**Understanding and responding to workplace violence**

***u.s. Department of Health and Human Services***

**January 2008**

**TABLE OF CONTENTS**

**CHAPTER 1: INTRODUCTION (Page 4)**

4\. Purpose and Scope of this Handbook

4\. Background

6\. Handbook Structure

**CHAPTER 2: DEFINITIONS (Page 7)**

**CHAPTER 3: ROLES AND RESPONSIBILITIES (Page 9)**

9\. All Employees

9\. Managers and Supervisors

9\. Human Resources Centers

10\. Security Office and Federal Police

10\. Employee Assistance Program

10\. HHS University

11\. Unions and Their Representatives

11\. Safety Officers

**CHAPTER 4: POLICY AND AUTHORITIES (Page 12)**

**CHAPTER 5: IS THIS A VIOLENT SITUATION? LEARN THE WARNING SIGNS (Page
16)**

16\. Introduction

16\. Forms of Violence

17\. Levels of Violence

18\. Performance Indicators

19\. Threat Assessment

19\. Contacting the Crisis Management Team in Your Area

**CHAPTER 6: RESPONDING TO A VIOLENT SITUATION (Page 21)**

21\. Introduction

21\. When Early Warning Signs Occur (Level 1)

22\. When the Situation Has Escalated (Level 2)

23\. In An Emergency (Level 3)

> 23\. Handling Bomb Threats
>
> 24\. Domestic Violence

**CHAPTER 7: AFTER THE FACT (Page 25)**

25\. Introduction

25\. First Things First

26\. How Traumas Affect Employees

26\. Psychological First Aid/Critical Incident Debriefing Process

27\. Considerations for Management

27\. Helping Yourself

**CHAPTER 8: PREVENTION (Page 29)**

29\. Policy

29\. Work Environment

29\. Employment Screening

30\. Weapons

30\. Security

30\. Education

31\. Early Intervention

**CHAPTER 9: RESOURCE GUIDE (Page 32)**

32\. Department of Health and Human Services

33\. Additional Federal Government Information

**CHAPTER 1: INTRODUCTION**

***PURPOSE AND SCOPE OF THIS HANDBOOK***

The purpose of this handbook is to provide guidance to employees of the
Department of Health and Human Services (HHS) on managing violent or
potentially violent situations. It is intended to help employees become
aware of the potential for violence in the workplace, to increase their
ability to recognize early warning signs of potentially violent
situations, and to understand how to respond to actual or potential
incidents. This handbook also provides some prevention ideas. Finally,
some additional resources are included for those who want to learn more.

This guidance is general in order to address the wide array of
occupations and locations in HHS. It is recognized that many sites and
operations have unique risk factors that should be addressed with an
expanded strategy.

All employees (including officers of the Commissioned Corps) and all
facilities of HHS are covered by the policies and guidance provided in
this handbook. Certain portions of this text may also apply to
contractors and visitors to HHS buildings.

***BACKGROUND***

Violence is a complex phenomenon that impacts the workplace in a number
of ways. While many think of workplace violence as the sensational
multiple homicides they see on the television, those events represent a
very small portion of the incidents that make up workplace violence. The
majority of incidents in the workplace involve assaults, domestic
violence, stalking, harassment (including sexual), bullying, and other
emotional abuse. These types of incidents rarely show up in the
headlines and are often not even reported to agency management.

Data on workplace violence is sketchy but all the experts agree the
number of incidents is vast and the cost of violence to organizations is
staggering.

-   The number of violent deaths in the workplace seems to be declining
    for a number of reasons. The Department of Labor's Bureau of Labor
    Statistics reports there were 516 deaths in 2006, down from 632 in
    2003 and from an average of 800 yearly in the 1990s.

-   A Bureau of Justice Statistics report estimated there was an average
    of 1.7 million violent victimizations per year in the workplace each
    year from 1993-1999.

-   Estimates of the cost to businesses due to workplace violence are
    less exact but, by most expert accounts, it runs into the billions
    of dollars.

It is impossible to overstate the costs of workplace violence, because a
single incident can have such sweeping repercussions. There is the
immediate and profound loss of life and agonizing psychological
repercussions to the victim's family, friends and co-workers. There is
the loss of productivity and morale that sweeps through an organization
after a violent incident. There is the public relations impact on a
company when news of violence reaches the media. And increasingly, there
is significant cost to organizations when a court finds them guilty of
negligence. (from "Workplace Violence: First Line of Defense," The
Employment and Labor Law Series)

Workplace violence affects other areas as well. The adverse impacts on
organizations and individuals are wide-ranging and include:

-   psychological damage:

    -   substance abuse

    -   trauma

-   mental health services

-   survivor guilt

-   suicide

-   property damage, theft and sabotage

-   productivity impediments:

    -   increased turnover

    -   absenteeism

    -   lower morale

-   diversion of management resources:

    -   response to crisis and problems

    -   costly litigation

-   increased security costs

-   increased workers' compensation costs

-   increased personnel costs (employment, training)

There are many theories about the causes of workplace violence. Research
indicates that the probability of workplace violence increases if a
number of risk factors are present. These include dealing with the
public and the exchange of money. Research at NIOSH also describes
increased risk in certain work settings such as hospitals and
convenience stores. Other researchers attribute it to the violent
culture in society as a whole. The availability of guns, an inefficient
criminal justice system, an unstable economy, instability of home and
family life, and the glamorization of violence by the media are
mentioned frequently as contributors to violence.

The work environment can also influence the probability for threats and
violent behavior. Some of the problems frequently found in workplaces
where violence has occurred include chronic labor/management disputes, a
rigid authoritarian style of management, insensitive terminations, high
number of stressed personnel, improper handling of grievances, lack of
consistency in handling personnel matters, ineffective communication,
insufficient attention to physical security, and understaffing.

Finally, violence is often associated with factors related to the
individual perpetrator. An individual who commits such acts may have a
history of domestic violence, mental health or substance abuse problems,
be a loner, have low self-esteem, have a victim mentality, be under
extreme stress, or externalize blame or disappointment. It is important
to avoid profiling or stereotyping individuals or organizations,
however. The presence of any of the above factors does not necessarily
indicate a violent act will be carried out. An incident can be the
result of any one or a combination of these factors.

***HANDBOOK STRUCTURE***

The first part of the handbook will explain the nature of violence,
including commonly used definitions, and the roles of various HHS staff
in addressing the issue (Chapters 1, 2, and 3). Next, the workplace
violence policy of this Department is provided as well as information
about other policies and procedures which impact these situations
(Chapter 4). The next chapters will help employees understand the
indicators of a violent or potentially violent situation and how to
respond (Chapters 5, 6, and 7). Ideas for prevention are next discussed
(Chapter 8). Information about other resources is provided last (Chapter
9).

**CHAPTER 2: DEFINITIONS**

These definitions are provided for use in the context of this document
and should not be construed as legal definitions.

***WORKPLACE VIOLENCE.*** An action (verbal, written or physical
aggression) which is intended to control or cause, or is capable of
causing, death or serious bodily injury to oneself or others, or damage
to property. Workplace violence includes abuse of authority,
intimidating or harassing behavior and threats. Workplace violence may
make an employee afraid to come to work or interact with others.

