IIB 

116TH CONGRESS 

1ST SESSION H. R. 1309 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 21, 2019 

Received; read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

AN ACT 

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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Prevention for Health Care and Social Service Workers 

4 Act’’. 

5 SEC. 2. TABLE OF CONTENTS. 

6 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. 

7 TITLE I—WORKPLACE VIOLENCE 

8 PREVENTION STANDARD 

9 SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD. 

10 (a) INTERIM FINAL STANDARD.— 

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

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

13 Labor shall promulgate an interim final standard on 

14 workplace violence prevention— 

15 (A) to require certain employers in the 

16 health care and social service sectors, and cer17 tain employers in sectors that conduct activities 

18 similar to the activities in the health care and 

19 social service sectors, to develop and implement 


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1 a comprehensive workplace violence prevention 

2 plan to protect health care workers, social serv3 ice workers, and other personnel from work4 place violence; 

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

6 the Guidelines for Preventing Workplace Vio7 lence for Health care and Social Service Work8 ers published by the Occupational Safety and 

9 Health Administration of the Department of 

10 Labor in 2015 and adhere to the requirements 

11 of this title; and 

12 (C) that provides for a period determined 

13 appropriate by the Secretary, not to exceed 1 

14 year, during which the Secretary shall prioritize 

15 technical assistance and advice consistent with 

16 section 21(d) of the Occupational Safety and 

17 Health Act of 1970 (29 U.S.C. 670(d)) to em18 ployers subject to the standard with respect to 

19 compliance with the standard. 

20 (2) APPLICABILITY OF OTHER STATUTORY RE21 QUIREMENTS.—The following shall not apply to the 

22 promulgation of the interim final standard under 

23 this subsection: 

24 (A) The requirements applicable to occupa25 tional safety and health standards under section 


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1 6(b) of the Occupational Safety and Health Act 

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

3 (B) The requirements of chapters 5 and 6 

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

5 42, United States Code. 

6 (3) NOTICE AND COMMENT.—Notwithstanding 

7 paragraph (2)(B), the Secretary shall, prior to pro8 mulgating the interim final standard under this sub9 section, provide notice in the Federal Register of the 

10 interim final standard and a 30-day period for pub11 lic comment. 

12 (4) EFFECTIVE DATE OF INTERIM STAND13 ARD.—The interim final standard shall— 

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

15 than 30 days after promulgation, except that 

16 such interim final standard may include a rea17 sonable phase-in period for the implementation 

18 of required engineering controls that take effect 

19 after such date; 

20 (B) be enforced in the same manner and 

21 to the same extent as any standard promul22 gated under section 6(b) of the Occupational 

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

24 655(b)); and 


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1 (C) be in effect until the final standard de2 scribed in subsection (b) becomes effective and 

3 enforceable. 

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

5 final standard described in paragraph (1) is not pro6 mulgated not later than 1 year of the date of enact7 ment of this Act, the provisions of this title shall be 

8 in effect and enforced in the same manner and to 

9 the same extent as any standard promulgated under 

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

11 Act (29 U.S.C. 655(b)) until such provisions are su12 perseded in whole by an interim final standard pro13 mulgated by the Secretary that meets the require14 ments of paragraph (1). 

15 (b) FINAL STANDARD.— 

16 (1) PROPOSED STANDARD.—Not later than 2 

17 years after the date of enactment of this Act, the 

18 Secretary of Labor shall, pursuant to section 6 of 

19 the Occupational Safety and Health Act (29 U.S.C. 

20 655), promulgate a proposed standard on workplace 

21 violence prevention— 

22 (A) for the purposes described in sub23 section (a)(1)(A); and 


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

2 elements contained in the interim final standard 

3 promulgated under subsection (a). 

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

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

6 Secretary shall promulgate a final standard on such 

7 proposed standard that shall— 

8 (A) provide no less protection than any 

9 workplace violence standard adopted by a State 

10 plan that has been approved by the Secretary 

11 under section 18 of the Occupational Safety 

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

13 (B) be effective and enforceable in the 

14 same manner and to the same extent as any 

15 standard promulgated under section 6(b) of the 

16 Occupational Safety and Health Act of 1970 

17 (29 U.S.C. 655(b)). 

18 SEC. 102. SCOPE AND APPLICATION. 

19 In this title: 

20 (1) COVERED FACILITY.— 

21 (A) IN GENERAL.—The term ‘‘covered fa22 cility’’ includes the following: 

23 (i) Any hospital, including any spe24 cialty hospital, in-patient or outpatient set25 ting, or clinic operating within a hospital 


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1 license, or any setting that provides out2 patient services. 

3 (ii) Any residential treatment facility, 

4 including any nursing home, skilled nurs5 ing facility, hospice facility, and long-term 

6 care facility. 

