II 

116TH CONGRESS 

1ST SESSION S. 851 

To direct the Secretary of Labor to issue an occupational safety and health 

standard that requires covered employers within the health care and 

social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 14, 2019 

Ms. BALDWIN (for herself, Ms. WARREN, Mr. SCHATZ, Mrs. GILLIBRAND, Mr. 

BROWN, and Mr. BLUMENTHAL) introduced the following bill; which was 

read twice and referred to the Committee on Health, Education, Labor, 

and Pensions 

A BILL 

To direct the Secretary of Labor to issue an occupational 

safety and health standard that requires covered employers within the health care and social service industries 

to develop and implement a comprehensive workplace 

violence prevention plan, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Workplace Violence 

5 Prevention for Health Care and Social Service Workers 

6 Act’’. 


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1 SEC. 2. TABLE OF CONTENTS. 

2 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—WORKPLACE VIOLENCE PREVENTION STANDARD 

Sec. 101. Workplace violence prevention standard. 

Sec. 102. Scope and application. 

Sec. 103. Requirements for workplace violence prevention standard. 

Sec. 104. Rules of construction. 

Sec. 105. Other definitions. 

TITLE II—AMENDMENTS TO THE SOCIAL SECURITY ACT 

Sec. 201. Application of the workplace violence prevention standard to certain 

facilities receiving Medicare funds. 

3 TITLE I—WORKPLACE VIOLENCE 

4 PREVENTION STANDARD 

5 SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD. 

6 (a) INTERIM FINAL STANDARD.— 

7 (1) IN GENERAL.—Not later than 1 year after 

8 the date of enactment of this Act, the Secretary of 

9 Labor shall promulgate an interim final standard on 

10 workplace violence prevention— 

11 (A) to require certain employers in the 

12 health care and social service sectors, and cer13 tain employers in sectors that conduct activities 

14 similar to the activities in the health care and 

15 social service sectors, to develop and implement 

16 a comprehensive workplace violence prevention 

17 plan to protect health care workers, social serv18 ice workers, and other personnel from work19 place violence; and 


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1 (B) that shall, at a minimum, be based on 

2 the Guidelines for Preventing Workplace Vio3 lence for Healthcare and Social Service Work4 ers published by the Occupational Safety and 

5 Health Administration of the Department of 

6 Labor in 2015 and adhere to the requirements 

7 of this title. 

8 (2) APPLICABILITY OF OTHER STATUTORY RE9 QUIREMENTS.—The following shall not apply to the 

10 promulgation of the interim final standard under 

11 this subsection: 

12 (A) The requirements applicable to occupa13 tional safety and health standards under section 

14 6(b) of the Occupational Safety and Health Act 

15 of 1970 (29 U.S.C. 655(b)). 

16 (B) The requirements of chapters 5 and 6 

17 of title 5, United States Code, and titles 2 and 

18 42, United States Code. 

19 (3) NOTICE AND COMMENT.—Notwithstanding 

20 paragraph (2)(B), the Secretary shall, prior to pro21 mulgating the interim final standard under this sub22 section, provide notice of the interim final standard 

23 and a 30-day opportunity for public comment. 

24 (4) EFFECTIVE DATE OF INTERIM STAND25 ARD.—The interim final standard shall— 


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1 (A) take effect on a date that is not later 

2 than 30 days after promulgation, except that 

3 such interim final standard may include a rea4 sonable phase-in period for the implementation 

5 of required engineering controls that take effect 

6 after such date; 

7 (B) be enforced in the same manner and 

8 to the same extent as any standard promul9 gated under section 6(b) of the Occupational 

10 Safety and Health Act of 1970 (29 U.S.C. 

11 655(b)); and 

12 (C) be in effect until the final standard de13 scribed in subsection (b) becomes effective and 

14 enforceable. 

15 (5) FAILURE TO PROMULGATE.—If an interim 

16 final standard described in paragraph (1) is not pro17 mulgated not later than 1 year of the date of enact18 ment of this Act, the provisions of this title shall be 

19 in effect and enforced in the same manner and to 

20 the same extent as any standard promulgated under 

21 section 6(b) of the Occupational Safety and Health 

22 Act of 1970 (29 U.S.C. 655(b)) until such provi23 sions are superseded in whole by an interim final 

24 standard promulgated by the Secretary that meets 

25 the requirements of paragraph (1). 