***ASSAULT.*** To attack someone physically or verbally, causing bodily
or emotional injury, pain and/or distress. This might involve the use of
a weapon, and includes actions such as hitting, punching, pushing,
poking, or kicking.

***CRISIS MANAGEMENT TEAM.*** A group of agency specialists convened on
an ongoing or *ad hoc* basis to implement policies regarding workplace
violence; investigate and assess a violent or potentially violent
situation; intervene to resolve or diffuse some violent situations
(which are not better handled by the police); implement the agency\'s
action plan when required; and/or implement any corrective, preventive
or follow-up action during or following an incident of workplace
violence. It is not the intention of this team to interfere with
official police investigations.

***CRITICAL INCIDENT STRESS DEBRIEFING.*** An element of threat
assessment and crisis management involving a meeting or series of
meetings held with witnesses, victims or co-workers involved in an
incident of workplace violence. It is a counseling protocol for
gathering information and responding to the immediate ***emotional***
needs of employees who have been traumatized. It is conducted by a
professional with specialized training. There are a number of phases to
the process starting at the normalization of the event and ending with
reentry into the workplace.

***DANGEROUS WEAPON.*** A device, instrument, material, or substance
(animate or inanimate) that is used for, or is readily capable of,
causing death or serious bodily injury. These include guns, knives,
clubs, chemicals and explosive devices.

***DOMESTIC VIOLENCE.*** A reference to acts of physical and
psychological violence, including harassing or intimidating behavior,
that occur as part of personal relationships such as marriages or other
intimate relationships. Included in the concept of domestic violence are
spousal abuse, abuse among intimates, as well as sexual and physical
abuse of children and/or the elderly or the infirmed.

***EMPLOYEE ASSISTANCE PROGRAM (EAP).*** A professional assessment,
referral, and short-term counseling service available to all HHS
employees and, in some situations, to their family members to help with
personal problems such as substance abuse, job stress, and family
dysfunction which may be affecting work performance. EAP services are
voluntary, confidential, and provided at no cost to the employee.

***INTIMIDATING OR HARASSING BEHAVIOR.*** Threats or other conduct which
in any way creates a hostile environment; impairs agency operations; or
frightens, alarms, or inhibits others. Psychological intimidation or
harassment includes making statements which are false, malicious,
disparaging, derogatory, rude, disrespectful, abusive, obnoxious,
insubordinate, or which have the intent to hurt others' reputations.
Physical intimidation or harassment may include holding, impeding or
blocking movement, following, stalking, touching or any other
inappropriate physical contact or advances.

***HHS FACILITY.*** A building, or part thereof, including appurtenant
grounds and parking lots, utilized or under the control of, assigned to
or leased by or on behalf of HHS and/or its components where its
employees or contractors are present for the purpose of performing their
official duties.

***LOCAL AUTHORITIES.*** Municipal, county, state, and federal law
enforcement (having local responsibilities); or public safety personnel,
such as police, fire fighters, arson investigators, bomb/threat
investigators, etc., of the civil jurisdictions where HHS facilities are
located or acts of violence occur.\
\
***PSYCHOLOGICAL FIRST AID.*** For those impacted by a violent event,
this is an intervention that creates and sustains an environment of 1)
safety; 2) calming; 3) connectedness to others; 4) self empowerment; and
5) hopefulness.

***SABOTAGE.*** An act to destroy, damage, incapacitate or contaminate
property (animate or inanimate), equipment, supplies or data (e.g., hard
copy files and records, computerized information, etc.); to cause
injury, illness or death to humans; or to interfere with, disrupt,
cripple, disable or hinder the normal operations or missions of this
organization.

***STALKING.*** Malicious conduct that includes approaching or pursuing
another person with intent to place that person in reasonable fear of
serious bodily injury or death to him/herself or to a third party.

***THREAT.*** Any oral or written expression or gesture that could be
interpreted by a reasonable person as conveying intent to cause physical
harm to persons or property. Statements such as, "I'll get him" or "She
won't get away with this" are examples of threatening expressions.

**CHAPTER 3: ROLES AND RESPONSIBILITIES**

***ALL EMPLOYEES (INCLUDING MANAGERS AND SUPERVISORS) ARE RESPONSIBLE
FOR:***

-   their own behavior and interacting responsibly with fellow employees
    and their supervisors;

-   promptly reporting, anonymously if necessary, any acts of violence,
    threats, and similar disruptive behavior in the workplace to
    appropriate authorities;

-   cooperating fully in investigations/assessments of allegations of
    workplace violence;

-   seeking appropriate assistance (e.g., Employee Assistance Program or
    other counseling) if they are experiencing stressful personal or
    work circumstances, emanating from any source, which may adversely
    affect their productivity or lead to unacceptable behavior; and,

-   informing appropriate persons in the agency about restraining orders
    and other protective court orders related to domestic situations so
    that assistance can be offered at the worksite.

***MANAGERS AND SUPERVISORS ARE ADDITIONALLY RESPONSIBLE FOR:***

-   ensuring that all employees are fully informed of and understand HHS
    workplace violence policy and procedures;

-   being cognizant of situations that have the potential to produce
    violent behavior and promptly addressing them with all concerned
    parties;

-   being sensitive to stress generated by the workplace and considering
    changes that could alleviate work-related stress;

-   encouraging employees who show signs of stress or evidence of
    possible domestic violence to seek and receive assistance, such as
    that provided by the Employee Assistance Program;

-   documenting and responding to allegations of workplace violence in a
    timely fashion (this may include referring the case to the Human
    Resources Center, local Crisis Management Team, if there is one, and
    assisting them with any follow-up/investigative activities);

-   assuring that employees have time and opportunity to attend training
    concerning understanding and responding to threats or violence in
    the workplace; and

-   consistent with all applicable Federal laws and regulations,
    ensuring that thorough and appropriate reference screening is
    performed to avoid hiring individuals with an authenticated history
    of violent, threatening, or other unacceptable disruptive behavior
    that would preclude them from performing the duties of the job or
    place individuals at reasonable risk of serious injury or death.

***THE HUMAN RESOURCES CENTERS ARE RESPONSIBLE FOR:\
***

-   assisting in investigating allegations of workplace violence raised
    by supervisors, managers, and all other employees or as requested by
    the Crisis Management Team (if one exists) or law enforcement
    personnel;

-   providing advise and assistance to managers and supervisors
    regarding employees' personnel and administrative actions related to
    violent behavior, threats of violence, or other performance and
    conduct deficiencies;

-   informing supervisors and managers of the importance and proper
    methods of screening applicants to avoid hiring an individual with a
    history of or the potential for violent behavior; and

-   advising supervisors and managers when a potentially violent
    situation exists so that corrective action can be taken.

