prevention activities into daily procedures, such as checking lighting, locks and security cameras to help maintain a secure worksite.

Require workers to use the drop safes and keep a minimal amount of cash in each register.

Develop and implement procedures for the correct use of physical barriers, such as enclosures and pass-through windows.

Establish a policy of when doors should be locked. Require workers to keep doors locked before and after official business hours.

Require workers to lock unlocked doors when not in use.

Require that deliveries be made during normal daytime operations.

Develop and implement emergency procedures for workers to use in case of a robbery or security breach, such as calling the police or triggering an alarm.

Train all staff to recognize and defuse verbal abuse that can escalate to physically combative behavior.

Train all staff and practice drills for physically restraining combative patients or clients, including the use of physical restraints and medication, when appropriate.

Additional Considerations for Healthcare and Social Services Facilities

See OSHA publication 3148.

Engineering Controls and Workplace Adaptations to Minimize Risk

Enclose nurses' stations and install deep service counters or bullet-resistant, shatter-proof glass in reception, triage and admitting areas or client service rooms.

Provide employee "safe rooms" for use during emergencies.

Establish "time-out" or seclusion areas with high ceilings without grids for patients who "act out" and establish separate rooms for criminal patients.

Provide comfortable waiting rooms (client or patient) designed to minimize stress.

Ensure that counseling or patient care rooms have two exits.

Lock doors to staff counseling rooms and treatment rooms to limit access.

Arrange furniture to prevent entrapment of staff.

Use minimal furniture in interview rooms or crisis treatment areas and ensure that it is lightweight, without sharp corners or edges and affixed to the floor, if possible. Limit the number of pictures, vases, ashtrays or other items that can be used as weapons.

Provide lockable and secure bathrooms for staff members separate from patient/client and visitor facilities.

Install partitions in transport vehicles to protect drivers from aggressive patients or clients.

Administrative and Work Practice Controls to Minimize Risk

State clearly to patients, clients and employees that violence is not permitted or tolerated.

Ensure that adequate and properly trained staff is available to restrain patients or clients, if necessary.

Provide sensitive and timely information to people waiting in line or in waiting rooms. Adopt measures to decrease waiting time.

Ensure that adequate and qualified staff is available at all times. The times of greatest risk occur during patient transfers, emergency responses, mealtimes and at night. Areas with the greatest risk include admission units and crisis or acute care units.

Institute a sign-in procedure with passes for visitors, especially in a newborn nursery or pediatric department. Enforce visitor hours and procedures.

Establish a list of "restricted visitors" for patients with a history of violence or gang activity. Make copies available at security checkpoints, nurses' stations and visitor sign-in areas.

Review and revise visitor check systems, when necessary. Limit information given to outsiders about hospitalized victims of violence.

Supervise the movement of psychiatric clients and patients throughout the facility.

Control access to facilities other than waiting rooms, particularly drug storage or pharmacy areas.

Prohibit employees from working alone in emergency areas or walk-in clinics, particularly at night or when assistance is unavailable. Do not allow employees to enter seclusion rooms alone.

Establish policies and procedures for secured areas and emergency evacuations.

Determine the behavioral history of new and transferred patients to learn about any past violent or assaultive behaviors.

Establish a system-such as chart tags, log books or verbal census reports-to identify patients and clients with assaultive behavior problems. Keep in mind patient confidentiality and worker safety issues. Update as needed. Review any workplace violence incidents from the previous shift during change-in-shift meetings.

Treat and interview aggressive or agitated clients in relatively open areas that still maintain privacy and confidentiality (such as rooms with removable partitions).

Use case management conferences with coworkers and supervisors to discuss ways to effectively treat potentially violent patients.

Prepare contingency plans to treat clients who are "acting out" or making verbal or physical attacks or threats. Consider using certified employee assistance professionals or in-house social service or occupational health service staff to help diffuse patient or client anger.

Transfer assaultive clients to acute care units, criminal units or other more restrictive settings.

Ensure that nurses, physicians and other clinicians are not alone when performing intimate physical examinations of patients.

Discourage employees from wearing necklaces or chains to help prevent possible strangulation in confrontational situations. Urge community workers to carry only required identification and money.

Survey the facility periodically to remove tools or possessions left by visitors or maintenance staff that could be used inappropriately by patients.

Provide staff with identification badges, preferably without last names, to readily verify employment.

Discourage employees from carrying keys, pens or other items that could be used as weapons.

Provide staff members with security escorts to parking areas in evening or late hours. Ensure that parking areas are highly visible, well lit and safely accessible to the building.

Use the "buddy system," especially when personal safety may be threatened. Encourage home healthcare providers, social service workers and others to avoid threatening situations.

Advise staff to exercise extra care in elevators, stairwells and unfamiliar residences; leave the premises immediately if there is a hazardous situation; or request police escort, if needed.

Develop policies and procedures covering home healthcare providers, such as contracts on how visits will be conducted, the presence of others in the home during the visits and the refusal to provide services in a clearly hazardous situation.

Establish a daily work plan for field staff to keep a designated contact person informed about their whereabouts throughout the workday. Have the contact person follow up if an employee does not report in as expected.