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1 (b) FINAL STANDARD.— 

2 (1) PROPOSED FINAL STANDARD.—Not later 

3 than 2 years after the date of enactment of this Act, 

4 the Secretary of Labor shall, pursuant to section 6 

5 of the Occupational Safety and Health Act of 1970 

6 (29 U.S.C. 655), promulgate a proposed final stand7 ard on workplace violence prevention— 

8 (A) for the purposes described in sub9 section (a)(1)(A); and 

10 (B) that shall include, at a minimum, the 

11 elements contained in the interim final standard 

12 promulgated under subsection (a). 

13 (2) FINAL STANDARD.—Not later than 42 

14 months after the date of enactment of this Act, the 

15 Secretary shall promulgate a final standard on such 

16 proposed standard that shall— 

17 (A) provide no less protection than any 

18 workplace violence standard adopted by a State 

19 plan that has been approved by the Secretary 

20 under section 18 of the Occupational Safety 

21 and Health Act of 1970 (29 U.S.C. 667); and 

22 (B) be effective and enforceable in the 

23 same manner and to the same extent as any 

24 standard promulgated under section 6(b) of the 


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1 Occupational Safety and Health Act of 1970 

2 (29 U.S.C. 655(b)). 

3 SEC. 102. SCOPE AND APPLICATION. 

4 In this title: 

5 (1) COVERED FACILITY.—The term ‘‘covered 

6 facility’’ includes the following: 

7 (A) Any hospital, including any specialty 

8 hospital, in-patient or outpatient setting, or 

9 clinic operating within a hospital license, or any 

10 setting that provides outpatient services. 

11 (B) Any residential treatment facility, in12 cluding any nursing home, skilled nursing facil13 ity, hospice facility, and long-term care facility. 

14 (C) Any non-residential treatment or serv15 ice setting. 

16 (D) Any medical treatment or social serv17 ice setting or clinic at a correctional or deten18 tion facility. 

19 (E) Any community care setting, including 

20 a community-based residential facility, group 

21 home, and mental health clinic. 

22 (F) Any psychiatric treatment facility. 

23 (G) Any drug abuse or substance use dis24 order treatment center. 


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1 (H) Any independent freestanding emer2 gency centers. 

3 (I) Any facility described in subparagraphs 

4 (A) through (H) operated by a Federal Govern5 ment agency and required to comply with occu6 pational safety and health standards pursuant 

7 to part 1960 of title 29, Code of Federal Regu8 lations (or any corresponding similar regula9 tions or rulings). 

10 (J) Any other facility the Secretary deter11 mines should be covered under the standards 

12 promulgated under section 101. 

13 (2) COVERED SERVICES.—The term ‘‘covered 

14 service’’ includes the following services and oper15 ations: 

16 (A) Any services and operations provided 

17 in any field work setting, including home health 

18 care, home-based hospice, and home-based so19 cial work. 

20 (B) Any emergency services and transport, 

21 including such services provided by firefighters 

22 and emergency responders. 

23 (C) Any services described in subpara24 graphs (A) and (B) performed by a Federal 

25 Government agency and required to comply 


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1 with occupational safety and health standards 

2 pursuant to part 1960 of title 29, Code of Fed3 eral Regulations (or any corresponding similar 

4 regulations or rulings). 

5 (D) Any other services and operations the 

6 Secretary determines should be covered under 

7 the standards promulgated under section 101. 

8 (3) COVERED EMPLOYER.— 

9 (A) IN GENERAL.—The term ‘‘covered em10 ployer’’ includes a person (including a con11 tractor, subcontractor, a temporary service 

12 firm, or an employee leasing entity) that em13 ploys an individual to work at a covered facility 

14 or to perform covered services. 

15 (B) EXCLUSION.—The term ‘‘covered em16 ployer’’ does not include an individual who pri17 vately employs, in the individual’s residence, a 

18 person to perform covered services for the indi19 vidual or a family member of the individual. 

20 (4) COVERED EMPLOYEE.—The term ‘‘covered 

21 employee’’ includes an individual employed by a cov22 ered employer to work at a covered facility or to per23 form covered services. 