***THE SECURITY OFFICE AND FEDERAL POLICE ARE RESPONSIBLE FOR:***

-   providing technical advice and support regarding physical security
    matters;

-   participating in conducting surveys and threat assessments;

-   assisting in the provision of training to managers and supervisors
    on dealing with violent and threatening behavior in the workplace;

-   assisting with or actually conducting investigations of threats or
    incidents of workplace violence;

-   acting as liaison with local authorities and outside law enforcement
    agencies;

-   maintaining an ongoing security awareness program; and

-   making arrests for acts of violence in Government owned and leased
    buildings, when appropriate and when having authority.

***THE EMPLOYEE ASSISTANCE PROGRAM IS RESPONSIBLE FOR:***

-   providing consultation and guidance to supervisors in dealing with
    employees with performance or conduct problems;

-   providing diagnostic counseling for employees experiencing personal
    problems on and off the job;

-   providing short-term counseling for employees;

-   referring employees needing long-term counseling to appropriate
    treatment resources; and

-   assisting in the provision of training about dealing with violent
    and threatening behavior in the workplace

***THE HHS UNIVERSITY IS RESPONSIBLE FOR:***

-   assisting with the development and delivery of appropriate training
    and education sessions on violence in the workplace, to include
    agency policy, warning signs, workforce issues which contribute to
    stress, response procedures, and prevention techniques;

-   offering training courses to assist employees to deal with
    situations which may lead to potential violence, for example,
    conflict resolution, stress management, and negotiating skills; and

-   implementing violence training plans developed by HHS.

***THE UNIONS AND THEIR REPRESENTATIVES ARE RESPONSIBLE FOR:\
***

-   being cognizant of situations that have the potential to produce
    violence and promptly addressing them with all concerned parties;

-   being sensitive to stress generated by the workplace and assisting
    employees in alleviating it;

-   encouraging employees who show signs of stress to receive
    assistance, such as that provided by the Employee Assistance
    Program;

-   promptly reporting incidents of workplace violence or threats of
    violence or similar disruptive behavior to appropriate authorities;
    and

-   advising employees, if they inquire, of the proper procedures for
    reporting violent behavior.

***SAFETY OFFICERS (WHEN AVAILABLE) ARE RESPONSIBLE FOR:***

-   gathering incident reports on workplace violence in HHS;

-   preparing trend reports and other analyses of the incident report
    data;

-   emergency preparedness activities in HHS; and

-   when appropriate, assisting with threat assessment and response
    activities of the Crisis Management Team (if one exists).

**CHAPTER 4: POLICY AND AUTHORITIES**

This chapter outlines some of the more relevant laws, regulations, and
HHS policies related to violence in the workplace.

***HHS VIOLENCE IN THE WORKPLACE POLICY STATEMENT.*** In 1996, Secretary
Shalala signed the first workplace violence policy statement that was
distributed to all HHS employees. An updated policy statement was
released in 2008. The policy states that threatening or intimidating
behavior and violence in the workplace are unacceptable conduct and will
not be tolerated in HHS. It also encourages employees at all levels to
report threatening or intimidating behavior to the appropriate
authorities in and outside the Department.

***STANDARDS OF ETHICAL CONDUCT.*** Threatening or intimidating behavior
and violent acts may be viewed as a job [conduct]{.underline} problem.
In these situations, the [Standards of Ethical Conduct]{.underline} may
influence sanctions imposed concerning the conduct. The standards are
promulgated by the Office of Government Ethics to ensure that the
business of Federal agencies is conducted effectively, objectively, and
without improper influence or the appearance of improper influence. They
also attempt to ensure that Government employees are persons of
integrity and observe high standards of honesty, impartiality, and
behavior.

***THE REHABILITATION ACT OF 1973 AND THE AMERICANS WITH DISABILITIES
ACT (ADA).*** In 1990, Congress passed the Americans with Disabilities
Act. It is a comprehensive anti-discrimination statute that prohibits
discrimination against individuals with disabilities in private, state
and local government employment, and in the provision of public
accommodations, public transportation, state and local government
services, and telecommunications. The purposes of the ADA are to provide
a clear national mandate to end discrimination against individuals with
disabilities (physical and mental) and to provide strong, consistent,
enforceable standards prohibiting discrimination against such
individuals. For the most part, the Federal Government is exempted from
the ADA because it is already covered by similar non-discrimination
requirements and additional affirmative employment requirements under
Section 501 of the Rehabilitation Act of 1973. However, the ADA made
some amendments to the Rehabilitation Act.

The ADA and the Rehabilitation Act are relevant to the issue of
workplace violence. Employees who threaten or commit acts of violence
may seek protection under the laws because of psychological handicaps
that may lead to violence, but the laws do not shield employees from the
consequences of violent behavior. Employees must be qualified to perform
the basic functions of the job, and in most cases violent behavior will
be disqualifying. Victims of threatening or violent behavior may also
seek protection after being victimized because they develop emotional
handicaps that may limit their ability to perform on the job without
reasonable accommodation(s).

Regarding employment discrimination and violence, an individual may only
be denied employment or discharged where (1) that individual poses a
direct threat to the health and safety of others; and (2) the direct
threat cannot be reduced or eliminated by a reasonable accommodation
without undue hardship. A direct threat of violence is generally
understood to mean a specific and significant risk of violence coupled
with a high probability of substantial harm. It is determined on a case
by case basis. Once it is determined that an individual poses a direct
threat to the safety of others, the agency must then determine whether a
reasonable accommodation can eliminate or reduce the threat without
undue hardship to the agency.

***EMPLOYEE ASSISTANCE PROGRAM (EAP).*** The Employee Assistance Program
in HHS was authorized originally in 1970 by Congress through the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act. Since then, this law has been amended by several
other laws that expand program coverage, explain its role under the
Drug-Free Workplace Act, and assure the confidentiality of client
records. The EAP was established Department-wide in HHS in 1979. The
program was developed to address deficient work performance, conduct,
attendance, reliability, or safety resulting from employees' personal
problems.

The basic program philosophy is that when personal problems of all types
are effectively dealt with and treated, affected employees are expected
to become healthier, better adjusted individuals, who are likely to
perform more effectively on the job. The EAP also has a strong
preventative philosophy. The EAP plays a critical role in preventing
workplace violence through assisting employees with stress or other
personal issues that may lead to violence. The EAP also assists victims
of threatening or violent behavior by providing counseling and referral
for emotional problems that may result from acts of violence. Assistance
for entire workgroups is also provided by the EAP after traumatic
events.

***OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION STANDARDS (OSHA).***
The Occupational Safety and Health Administration (OSHA), under the U.S.
Department of Labor, establishes standards for maintaining safe work
environments. The standards require that each employer furnish to each
of its employees, employment and a place of employment that are free
from recognized hazards that are causing or are likely to cause death or
serious physical harm. OSHA investigates and makes determinations about
violations to their standards. To prove a violation, OSHA must find that
the employer failed to keep the workplace free of a hazard to which
employees of that employer were exposed, the hazard was recognized, the
hazard was causing or was likely to cause death or serious physical
harm, and there was a feasible and useful method to correct the hazard.

There are currently no specific OSHA standards for workplace violence.
However, they do provide information found in Federal Registers (rules,
proposed rules, and notices) and standard interpretations (official
letters of interpretation of the standards) related to workplace
violence.