7 (iii) Any non-residential treatment or 

8 service setting. 

9 (iv) Any medical treatment or social 

10 service setting or clinic at a correctional or 

11 detention facility. 

12 (v) Any community care setting, in13 cluding a community-based residential fa14 cility, group home, and mental health clin15 ic. 

16 (vi) Any psychiatric treatment facility. 

17 (vii) Any drug abuse or substance use 

18 disorder treatment center. 

19 (viii) Any independent freestanding 

20 emergency centers. 

21 (ix) Any facility described in clauses 

22 (i) through (viii) operated by a Federal 

23 Government agency and required to comply 

24 with occupational safety and health stand25 ards pursuant to section 1960 of title 29, 


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1 Code of Federal Regulations (as such sec2 tion is in effect on the date of enactment 

3 of this Act). 

4 (x) Any other facility the Secretary 

5 determines should be covered under the 

6 standards promulgated under section 101. 

7 (B) EXCLUSION.—The term ‘‘covered facil8 ity’’ does not include an office of a physician, 

9 dentist, podiatrist, or any other health practi10 tioner that is not physically located within a 

11 covered facility described in clauses (i) through 

12 (x) of subparagraph (A). 

13 (2) COVERED SERVICES.— 

14 (A) IN GENERAL.—The term ‘‘covered 

15 service’’ includes the following services and op16 erations: 

17 (i) Any services and operations pro18 vided in any field work setting, including 

19 home health care, home-based hospice, and 

20 home-based social work. 

21 (ii) Any emergency services and trans22 port, including such services provided by 

23 firefighters and emergency responders. 

24 (iii) Any services described in clauses 

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1 ernment agency and required to comply 

2 with occupational safety and health stand3 ards pursuant to section 1960 of title 29, 

4 Code of Federal Regulations (as such sec5 tion is in effect on the date of enactment 

6 of this Act). 

7 (iv) Any other services and operations 

8 the Secretary determines should be covered 

9 under the standards promulgated under 

10 section 101. 

11 (B) EXCLUSION.—The term ‘‘covered serv12 ice’’ does not include child day care services. 

13 (3) COVERED EMPLOYER.— 

14 (A) IN GENERAL.—The term ‘‘covered em15 ployer’’ includes a person (including a con16 tractor, subcontractor, a temporary service 

17 firm, or an employee leasing entity) that em18 ploys an individual to work at a covered facility 

19 or to perform covered services. 

20 (B) EXCLUSION.—The term ‘‘covered em21 ployer’’ does not include an individual who pri22 vately employs, in the individual’s residence, a 

23 person to perform covered services for the indi24 vidual or a family member of the individual. 


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

2 employee’’ includes an individual employed by a cov3 ered employer to work at a covered facility or to per4 form covered services. 

5 SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 

6 PREVENTION STANDARD. 

7 Each standard described in section 101 shall include, 

8 at a minimum, the following requirements: 

9 (1) WORKPLACE VIOLENCE PREVENTION

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

11 promulgation of the interim final standard under 

12 section 101(a), a covered employer shall develop, im13 plement, and maintain an effective written workplace 

14 violence prevention plan for covered employees at 

15 each covered facility and for covered employees per16 forming a covered service on behalf of such em17 ployer, which meets the following: 

18 (A) PLAN DEVELOPMENT.—Each Plan 

19 shall— 

20 (i) be developed and implemented with 

21 the meaningful participation of direct care 

22 employees, other employees, and employee 

23 representatives, for all aspects of the Plan; 

24 (ii) be tailored and specific to condi25 tions and hazards for the covered facility 


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1 or the covered service, including patient2 specific risk factors and risk factors spe3 cific to each work area or unit; and 

4 (iii) be suitable for the size, com5 plexity, and type of operations at the cov6 ered facility or for the covered service, and 

7 remain in effect at all times. 

8 (B) PLAN CONTENT.—Each Plan shall in9 clude procedures and methods for the following: 

10 (i) Identification of the individual re11 sponsible for implementation of the Plan. 

12 (ii) With respect to each work area 

13 and unit at the covered facility or while 

14 covered employees are performing the cov15 ered service, risk assessment and identi16 fication of workplace violence risks and 

17 hazards to employees exposed to such risks 

18 and hazards (including environmental risk 

19 factors and patient-specific risk factors), 

20 which shall be— 

21 (I) informed by past violent inci22 dents specific to such covered facility 

23 or such covered service; and 

24 (II) conducted with, at a min25 imum— 


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1 (aa) direct care employees; 

2 (bb) where applicable, the 

3 representatives of such employ4 ees; and 

5 (cc) the employer. 