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1 SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 

2 PREVENTION STANDARD. 

3 Each standard described in section 101 shall include, 

4 at a minimum, the following requirements: 

5 (1) WORKPLACE VIOLENCE PREVENTION

6 PLAN.—Not later than 6 months after the date of 

7 promulgation of the interim final standard under 

8 section 101(a), a covered employer shall develop, im9 plement, and maintain an effective written workplace 

10 violence prevention plan (referred to in this section 

11 as a ‘‘Plan’’) for covered employees at each covered 

12 facility and for covered employees performing a cov13 ered service on behalf of such employer, which meets 

14 the following: 

15 (A) PLAN DEVELOPMENT.—Each Plan 

16 shall— 

17 (i) be developed and implemented with 

18 the meaningful participation of direct care 

19 employees and, where applicable, employee 

20 representatives and collective bargaining 

21 representatives, for all aspects of the Plan; 

22 (ii) be tailored and specific to condi23 tions and hazards for the covered facility 

24 or the covered service, including patient25 specific risk factors and risk factors spe26 cific to each work area or unit; and 


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1 (iii) be suitable for the size, com2 plexity, and type of operations at the cov3 ered facility or for the covered service, and 

4 remain in effect at all times. 

5 (B) PLAN CONTENT.—Each Plan shall in6 clude procedures and methods for the following: 

7 (i) Identification of the individual re8 sponsible for implementation of the Plan. 

9 (ii) With respect to each work area 

10 and unit at the covered facility or while 

11 covered employees are performing the cov12 ered service, risk assessment and identi13 fication of workplace violence risks and 

14 hazards to employees exposed to such risks 

15 and hazards (including environmental risk 

16 factors and patient-specific risk factors), 

17 which shall be— 

18 (I) informed by past violent inci19 dents specific to such covered facility 

20 or such covered service; and 

21 (II) conducted with, at a min22 imum— 

23 (aa) direct care employees; 


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1 (bb) where applicable, the 

2 representatives of such employ3 ees; and 

4 (cc) the employer. 

5 (iii) Hazard prevention, engineering 

6 controls, or work practice controls to cor7 rect hazards in a timely manner, applying 

8 industrial hygiene principles of the hier9 archy of controls, which— 

10 (I) may include security and 

11 alarm systems, adequate exit routes, 

12 monitoring systems, barrier protec13 tion, established areas for patients 

14 and clients, lighting, entry procedures, 

15 staffing and working in teams, and 

16 systems to identify and flag clients 

17 with a history of violence; and 

18 (II) shall ensure that employers 

19 correct, in a timely manner, hazards 

20 identified in the annual report de21 scribed in paragraph (5). 

22 (iv) Reporting, incident response, and 

23 post-incident investigation procedures, in24 cluding procedures— 


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1 (I) for employees to report work2 place violence risks, hazards, and inci3 dents; 

4 (II) for employers to respond to 

5 reports of workplace violence; 

6 (III) for employers to perform a 

7 post-incident investigation and de8 briefing of all reports of workplace vi9 olence with the participation of em10 ployees and their representatives; and 

11 (IV) to provide medical care or 

12 first aid to affected employees. 

13 (v) Procedures for emergency re14 sponse, including procedures for threats of 

15 mass casualties and procedures for inci16 dents involving a firearm or a dangerous 

17 weapon. 

18 (vi) Procedures for communicating 

19 with and training of covered employees on 

20 workplace violence hazards, threats, and 

21 work practice controls, the Plan, and pro22 cedures for confronting, responding to, and 

23 reporting workplace violence threats, inci24 dents, and concerns, and employee rights. 


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1 (vii) Procedures for determining which 

2 covered employer or employers shall be re3 sponsible for implementing and complying 

4 with the provisions of the standard appli5 cable to the working conditions over which 

6 such employers have control, and ensuring 

7 the coordination of risk assessment efforts, 

8 Plan development, and implementation of 

9 the Plan with other employers who have 

10 employees who work at the covered facility 

11 or who are performing the covered service. 

12 (viii) Procedures for conducting the 

13 annual evaluation under paragraph (6). 

14 (C) AVAILABILITY OF PLAN.—Each Plan 

15 shall be made available at all times to the cov16 ered employees who are covered under such 

17 Plan. 

18 (2) VIOLENT INCIDENT INVESTIGATION.— 

19 (A) IN GENERAL.—As soon as practicable 

20 after a workplace violence incident, risk, or haz21 ard of which a covered employer has knowledge, 

22 the employer shall conduct an investigation of 

23 such incident, risk, or hazard under which the 

24 employer shall— 


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1 (i) review the circumstances of the in2 cident, risk, or hazard, and whether any 

3 controls or measures implemented pursu4 ant to the Plan of the employer were effec5 tive; and 

6 (ii) solicit input from involved employ7 ees, their representatives, and supervisors, 

8 about the cause of the incident, risk, or 

9 hazard, and whether further corrective 

10 measures (including system-level factors) 

11 could have prevented the incident, risk, or 

12 hazard. 