***FAMILY AND MEDICAL LEAVE ACT (FMLA).*** The Family and Medical Leave
Act of 1993 guarantees an eligible worker the right to take up to 12
weeks of unpaid, job protected leave in a year to care for one's own
serious health condition or to attend to family members' serious health
conditions. If a mental or physical injury occurs due to workplace
violence, an employee may be eligible to utilize this leave for care of
the injury.

***DISCIPLINARY AND ADVERSE ACTIONS.*** Increasingly, employee and labor
relations staff are being asked to handle cases involving the discipline
of employees who threaten or actually commit violent acts in this
Department. Since this is often a complex issue, employee and labor
relations staffs need to know how to analyze various warning signs and
behaviors to determine whether an employee is a threat and how to react
appropriately. The U.S. Office of Personnel Management (OPM) has
developed a guideline which discusses available disciplinary and
non-disciplinary personnel actions, disability retirement, and
reasonable accommodation for these types of cases. They have also
developed a thorough discussion of current case law with regard to
violence.

***MEDICAL EXAMINATIONS.*** Supervisors often want to know if the agency
can order a medical/psychiatric examination when an employee
demonstrates bizarre, threatening, or violent behavior. Agencies may
[offer]{.underline} an examination at any time they believe there may be
a medical or psychiatric reason for unacceptable behavior. However, they
may [order]{.underline} a general medical exam only in these situations:

-   when the position has medical standards/physical requirements;

-   when the agency has an approved ongoing medical evaluation program
    (usually applicable in a hospital situation where the agency must
    ensure that employees have not contracted conditions which would be
    of danger to themselves or patients);

-   in Continuation of Pay/Workers' Compensation cases to assist in
    placement efforts; and

-   in reduction-in-force actions if the new position to which the
    employee would have placement rights has different medical standards
    than the one currently occupied by the employee.

A psychiatric examination may be ordered only when a general medical
examination, properly ordered, indicates no basis or unsafe or
inefficient behavior or when such an examination is required by the
position.

***FEDERAL PROPERTY MANAGEMENT REGULATIONS*.** These regulations are
promulgated by the General Services Administration (GSA). They contain
several provisions prohibiting disruptive conduct in Federal buildings.
The regulations prohibit the creation of hazards as well as disturbances
of all kinds that disrupt the performance of official job duties. They
also prohibit the use of alcohol and drugs and intoxication at work and
contain penalties for violations of these regulations. Physical
protection and building security is also required to be provided by GSA
under these regulations.

***WORKERS' COMPENSATION.*** The role of workers' compensation is
significant in workplace violence. Injuries resulting from personal
disputes are typically judged compensable, no matter how unusual. But an
employee's injury is covered under workers' compensation only if the
dispute leading to the injury is related to the employment. In other
words, the employee must have been acting within the scope of his or her
job when the injury occurred for the injury to be compensable. An
employee who commits a violent act in the workplace and who sustains
injuries during the course of the violent act, may also be entitled to
workers' compensation benefits. There are certain restrictions to the
right of recovery of benefits for the perpetrator, however, that make it
more difficult to collect benefits.

***OTHER RESPONSIBILITIES.*** Agencies may also need to be aware of
other laws and regulations that impact their response to violence in the
workplace. For example, most states now have stalking laws that prohibit
willful, malicious and repeated following and harassing of another
person. These stalking laws would prohibit this type of behavior at work
as well. Restraining orders and protective court orders are another
measure used in the community for preventing further violence, threats
or harassment. They are issued by a court and forbid, for a specified
period of time, one party from making contact with another. It is
important that appropriate persons in the agency know about these orders
so that the individuals can be protected at work, particularly when the
two parties work together. Individual states also have laws related to
safety and health in the workplace which typically mirror OSHA. Some
recognize violence as a workplace hazard and others do not.

**CHAPTER 5: IS THIS A VIOLENT SITUATION?**

**LEARN THE WARNING SIGNS**

***INTRODUCTION***

While they are often preventable, it is still difficult to determine
whether or not any particular workplace situation is potentially
violent. This is an emotional and complex topic, and decisions about
what to do in certain situations are not always straightforward or made
in a clearheaded state of mind. In many cases, employees ignore warning
signs because they believe they are not important, "that's just the way
Joe is," or that it is none of their business. In other situations,
employees react based on fear and what they believe is the profile of a
potentially violent person, not necessarily observed actual behavior.
Another major hindrance is not knowing where to go to get help in making
determinations regarding real and potential risks.

Actual threats should always be taken seriously and responded to
immediately. When there is not an actual threat, judgment and senses
should be trusted. "The gut feeling that one gets when talking to people
should be respected. If one feels that someone is dangerous, that person
should be considered dangerous." (from [Violence in the
Workplace]{.underline}, S. Anthony Baron, 1993, p.29)

***FORMS OF VIOLENCE***

There are many forms of workplace violence. The one form that frequently
receives the most attention is workplace homicide as well as deaths due
to terrorism attacks. While violence is a substantial contributor to
death on the job, it also takes many forms that are non-fatal. Some
examples of non-fatal forms are:

-   verbal abuse including offensive, profane and vulgar language;

-   threats (direct or indirect), whether made at work or at home, in
    person or through letters, phone calls, or electronic mail;

-   physical assault upon oneself or another person;

-   throwing or striking objects;

-   intimidating or frightening others;

-   harassing, stalking, or showing undue focus on another person;

-   concealing or using a weapon;

-   actions which damage, destroy, or sabotage property;

-   physically aggressive acts, such as shaking fists at another person,
    kicking, pounding on

```{=html}
<!-- -->
```
-   desks, punching a wall, angrily jumping up and down, screaming at
    others; and

-   bomb threats.

Because of the nature of the services provided by HHS programs, these
types of non-fatal incidents may be perpetrated by our clients or
patients, particularly in health settings. They may also be committed by
co-workers.

It is important to recognize that violent incidents in the workplace may
also include acts of domestic violence. Often, co-workers and
supervisors believe that domestic violence is something that is not
their concern, but a private family matter that should not be brought to
work. But the problem is pervasive in the workplace. If the victim has
sought shelter, the workplace is sometimes the place she can be found.
Occasionally, therefore, the perpetrator will show up at the partner's
worksite to carry out acts of violence against her or anyone trying to
protect her.

***LEVELS OF VIOLENCE***

Potentially or actual violent situations among employees typically
escalate if not defused. Dr. S. Anthony Baron, author of [Violence in
the Workplace]{.underline} (1993), identifies three levels of violence
and the warning signs that typically occur at each of the levels. These
levels may be seen in clients and patients of HHS programs, among
co-workers, and others not related to this Department. They are:

**Level One (Early Warning Signs)**

The person:

-   refuses to cooperate with those in authority;

-   spreads rumors and gossip to harm others;

-   consistently argues with employees/clients/patients;

-   belligerent toward employees/clients/patients;

-   constantly swears at others; and/or

-   makes unwanted sexual comments.