6 (iii) Hazard prevention, engineering 

7 controls, or work practice controls to cor8 rect hazards, in a timely manner, applying 

9 industrial hygiene principles of the hier10 archy of controls, which— 

11 (I) may include security and 

12 alarm systems, adequate exit routes, 

13 monitoring systems, barrier protec14 tion, established areas for patients 

15 and clients, lighting, entry procedures, 

16 staffing and working in teams, and 

17 systems to identify and flag clients 

18 with a history of violence; and 

19 (II) shall ensure that employers 

20 correct, in a timely manner, hazards 

21 identified in any violent incident in22 vestigation described in paragraph (2) 

23 and any annual report described in 

24 paragraph (5). 


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1 (iv) Reporting, incident response, and 

2 post-incident investigation procedures, in3 cluding procedures— 

4 (I) for employees to report work5 place violence risks, hazards, and inci6 dents; 

7 (II) for employers to respond to 

8 reports of workplace violence; 

9 (III) for employers to perform a 

10 post-incident investigation and de11 briefing of all reports of workplace vi12 olence with the participation of em13 ployees and their representatives; 

14 (IV) to provide medical care or 

15 first aid to affected employees; and 

16 (V) to provide employees with in17 formation about available trauma and 

18 related counseling. 

19 (v) Procedures for emergency re20 sponse, including procedures for threats of 

21 mass casualties and procedures for inci22 dents involving a firearm or a dangerous 

23 weapon. 

24 (vi) Procedures for communicating 

25 with and training the covered employees on 


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1 workplace violence hazards, threats, and 

2 work practice controls, the employer’s plan, 

3 and procedures for confronting, responding 

4 to, and reporting workplace violence 

5 threats, incidents, and concerns, and em6 ployee rights. 

7 (vii) Procedures for— 

8 (I) ensuring the coordination of 

9 risk assessment efforts, Plan develop10 ment, and implementation of the Plan 

11 with other employers who have em12 ployees who work at the covered facil13 ity or who are performing the covered 

14 service; and 

15 (II) determining which covered 

16 employer or covered employers shall 

17 be responsible for implementing and 

18 complying with the provisions of the 

19 standard applicable to the working 

20 conditions over which such employers 

21 have control. 

22 (viii) Procedures for conducting the 

23 annual evaluation under paragraph (6). 

24 (C) AVAILABILITY OF PLAN.— 


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1 (i) IN GENERAL.—Each Plan shall 

2 be— 

3 (I) made available at all times to 

4 the covered employees who are cov5 ered under such Plan; and 

6 (II) to the extent possible, 

7 emailed to each such employee upon 

8 completion of the employee’s annual 

9 training under paragraph (3)(A). 

10 (ii) RULE OF CONSTRUCTION.—Noth11 ing in this subparagraph shall be construed 

12 to serve in lieu of training or any other re13 quirements under this Act. 

14 (2) VIOLENT INCIDENT INVESTIGATION.— 

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

16 after a workplace violence incident, risk, or haz17 ard of which a covered employer has knowledge, 

18 the employer shall conduct an investigation of 

19 such incident, risk, or hazard under which the 

20 employer shall— 

21 (i) review the circumstances of the in22 cident, risk, or hazard, and whether any 

23 controls or measures implemented pursu24 ant to the Plan of the employer were effec25 tive; and 


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1 (ii) solicit input from involved employ2 ees, their representatives, and supervisors 

3 about the cause of the incident, risk, or 

4 hazard, and whether further corrective 

5 measures (including system-level factors) 

6 could have prevented the incident, risk, or 

7 hazard. 

8 (B) DOCUMENTATION.—A covered em9 ployer shall document the findings, rec10 ommendations, and corrective measures taken 

11 for each investigation conducted under this 

12 paragraph. 

13 (3) TRAINING AND EDUCATION.—With respect 

14 to the covered employees covered under a Plan of a 

15 covered employer, the employer shall provide train16 ing and education to such employees who may be ex17 posed to workplace violence hazards and risks, which 

18 meet the following requirements: 

19 (A) Annual training and education shall 

20 include information on the Plan, including iden21 tified workplace violence hazards, work practice 

22 control measures, reporting procedures, record 

23 keeping requirements, response procedures, 

24 anti-retaliation policies, and employee rights. 


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1 (B) Additional hazard recognition training 

2 shall be provided for supervisors and managers 

3 to ensure they— 

4 (i) can recognize high-risk situations; 

5 and 

6 (ii) do not assign employees to situa7 tions that predictably compromise the safe8 ty of such employees. 

9 (C) Additional training shall be provided 

10 for each such covered employee whose job cir11 cumstances have changed, within a reasonable 

12 timeframe after such change. 

13 (D) Additional training shall be provided 

14 for each such covered employee whose job cir15 cumstances require working with victims of tor16 ture, trafficking, or domestic violence. 

17 (E) Applicable training shall be provided 

18 under this paragraph for each new covered em19 ployee prior to the employee’s job assignment. 