13 (B) DOCUMENTATION.—A covered em14 ployer shall document the findings, rec15 ommendations, and corrective measures taken 

16 for each investigation conducted under this 

17 paragraph. 

18 (3) TRAINING AND EDUCATION.—With respect 

19 to the covered employees covered under a Plan of a 

20 covered employer, the employer shall provide train21 ing and education to such employees who may be ex22 posed to workplace violence hazards and risks, which 

23 meet the following requirements: 

24 (A) Annual training and education includes 

25 information on the Plan, including identified 


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1 workplace violence hazards, work practice con2 trol measures, reporting procedures, record 

3 keeping requirements, response procedures, and 

4 employee rights. 

5 (B) Additional hazard recognition training 

6 for supervisors and managers to ensure they 

7 can recognize high-risk situations and do not 

8 assign employees to situations that predictably 

9 compromise their safety. 

10 (C) Additional training for each such cov11 ered employee whose job circumstances has 

12 changed, within a reasonable timeframe after 

13 such change. 

14 (D) New employee training prior to assign15 ment. 

16 (E) All training provides such employees 

17 opportunities to ask questions, give feedback on 

18 such training, and request additional instruc19 tion, clarification, or other follow up. 

20 (F) All training is provided in-person and 

21 by an individual with knowledge of workplace 

22 violence prevention and of the Plan. 

23 (G) All training is appropriate in content 

24 and vocabulary to the language, educational 

25 level, and literacy of such covered employees. 


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1 (4) RECORDKEEPING AND ACCESS TO PLAN

2 RECORDS.— 

3 (A) IN GENERAL.—Each covered employer 

4 shall— 

5 (i) maintain at all times— 

6 (I) records related to each Plan 

7 of the employer, including workplace 

8 violence risk and hazard assessments, 

9 and identification, evaluation, correc10 tion, and training procedures; 

11 (II) a violent incident log de12 scribed in subparagraph (B) for re13 cording all workplace violence inci14 dents; and 

15 (III) records of all incident inves16 tigations as required under paragraph 

17 (2)(B); and 

18 (ii) make such records and logs avail19 able, upon request, to covered employees 

20 and their representatives for examination 

21 and copying in accordance with section 

22 1910.1020 of title 29, Code of Federal 

23 Regulations (or any corresponding similar 

24 regulation or ruling), and in a manner con25 sistent with HIPAA privacy regulations 


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1 (defined in section 1180(b)(3) of the Social 

2 Security Act (42 U.S.C. 1320d–9(b)(3))) 

3 and part 2 of title 42, Code of Federal 

4 Regulations (or any corresponding similar 

5 regulations or rulings). 

6 (B) VIOLENT INCIDENT LOG DESCRIP7 TION.—Each violent incident log shall— 

8 (i) be maintained by a covered em9 ployer for each covered facility controlled 

10 by the employer and for each covered serv11 ice being performed by a covered employee 

12 on behalf of such employer; 

13 (ii) be based on a template developed 

14 by the Secretary not later than 1 year 

15 after the date of enactment of this Act; 

16 (iii) include, at a minimum, a descrip17 tion of— 

18 (I) the violent incident (including 

19 environmental risk factors present at 

20 the time of the incident); 

21 (II) the date, time, and location 

22 of the incident, and the names and 

23 job titles of involved employees; 

24 (III) the nature and extent of in25 juries to covered employees; 


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1 (IV) a classification of the perpe2 trator who committed the violence, in3 cluding whether the perpetrator was— 

4 (aa) a patient, client, or cus5 tomer of a covered employer; 

6 (bb) a family or friend of a 

7 patient, client, or customer of a 

8 covered employer; 

9 (cc) a stranger with criminal 

10 intent; 

11 (dd) a coworker, supervisor, 

12 or manager of a covered em13 ployee; 

14 (ee) a partner, spouse, par15 ent, or relative of a covered em16 ployee; or 

17 (ff) any other appropriate 

18 classification; 