**Level Two (Escalation of the Situation)**

The person:

-   argues increasingly with customers, vendors, employees, and
    management;

-   refuses to obey agency policies and procedures;

-   sabotages equipment and steals property for revenge;

-   verbalizes wishes to hurt employees and/or management;

-   sends sexual or violent notes to employees and/or management; and/or

-   sees self as victimized by the Department (me against them).

**Level Three (Further Escalation, Usually Resulting in an Emergency
Response)**

The person frequently displays intense anger resulting in:

-   recurrent suicidal threats;

-   recurrent physical fights;

```{=html}
<!-- -->
```
-   destruction of property;

-   utilization of weapons to harm others; and/or

-   commission of murder, rape, and/or arson.

***A Note about Domestic Violence***

Except when those involved in domestic violence are co-workers, most
incidents are perpetrated by individuals outside the agency. It is
unlikely, therefore, that the levels of violence described above will be
evident. There will, however, be early warning signs that this type of
violence is escalating outside the workplace. The victim may show
symptoms such as increased fear, emotional episodes, signs of physical
injury, and other evidence of physical stress such as excessive phone
calls. Victims, as well as perpetrators, also show signs of work
performance deterioration as described in the next section. By
intervening when the early warning signs occur, even though the violence
may not yet have been committed at work, it may prevent a serious
incident from occurring.

***PERFORMANCE INDICATORS***

In addition to the indicators described above, there are also a number
of additional performance problems that may be warning signs of
potential trouble. Research into incidents of workplace violence
discloses without exception the presence of at least several of the
characteristics described below. These signs may show up in perpetrators
of violence, those who are victims, those who fear violence because they
are being threatened, and those involved in domestic violence. Although
it is possible that only one of these indicators will occur, it is more
likely that a pattern will occur or that they will represent a change
from normal behavior. Remember that the presence of any of these
characteristics does not necessarily mean a violent act will occur. They
may be indicators of another type of problem. Examples of performance
indicators are listed below.

-   attendance problems: falling within this category are excessive sick
    leave, excessive tardiness, leaving work early, improbable excuses
    for absences, higher than average absenteeism rate, on-the-job
    accidents

-   impact on supervisor's/manager's time: supervisor is spending an
    inordinate amount of time coaching or counseling the individual
    concerning personal problems, re-doing the employee's work, or
    dealing with co-worker concerns

-   decreased productivity: making excessive mistakes, poor judgment,
    missed deadlines, wasting work time and materials

-   inconsistent work patterns: alternating periods of high and low
    productivity and quality of work inappropriate reactions:
    overreaction to criticism, mood swings

-   concentration problems: usually distracted and often has trouble
    recalling instructions, project details, and deadline requirements

-   safety issues: more accident prone, disregard for personal safety as
    well as equipment and machinery safety, needless risks

-   poor health and hygiene: marked changes in personal grooming habits

-   unusual/changed behavior

-   evidence of possible drug or alcohol use/abuse: often the same
    indicators discussed in this section

-   evidence of serious stress in the employee's personal life: crying,
    excessive phone calls, recent separation, death of a loved one

-   continual excuses/blame: inability to accept responsibility for even
    the most inconsequential errors

-   unshakable depression: low energy, little enthusiasm, despair

(Source: [Violence in the Workplace]{.underline}, S. Anthony Baron,
1993)

***THREAT ASSESSMENT***

Determining the seriousness of a violent or stressful situation and how
to best intervene is the basis of a threat assessment. The assessment
must be performed by a competent professional or group of professionals
with experience in this area. Typically, a threat assessment is
considered if an [employee]{.underline} shows signs of potential
trouble. But assessments should also be conducted when there are threats
from persons outside the Department or from patients/clients of HHS.
While these types do not usually include psychological threat
assessments, they do include examining ways to reduce risk of injury
such as shifting work patterns if the potential offender is
knowledgeable about workplace procedures and time frames. The assessment
may also look at the physical security procedures. Resolutions of these
kinds of issues may include adding metal detectors, locking remote
entrances, training staff on defensive behavior, etc.

When assessing the threat of an employee behaving inappropriately, it
should also be performed by competent professionals. One of the most
common mistakes made by organizations and managers is to use standard
psychiatric/psychological services to assess threats of violence. The
professional assessment must be done as part of an integral information
gathering and management process. This includes:

-   consultation and coordination with the person asking for assistance;

-   information gathering involving co-workers, supervisors, family,
    police/criminal records, school records, employment history,
    military records, credit history, other personnel records;

-   engagement of the accused person; he or she should feel part of this
    process by being included, rather than excluded; and

-   management involvement with the situation should be on-going and
    reinforced.

After the investigation has been completed, a determination will be made
regarding the resolution of the incident or potential incident.
Resolutions may be many interventions such as disciplinary action,
removal from the workaday, police involvement, etc.

***CONTACTING THE HHS CRISIS MANAGEMENT TEAM IN YOUR AREA***

Threat assessment (as well as actual crisis response) is best handled by
a local Crisis Management Team. The team is a group convened to
investigate and assess a violent or potentially violent situation.
Depending on the situation, the team may intervene to diffuse
threatening occurrences or to implement an action plan. Members of the
team, whenever possible, should include representatives from the
functional areas listed below.

-   security

-   Employee Assistance Program

-   employee/labor relations

-   Equal Employment Opportunity

-   union

-   General Counsel

-   health unit

-   senior management

-   safety officers

If help is needed in assessing whether a situation (such as those
described in level 1 above) is potentially violent contact the
designated Crisis Management Team leader found at the back of this
handbook OR any member of the team, if the leader is not available. The
call should be made immediately. If the situation has escalated, contact
emergency numbers (such as 911) before contacting the Crisis Management
Team. Do not wait if there is imminent danger. See Chapter 6 for more
information about responding to violent or potentially violent
situations.

If no Crisis Management Team has been established in your location,
contact the Human Resources Center, a supervisor or one of the programs
listed in this section for assistance in making a threat assessment.
Again, contact appropriate law enforcement personnel if there is
imminent danger. For more information about establishing a local Crisis
Management Team, refer to the [HHS Understanding and Responding to
Violence in the Workplace Crisis Management Team
Guidelines]{.underline}.

**CHAPTER 6: RESPONDING TO A VIOLENT SITUATION**

***INTRODUCTION***

Workplace violence, as well as threatening and similar disruptive
actions, is prohibited because it adversely affects safety, morale and
productivity. Ignoring an employee or customer who exhibits these
behaviors sends the message that such behaviors are acceptable.
Consequently, the behaviors are likely to continue and may even increase
in frequency and severity. It is, therefore, critical to identify and
report the behaviors described in Chapter 5 at the earliest possible
moment so that appropriate action can be taken. When the violent or
potentially violent person is an employee, it is also important to note
that if it becomes necessary to take disciplinary action later based on
the threat or act, the fact that the Department took the behavior
seriously will strengthen the basis for the disciplinary action.

As stated repeatedly in this guidance, to help prevent incidents in the
workplace, **early intervention into potentially violent situations is
recommended**. Employees are urged to make use of the resources
available to help in managing conflict and stress that may lead to
violence. Available resources include but are not limited to
supervisors, Employee Assistance Program counselors; union
representatives/stewards; human resources and employee/labor relations
specialists; building security personnel; and EEO specialists or
counselors. Employees are also urged to stay alert to and respond
quickly to clients/patients of HHS programs who behave in a threatening
manner.

If, however, early intervention is not effective, this chapter describes
procedures for handling threatening, intimidating, violent, or similar
disruptive behaviors when they escalate. This chapter will also describe
some procedures for handling bomb threats and ideas for helping those
affected by domestic violence.

***WHEN EARLY WARNING SIGNS OCCUR (LEVEL 1)***

-   **OBSERVE AND DOCUMENT** (in detail) the behavior in question right
    after it happens.

```{=html}
<!-- -->
```
-   **REPORT** concerns to supervisor and other appropriate officials.
    If the offending person is an employee and is the reporting
    employee\'s immediate supervisor, the employee should notify the
    next level of supervision. If the offending person is not an
    employee, the supervisor of the employee reporting the incident is
    still the appropriate individual to receive and provide initial
    response to the report.

-   **CONTACT** HHS' local Crisis Management Team (if available) to
    alert members to any concerns and seek their help in assessing the
    situation (if you feel it is necessary, submit information
    anonymously). If a CMT is not available, contact the Human Resources
    Center.

-   If the offending person is an employee, the supervisor should
    **MEET** with him or her to discuss concerns. Follow the procedures
    below. (Note that many of these steps may also be useful for dealing
    with clients/patients of HHS.)

```{=html}
<!-- -->
```
-   Schedule private time and place.

-   Get straight to the point.

-   Ask the employee for his or her input.

-   Ask the employee what should be done about the behavior.

-   Ask how you can help.

-   Identify the performance and/or conduct problems that are of
    concern.

-   Identify the steps you would like to see to correct problems.

-   Set limits on what is acceptable behavior and performance.

-   Establish time frames to make changes and subsequent consequences
    for not meeting the deadlines.

-   Reward/recognize the desired performance or conduct.

-   Frequently at this level it is only necessary to remind the
    individual of the Department's policies.

***WHEN THE SITUATION HAS ESCALATED (LEVEL 2)***

-   **DOCUMENT** (in detail) the behavior in question immediately.

-   Immediately **CONTACT** the supervisor, the local Crisis Management
    Team (if one exists), your Human Resources Center, and appropriate
    law enforcement/security officials in your area.

-   If necessary, **SECURE** your own safety and the safety of others,
    including contacting people who are in danger (make sure emergency
    numbers for employees are kept up-to-date and accessible).

-   When appropriate, **CONTACT** others who can assist you such as
    employee relations, union, and the Employee Assistance Program.

-   If you encounter an angry employee or customer/patient:

```{=html}
<!-- -->
```
-   Call for assistance, if possible.

-   Set ground rules/boundaries.

-   Get others away from the person.

-   Avoid an audience.

-   Remain calm, speaking slowly, softly and clearly.

-   Ask the person to sit down; see if he or she is able to follow
    directions.

-   Ask questions relevant to the person's complaint such as "What can
    you do to try to regain control of yourself?"; "What can I do to
    help you regain control?"; "What do you hope to gain by committing
    violence?"; "Why do you believe you need to be violent to achieve
    that?"

-   If the person does not calm down, try matching the loudness of his
    or her voice and gradually bring your voice down to a calm level.

-   Try to direct the aggressive tendencies into another kind of
    behavior so that the person sees he or she has choices about how to
    behave.

```{=html}
<!-- -->
```
-   If the offending person is an employee, the supervisor should again
    **MEET** with him or her to discuss concerns and begin or continue
    progressive discipline (if appropriate).

***IN AN EMERGENCY (LEVEL 3)***

Any individual observing violent or threatening behavior which poses an
immediate danger to persons or property is expected to:

-   **REMAIN CALM**.

-   First **SECURE** the safety of him/her.

-   **CALL** 911 and other appropriate emergency contacts (such as
    building security and the Federal Protective Service) for that
    particular facility, particularly if the situation requires
    immediate aid of medical and/or law enforcement personnel.

-   **COOPERATE** with law enforcement personnel when they have
    responded to the situation. Once law enforcement personnel are on
    the scene, they will assume control of the situation. Witnesses
    should be prepared to provide a description of the violent or
    threatening individual, details of what was observed, and the exact
    location of the incident.

-   **CONTACT** members of the Crisis Management Team (if one exists) or
    the Human Resources Center staff so they can convene as quickly as
    possible.

-   If you are personally confronted by an angry or threatening person,
    follow the last procedures described in the section above.

***HANDLING BOMB THREATS***

The U.S. Department of Justice has prepared the following information on
handling bomb threats:

It is an unnerving experience for anyone to receive a telephone threat.
But there are ways to minimize personal threat and still concentrate on
gathering information that may help law enforcement personnel identify
the person making the threat. Below is a set of questions to help focus
on noticing important information and asking the right questions if a
bomb threat is received over the phone. Try to write down exactly what
the caller says and then call law enforcement personnel immediately.
Obtain the following information.

-   telephone number where the call was received

-   exact time of call

-   exact words of caller

-   answers to these questions:

```{=html}
<!-- -->
```
-   When will the bomb explode?

-   Where is the bomb?

-   What does it look like?

-   What kind of bomb is it?

-   What is your name?

-   What is your address?

-   Where are you calling from?

-   Why did you place the bomb?

```{=html}
<!-- -->
```
-   Make special note of the following information:

```{=html}
<!-- -->
```
-   caller's voice (calm, excited, disguised, accent, etc.)

-   caller's sex

-   caller's age (as determined by voice)

-   voice familiar to you?

-   background noise

-   names of those threatened

***DOMESTIC VIOLENCE***

In the event that the perpetrator shows up at work (or is a co-worker of
the partner) with the intent of harming the partner and any others who
happen to be in the way or involved, follow the procedures described
above in responding to the immediate crisis.

If you know someone at work who is being affected by domestic violence,
whether or not the perpetrator has shown up at work, it is important to
provide support and assistance. Not only is the person at risk for more
and usually escalated violence, but it has a negative impact on the
productivity of the entire workplace. Below are some ideas for helping
the co-worker affected by domestic violence.

-   Talk to the person about your concerns. Let her know that you are
    afraid for her safety and the safety of her children. Remind her
    that it will only get worse. Let her know that you will assist her
    in locating resources and developing a safety plan.

-   Contact the Employee Assistance Program for more information.

-   Recommend that she call the National Domestic Violence Hotline for
    more information about domestic violence or to help her find local
    resources. The number is 800-799-SAFE (7233) or for the hearing
    impaired 800-787-3224. Also recommend that she contact the HHS
    Employee Assistance Program where she can also get help in
    understanding and responding to the problem.

-   Recommend that a workplace safety plan be developed in case an
    incident occurs at the workplace. Think about the safety of the
    individual as well as everyone around her. Don't be a hero if the
    perpetrator shows up at work. Follow the safety plan and go for
    help.