19 (V) the type of violent incident 

20 (such as type 1 violence, type 2 vio21 lence, type 3 violence, or type 4 vio22 lence); and 

23 (VI) how the incident was 

24 abated; 


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1 (iv) omit any element of personal 

2 identifying information sufficient to allow 

3 identification of any patient, resident or 

4 client alleged to have committed a violent 

5 incident (including the person’s name, ad6 dress, electronic mail address, telephone 

7 number, or social security number, or 

8 other information that, alone or in com9 bination with other publicly available infor10 mation, reveals such person’s identity); 

11 (v) not later than 7 days after the em12 ployer learns of such incident, contain a 

13 record of each violent incident, which is 

14 updated to ensure completeness of such 

15 record; 

16 (vi) be maintained for not less than 5 

17 years; and 

18 (vii) in the case of a violent incident 

19 involving a privacy concern case, protect 

20 the identity of employees in a manner con21 sistent with section 1904.29(b) of title 29, 

22 Code of Federal Regulations (or any cor23 responding similar regulation or ruling). 

24 (C) ANNUAL SUMMARY.— 


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1 (i) COVERED EMPLOYERS.—Each cov2 ered employer shall prepare an annual 

3 summary of each violent incident log for 

4 the preceding calendar year that shall— 

5 (I) with respect to each covered 

6 facility, and each covered service, for 

7 which such a log has been maintained, 

8 include the total number of violent in9 cidents, the number of recordable in10 juries related to such incidents, and 

11 the total number of hours worked by 

12 the covered employees for such pre13 ceding year; 

14 (II) be completed on a form pro15 vided by the Secretary; 

16 (III) be posted for three months 

17 beginning February 1 of each year in 

18 a manner consistent with the require19 ments of part 1904 of title 29, Code 

20 of Federal Regulations (or any cor21 responding similar regulations or rul22 ings), relating to the posting of sum23 maries of injury and illness logs; 


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1 (IV) be located in a conspicuous 

2 place or places where notices to em3 ployees are customarily posted; and 

4 (V) not be altered, defaced, or 

5 covered by other material. 

6 (ii) SECRETARY.—Not later than 1 

7 year after the promulgation of the interim 

8 final standard under section 101(a), the 

9 Secretary shall make available a platform 

10 for the electronic submission of annual 

11 summaries required under this paragraph. 

12 (5) ANNUAL REPORT.—Not later than Feb13 ruary 15 of each year, each covered employer shall 

14 report to the Secretary, the frequency, quantity, and 

15 severity of workplace violence, and any incident re16 sponse and post-incident investigation (including 

17 abatement measures for the incidents) set forth in 

18 the annual summary of the violent incident log de19 scribed in paragraph (4)(C). 

20 (6) ANNUAL EVALUATION.—Each covered em21 ployer shall conduct an annual written evaluation, 

22 conducted with the full, active participation of cov23 ered employees and employee representatives, of— 


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1 (A) the implementation and effectiveness 

2 of the Plan, including a review of the violent in3 cident log; and 

4 (B) compliance with training required by 

5 each standard described in section 101, and 

6 specified in the Plan. 

7 (7) ANTI-RETALIATION.— 

8 (A) POLICY.—Each covered employer shall 

9 adopt a policy prohibiting any person (including 

10 an agent of the employer) from discriminating 

11 or retaliating against any employee for report12 ing, or seeking assistance or intervention from, 

13 a workplace violence incident, threat, or concern 

14 to the employer, law enforcement, local emer15 gency services, or a government agency, or par16 ticipating in an incident investigation. 

17 (B) PROHIBITION.—No covered employer 

18 shall discriminate or retaliate against any em19 ployee for reporting, or seeking assistance or 

20 intervention from, a workplace violence incident, 

21 threat, or concern to the employer, law enforce22 ment, local emergency services, or a government 

23 agency, or for exercising any other rights under 

24 this paragraph. 


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1 (C) ENFORCEMENT.—This paragraph shall 

2 be enforced in the same manner and to the 

3 same extent as any standard promulgated 

4 under section 6(b) of the Occupational Safety 

5 and Health Act of 1970 (29 U.S.C. 655(b)). 