**CHAPTER 7: AFTER THE FACT**

***INTRODUCTION***

No matter how effective HHS' policies and plans are in detecting and
preventing incidents, there are no guarantees against workplace
violence. Even the most responsive employers face this issue. When
violent incidents do occur, it is essential the response be timely,
appropriate to the situation, and carried out with the recognition that
employees are traumatized and their aftermath has just begun. Any trauma
moves most people out of their "comfort zones" and into a state of
highly stressful disequilibrium. This affects not only surviving victims
of workplace violence, but also the eyewitnesses to the event, the
people related to the victims, witnesses, or suspects, and the agency.
How well they recover and how quickly they return to full productivity
largely depends on what kind of care they get from the people who
respond to their needs.

This chapter will provide some information which will help in
understanding the short- and long-term effects as well as information on
the best ways to respond to the emotional, organizational, security, and
other needs that are present after a violent event.

***FIRST THINGS FIRST***

After a violent or traumatic event has occurred, there are immediate
procedures that must be put into place to address certain questions and
needs. **Every work organization should have the procedures put in place
BEFORE an incident occurs. Experts recommend that these procedures be
tested through role-playing hypothetical cases with management and
members of the Crisis Management Team.** Below is a list of such
procedures. There may be additional ones based on the specific location
of the event.

-   Notify the chain of command in HHS, including the Crisis Management
    Team (if one exists). Contact the Human Resources Center, Office of
    the General Counsel, the Employee Assistance Program and other
    Departmental units that can be of assistance. Any existing Crisis
    Management Team will immediately coordinate the debriefing process.

-   When appropriate, notify local authorities, medical, fire, police.

-   Determine the immediate safety of the workplace- do areas need to be
    secured, are there employees who need to be evacuated, etc.

-   Find out what information is available on the incident- who are the
    witnesses, were pictures taken, what are the local authorities
    investigating and what is HHS' proper relationship with them?

-   Determine if there are public relations concerns and, if so, contact
    Public Affairs for control of this information, reporters, etc.

-   Determine if there are people to be notified who are external to the
    organization such as family members.

-   Locate any equipment that needs to be utilized to handle the crisis
    such as computers to access employee records, cellular phones, first
    aid, etc.

-   Show employees and customers that the Department cares about them.

***HOW TRAUMAS AFFECT EMPLOYEES***

Following a violent incident, employees experience three stages of
"crisis reactions" to varying degrees:

**STAGE ONE.** In this stage, the employee experiences emotional
reactions characterized by shock, disbelief, denial, or numbness.
Physically, the employee experiences shock or a fight-or-flight survival
reaction in which the heart rate increases, perceptual senses become
heightened or distorted, and adrenaline levels increase to meet a real
or perceived threat.

**STAGE TWO.** This is the "impact" stage where the employee may feel a
variety of intense emotions, including anger, rage, fear, terror, grief,
sorrow, confusion, helplessness, guilt, depression or withdrawal. This
stage may last a few days, a few weeks, or a few months.

**STAGE THREE**. This is the "reconciliation stage" in which the
employee tries to make sense out of the event, understand its impact,
and, through trial and error, reach closure of the event so it does not
interfere with his or her ability to function and grow.

While it is difficult to predict how an incident will affect a given
individual, several factors influence the subjective intensity of
trauma. These factors include the duration of the event, the amount of
terror or horror the victim experienced, the sense of personal control
(or lack thereof) the employee had during the incident, and the amount
of injury or loss the victim experienced (i.e., loss of property,
self-esteem, physical well-being, etc.). Other variables include the
person's previous victimization experiences, recent losses such as the
death of a family member, and other intense stresses.

(Source: "Helping the Employee Recover from the Trauma of Workplace
Violence," Kenneth Wolf et al, [EAP Digest]{.underline}, March/April
1994)

***PSYCHOLOGICAL FIRST AID AND THE CRITICAL INCIDENT DEBRIEFING
PROCESS***

Providing crisis intervention and counseling assistance within the first
24 to 72 hours after a violent event is essential. There are a number of
models that inform the workplace how to conduct these interventions.
Psychological first aid is typically provided first in these situations.
This is an intervention that creates and sustains an environment of 1)
safety; 2) calming; 3) connectedness to others; 4) self empowerment; and
5) hopefulness. Depending on the location, this can be coordinated by a
Crisis Management Team, the Human Resources Center, or the Employee
Assistance Program.

Jeffrey Mitchell, from the University of Maryland, developed a protocol
for gathering information and responding to the immediate emotional
needs of employees who have been traumatized. It is called the Critical
Incident Stress Debriefing (CISD) process. This counseling process is
conducted by a professional with CISD training. The phases are described
below.

-   introductory: normalize event; support

-   fact phase: let people talk about what happened (heard, saw,
    smelled, etc.)

-   thought phase: move from cognitive experience to emotional

-   reaction phase: feeling/emotional state

-   symptoms phase: determining the signals of life changes such as
    physical complaints and behavioral changes

-   teaching phase: cognitive learning about symptoms; normalizing
    experiences and reactions

-   reentry phase: plan of action; follow-up; referral to additional
    information sources and long-term counseling, if necessary

The phases last different periods of time for each person, particularly
the later ones. An individual may get stuck at a certain phase depending
on the factors discussed in the previous section.

***CONSIDERATIONS FOR MANAGEMENT***

Supervisors and mangers play a critical role in responding to the
immediate and long-term needs of employees. The following suggestions
are provided for supervisory staff in handling employees after a violent
event:

-   Be sensitive to the "invisible" or emotional injuries described
    above.

-   Observe the ripple effect of these events; the range of those
    impacted typically grows.

-   Be sure the employee is not always isolated.

-   Control media access to employees.

-   Do not joke about the event.

-   Do not trivialize the event - "It could have been worse".

-   Suggest help through the EAP or other trauma interveners if symptoms
    and job performance changes do not normalize.

***HELPING YOURSELF***

There are a number of things employees can do to help themselves get
through a traumatic event, particularly if a victim. In addition to
availing themselves of help being offered by the Department, these ideas
may help with the management of physical and emotional effects:

-   Diet and exercise: eat balanced meals, keep stimulants to a minimum,
    do not use alcohol and drugs to cope, and exercise regularly after
    the first 24 hours following the incident.

-   Sleep: maintain a normal schedule, use relaxation techniques to help
    fall asleep.

-   Talk: use social support systems, talk about the incident.

-   Life-style: set realistic expectations, maintain a normal schedule,
    avoid boredom, don't fight flashbacks, and take time to do enjoyable
    things.

-   Get outside help when needed: seek medical assistance, plan for your
    safety, obtain counseling for trauma/stress, and obtain referrals to
    community facilities.

**CHAPTER 8: PREVENTION**

One of the major components of a workplace violence strategy is
prevention. This chapter will focus on measures that can be taken to
prevent inappropriate, threatening, intimidating, violent, or
potentially violent behavior.