6 SEC. 104. RULES OF CONSTRUCTION. 

7 Notwithstanding section 18 of the Occupational Safe8 ty and Health Act of 1970 (29 U.S.C. 667)— 

9 (1) nothing in this title shall be construed to 

10 curtail or limit authority of the Secretary under any 

11 other provision of the law; and 

12 (2) the rights, privileges, or remedies of covered 

13 employees shall be in addition to the rights, privi14 leges, or remedies provided under any Federal or 

15 State law, or any collective bargaining agreement. 

16 SEC. 105. OTHER DEFINITIONS. 

17 In this title: 

18 (1) WORKPLACE VIOLENCE.— 

19 (A) IN GENERAL.—The term ‘‘workplace 

20 violence’’ means any act of violence or threat of 

21 violence, without regard to intent, that occurs 

22 at a covered facility or while a covered employee 

23 performs a covered service. 


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1 (B) EXCLUSIONS.—The term ‘‘workplace 

2 violence’’ does not include lawful acts of self-de3 fense or defense of others. 

4 (C) INCLUSIONS.—The term ‘‘workplace 

5 violence’’ includes— 

6 (i) the threat or use of physical force 

7 against a covered employee that results in 

8 or has a high likelihood of resulting in in9 jury, psychological trauma, or stress, with10 out regard to whether the covered em11 ployee sustains an injury, psychological 

12 trauma, or stress; and 

13 (ii) an incident involving the threat or 

14 use of a firearm or a dangerous weapon, 

15 including the use of common objects as 

16 weapons, without regard to whether the 

17 employee sustains an injury, psychological 

18 trauma, or stress. 

19 (2) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio20 lence’’— 

21 (A) means workplace violence directed at a 

22 covered employee at a covered facility or while 

23 performing a covered service by an individual 

24 who has no legitimate business at the covered 


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1 facility or with respect to such covered service; 

2 and 

3 (B) includes violent acts by any individual 

4 who enters the covered facility or worksite 

5 where a covered service is being performed with 

6 the intent to commit a crime. 

7 (3) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio8 lence’’ means workplace violence directed at a cov9 ered employee by customers, clients, patients, stu10 dents, inmates, or any individual for whom a covered 

11 facility provides services or for whom the employee 

12 performs covered services. 

13 (4) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio14 lence’’ means workplace violence directed at a cov15 ered employee by a present or former employee, su16 pervisor, or manager. 

17 (5) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio18 lence’’ means workplace violence directed at a cov19 ered employee by an individual who is not an em20 ployee, but has or is known to have had a personal 

21 relationship with such employee. 

22 (6) THREAT OF VIOLENCE.—The term ‘‘threat 

23 of violence’’ means a statement or conduct that 

24 causes a person to fear for his or her safety because 

25 there is a reasonable possibility the person might be 


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1 physically injured, and that serves no legitimate pur2 pose. 

3 (7) ALARM.—The term ‘‘alarm’’ means a me4 chanical, electrical, or electronic device that does not 

5 rely upon an employee’s vocalization in order to alert 

6 others. 

7 (8) DANGEROUS WEAPON.—The term ‘‘dan8 gerous weapon’’ means an instrument capable of in9 flicting death or serious bodily injury, regardless of 

10 whether such instrument was designed for that pur11 pose. 

12 (9) ENGINEERING CONTROLS.— 

13 (A) IN GENERAL.—The term ‘‘engineering 

14 controls’’ means an aspect of the built space or 

15 a device that removes a hazard from the work16 place or creates a barrier between a covered 

17 employee and the hazard. 

18 (B) INCLUSIONS.—For purposes of reduc19 ing workplace violence hazards, the term ‘‘engi20 neering controls’’ includes electronic access con21 trols to employee occupied areas, weapon detec22 tors (installed or handheld), enclosed work23 stations with shatter-resistant glass, deep serv24 ice counters, separate rooms or areas for high25 risk patients, locks on doors, removing access to 


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1 or securing items that could be used as weap2 ons, furniture affixed to the floor, opaque glass 

3 in patient rooms (which protects privacy, but 

4 allows the health care provider to see where the 

5 patient is before entering the room), closed-cir6 cuit television monitoring and video recording, 

7 sight-aids, and personal alarm devices. 

8 (10) ENVIRONMENTAL RISK FACTORS.— 

9 (A) IN GENERAL.—The term ‘‘environ10 mental risk factors’’ means factors in the cov11 ered facility or area in which a covered service 

12 is performed that may contribute to the likeli13 hood or severity of a workplace violence inci14 dent. 

15 (B) CLARIFICATION.—Environmental risk 

16 factors may be associated with the specific task 

17 being performed or the work area, such as 

18 working in an isolated area, poor illumination 

19 or blocked visibility, and lack of physical bar20 riers between employees and persons at risk of 

21 committing workplace violence. 

22 (11) PATIENT-SPECIFIC RISK FACTORS.—The 

23 term ‘‘patient-specific risk factors’’ means factors 

24 specific to a patient that may increase the likelihood 


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1 or severity of a workplace violence incident, includ2 ing— 

3 (A) a patient’s history of violence and use 

4 of drugs or alcohol; and 

5 (B) any conditions or disease processes of 

6 the patient that may cause the patient to expe7 rience confusion or disorientation, to be non-re8 sponsive to instruction, to behave unpredictably, 

9 or to engage in disruptive, threatening, or vio10 lent behavior. 

11 (12) SECRETARY.—The term ‘‘Secretary’’ 

12 means the Secretary of Labor. 

13 (13) WORK PRACTICE CONTROLS.— 

14 (A) IN GENERAL.—The term ‘‘work prac15 tice controls’’ means procedures and rules that 

16 are used to effectively reduce workplace violence 

17 hazards. 

18 (B) INCLUSIONS.—The term ‘‘work prac19 tice controls’’ includes assigning and placing 

20 sufficient numbers of staff to reduce patient21 specific Type 2 workplace violence hazards, pro22 vision of dedicated and available safety per23 sonnel such as security guards, employee train24 ing on workplace violence prevention method 

25 and techniques to de-escalate and minimize vioVerDate Sep 11 2014 02:55 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S851.IS S851

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•S 851 IS

1 lent behavior, and employee training on proce2 dures for response in the event of a workplace 

3 violence incident and for post-incident response. 

4 TITLE II—AMENDMENTS TO THE 

5 SOCIAL SECURITY ACT 

6 SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE 

7 PREVENTION STANDARD TO CERTAIN FACILI8 TIES RECEIVING MEDICARE FUNDS. 

9 (a) IN GENERAL.—Section 1866 of the Social Secu10 rity Act (42 U.S.C. 1395cc) is amended— 

11 (1) in subsection (a)(1)— 

12 (A) by moving the indentation of subpara13 graph (W) 2 ems to the left; 

14 (B) in subparagraph (X)— 

15 (i) by moving the indentation 2 ems 

16 to the left; and 

17 (ii) by striking ‘‘and’’ at the end; 

18 (C) in subparagraph (Y), by striking the 

19 period at the end and inserting ‘‘; and’’; and 

20 (D) by inserting after subparagraph (Y) 

21 the following new subparagraph: 

22 ‘‘(Z) in the case of hospitals that are not other23 wise subject to the Occupational Safety and Health 

24 Act of 1970 (or a State occupational safety and 

25 health plan that is approved under 18(b) of such 


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1 Act) and skilled nursing facilities that are not other2 wise subject to such Act (or such a State occupa3 tional safety and health plan), to comply with the 

4 Workplace Violence Prevention Standard (as pro5 mulgated under section 101 of the Workplace Vio6 lence Prevention for Health Care and Social Service 

7 Workers Act).’’; and 

8 (2) in subsection (b)(4)— 

9 (A) in subparagraph (A), by inserting 

10 ‘‘and a hospital or skilled nursing facility that 

11 fails to comply with the requirement of sub12 section (a)(1)(Z) (relating to the Workplace Vi13 olence Prevention Standard)’’ after 

14 ‘‘Bloodborne Pathogens standard)’’; and 

15 (B) in subparagraph (B)— 

16 (i) by striking ‘‘(a)(1)(U)’’ and insert17 ing ‘‘(a)(1)(V)’’; and 

18 (ii) by inserting ‘‘(or, in the case of a 

19 failure to comply with the requirement of 

20 subsection (a)(1)(Z), for a violation of the 

21 Workplace Violence Prevention standard 

22 referred to in such subsection by a hospital 

23 or skilled nursing facility, as applicable, 

24 that is subject to the provisions of such 

25 Act)’’ before the period at the end. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply beginning on the date that is 

3 1 year after the date of issuance of the interim final stand4 ard on workplace violence prevention required under sec5 tion 101. 

Æ 


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