***POLICY***

Chapter 4 contains descriptions of the current policies regarding
intimidating or violent behavior in HHS. Becoming familiar with these
policies is an important step in preventing workplace violence. It is
imperative that all employees, including managers and supervisors,
understand the policies. Clients/patients of HHS may also need to become
familiar with these policies.

All managers and supervisors are expected to discuss the policies with
their respective staff members so that they understand how to handle
intimidating, threatening, or violent incidents as well as understand
the consequences of such behavior (such as disciplinary and/or adverse
action up to and including removal and criminal charges).

***WORK ENVIRONMENT***

The best prevention strategy is to maintain an environment which
minimizes negative feelings such as isolation, resentment and hostility
among employees as well as provides for the safety and security of all
employees. Although no workplace can be perceived as perfect by every
employee, there are several steps that management can take to help
create a professional, healthy, and caring climate. These include:

-   promoting sincere, open communication among management and
    employees;

-   offering opportunities for advancement and professional development;

-   fostering family activities and social opportunities open to all
    staff members;

-   maintaining mechanisms for complaints and concerns and allowing them
    to be expressed in a non-judgmental forum that includes feedback to
    the initiator;

-   taking a sincere interest in \"quality of life\" issues such as
    facilities, job satisfaction and recreation opportunities;

-   taking threats seriously and taking appropriate and timely action;
    and

-   maintaining fair treatment and discipline for all employees
    exhibiting improper conduct and performance.

***EMPLOYMENT SCREENING***

Another essential prevention measure is careful and thorough screening
of pre-employment references to avoid hiring potentially dangerous
individuals. Prior to hiring an employee, the supervisor/agency should
check with its servicing personnel office to determine what employment
screening techniques (such as interviewing questions, background and
reference checks, and drug testing) are appropriate for the position
under consideration and that are consistent with Federal laws and
regulations. Pre-employment screening is a critical and sensitive part
of workplace violence prevention and should receive due investigation
and care in its implementation.

***WEAPONS***

As part of HHS' violence prevention efforts, it is important to stress
compliance with appropriate statutory and regulatory requirements. All
HHS facilities are Federal facilities. Therefore, possession or use of
firearms and other dangerous weapons on the property (Government owned
or leased, including grounds, parking lots and buildings) of all HHS
facilities is illegal.

Any HHS employee who violates prohibitions on possession of weapons in
HHS facilities will be prosecuted and/or appropriately disciplined (up
to and including removal from Federal service). If an HHS employee is
aware of someone being on HHS facilities with a prohibited weapon, the
employee should immediately report it to a building security official, a
supervisor, or other appropriate authority.

***SECURITY***

Maintaining a physically safe work place is part of any good prevention
program. HHS facilities use a variety of security measures to help
ensure safety. Compliance with these measures is critical and is what
keeps employees safe. These measures include:

-   the Federal Protective Service or a designated security officer to
    respond to emergencies;

-   employee photo identification badges and other access cards allowing
    entry to areas within buildings;

-   on-site guard services;

-   guard force assistance in registering, badging and directing
    visitors in larger facilities;

-   other appropriate security measures; and

-   security surveys to determine physical security posture of
    building(s).

Additional law enforcement assistance is available through local police
departments for emergency situations. Employees should notify the
appropriate security office or designated police of suspicious or
unauthorized individuals on HHS property.

***EDUCATION***

Training and education are also critical components of any prevention
strategy. The following types of training are effective in preventing
violence and other threatening behavior and are recommended for
employees of HHS.

-   awareness training programs for employees and supervisors in
    workplace violence - what it is, what to do when faced with possible
    problems, employee and management responsibilities, early
    intervention techniques, identity of Crisis Management Team members,
    etc.

-   training for supervisors to increase their understanding of, and
    requirements and techniques for, screening applicants during the
    recruitment process to identify indicators of violent behavior as
    well as privacy issues

-   training on conflict resolution and stress management offering
    techniques and skills to deal effectively with conflict and reduce
    stress

***EARLY INTERVENTION***

Intervening early in a threatening or potentially violent situation is
vital to preventing its escalation. There are many intervention options,
and they vary greatly depending upon the situation. Early intervention
may diffuse the initial situation and give the supervisor and others
involved an opportunity to more thoroughly review options for
resolution. Intervention sets the tone for how the situation will be
resolved so it must be handled deftly. Procedures for assessing,
reporting, and acting upon allegations of threatening, intimidating,
violent or similar disruptive behavior are described in Chapters 5, 6,
and 7.

**CHAPTER 9: RESOURCES**

***DEPARTMENT OF HEALTH AND HUMAN SERVICES:***

***HHS Human Resource Centers***

Website:

[www.hhs.gov/ohr](http://www.hhs.gov/ohr)

ASAM, Office of Human Resources

200 Independence Avenue, SW

Room 300E

Washington, DC 20201

Local: 202-690-6191

***HHS Local Crisis Management Team***

Contact: determined locally

Telephone:

***Centers for Disease Control and Prevention***

Website:

[www.cdc.gov/niosh](http://www.cdc.gov/niosh)

National Institute for Occupational Safety & Health (NIOSH)

395 E Street, NW

Suite 9200

Patriots Plaza Building

Washington, DC 20201

Toll-free: 800-CDC INFO

TTY: 888-232-6348

***National Institutes of Health***

National Institute of Mental Health (NIMH)

Website:

[http://www.nimh.nih.gov](http://www.nimh.nih.gov/)

National Institute of Mental Health (NIMH)\
Science Writing, Press, and Dissemination Branch\
6001 Executive Boulevard, Room 8184, MSC 9663\
Bethesda, MD 20892-9663

Local: 301-443-4513\
Toll-free: 866-615-6464\
TTY: 301-443-8431\
TTY Toll-free: 866-415-8051

***National Domestic Violence Hotline***

Toll-free 800-799-SAFE

TDD 800-787-3224

***U.S. Public Health Service***

**Office on Women's Health**

Website:

[www.womenshealth.gov/owh](http://www.womenshealth.gov/owh)

200 Independence Avenue, S.W.

Room 712E

Washington, DC 20201

Local (202) 690-7650

Toll-free 800-994-9662

TDD 888-220-5446

***ADDITIONAL FEDERAL GOVERNMENT INFORMATION:***

***Department of Justice***

**Bureau of Justice Statistics**

Website:

[www.ojb.gov/bjs/welcome.html](http://www.ojb.gov/bjs/welcome.html)

810 7^th^ Street, NW

Washington, DC 20531

Local: 202-307-0765

**Office of Victims of Crime**

Website:

[www.ojp.gov/ovc/welcome.html](http://www.ojp.gov/ovc/welcome.html)

**Office for Victims of Crime Resource Center**\
National Criminal Justice Reference Service\
P.O. Box 6000\
Rockville, MD 20849-6000

Toll-free: 800-851-3420\
TTY 877-712-9279

***Department of Labor (DOL)***

**Occupational Safety and Health Administration**

Website:

[www.osha.gov](http://www.osha.gov/)

200 Constitution Avenue, N.W.

Washington, DC 20210

Toll-free: 800-321-OSHA

TTY: 877-889-5627