20 (F) All training shall provide such employ21 ees opportunities to ask questions, give feed22 back on training, and request additional in23 struction, clarification, or other followup. 

24 (G) All training shall be provided in-person 

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1 place violence prevention and of the Plan, ex2 cept that any annual training described in sub3 paragraph (A) provided to an employee after 

4 the first year such training is provided to such 

5 employee may be conducted by live video if in6 person training is impracticable. 

7 (H) All training shall be appropriate in 

8 content and vocabulary to the language, edu9 cational level, and literacy of such covered em10 ployees. 

11 (4) RECORDKEEPING AND ACCESS TO PLAN

12 RECORDS.— 

13 (A) IN GENERAL.—Each covered employer 

14 shall— 

15 (i) maintain for not less than 5 

16 years— 

17 (I) records related to each Plan 

18 of the employer, including workplace 

19 violence risk and hazard assessments, 

20 and identification, evaluation, correc21 tion, and training procedures; 

22 (II) a violent incident log de23 scribed in subparagraph (B) for re24 cording all workplace violence inci25 dents; and 


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1 (III) records of all incident inves2 tigations as required under paragraph 

3 (2)(B); and 

4 (ii)(I) make such records and logs 

5 available, upon request, to covered employ6 ees and their representatives for examina7 tion and copying in accordance with sec8 tion 1910.1020 of title 29, Code of Federal 

9 Regulations (as such section is in effect on 

10 the date of enactment of this Act), and in 

11 a manner consistent with HIPAA privacy 

12 regulations (defined in section 1180(b)(3) 

13 of the Social Security Act (42 U.S.C. 

14 1320d–9(b)(3))) and part 2 of title 42, 

15 Code of Federal Regulations (as such part 

16 is in effect on the date of enactment of this 

17 Act); and 

18 (II) ensure that any such records and 

19 logs that may be copied, transmitted elec20 tronically, or otherwise removed from the 

21 employer’s control for purposes of this 

22 clause omit any element of personal identi23 fying information sufficient to allow identi24 fication of any patient, resident, client, or 

25 other individual alleged to have committed 


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1 a violent incident (including the individ2 ual’s name, address, electronic mail ad3 dress, telephone number, or social security 

4 number, or other information that, alone 

5 or in combination with other publicly avail6 able information, reveals such individual’s 

7 identity). 

8 (B) VIOLENT INCIDENT LOG DESCRIP9 TION.—Each violent incident log shall— 

10 (i) be maintained by a covered em11 ployer for each covered facility controlled 

12 by the employer and for each covered serv13 ice being performed by a covered employee 

14 on behalf of such employer; 

15 (ii) be based on a template developed 

16 by the Secretary not later than 1 year 

17 after the date of enactment of this Act; 

18 (iii) include, at a minimum, a descrip19 tion of— 

20 (I) the violent incident (including 

21 environmental risk factors present at 

22 the time of the incident); 

23 (II) the date, time, and location 

24 of the incident, and the names and 

25 job titles of involved employees; 


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1 (III) the nature and extent of in2 juries to covered employees; 

3 (IV) a classification of the perpe4 trator who committed the violence, in5 cluding whether the perpetrator was— 

6 (aa) a patient, client, resi7 dent, or customer of a covered 

8 employer; 

9 (bb) a family or friend of a 

10 patient, client, resident, or cus11 tomer of a covered employer; 

12 (cc) a stranger; 

13 (dd) a coworker, supervisor, 

14 or manager of a covered em15 ployee; 

16 (ee) a partner, spouse, par17 ent, or relative of a covered em18 ployee; or 

19 (ff) any other appropriate 

20 classification; 

21 (V) the type of violent incident 

22 (such as type 1 violence, type 2 vio23 lence, type 3 violence, or type 4 vio24 lence); and 


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1 (VI) how the incident was 

2 abated; 

3 (iv) not later than 7 days after the 

4 employer learns of such incident, contain a 

5 record of each violent incident, which is 

6 updated to ensure completeness of such 

7 record; 

8 (v) be maintained for not less than 5 

9 years; and 

10 (vi) in the case of a violent incident 

11 involving a privacy concern case, protect 

12 the identity of employees in a manner con13 sistent with section 1904.29(b) of title 29, 

14 Code of Federal Regulations (as such sec15 tion is in effect on the date of enactment 

16 of this Act). 

17 (C) ANNUAL SUMMARY.— 

18 (i) COVERED EMPLOYERS.—Each cov19 ered employer shall prepare an annual 

20 summary of each violent incident log for 

21 the preceding calendar year that shall— 

22 (I) with respect to each covered 

23 facility, and each covered service, for 

24 which such a log has been maintained, 

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1 cidents, the number of recordable in2 juries related to such incidents, and 

3 the total number of hours worked by 

4 the covered employees for such pre5 ceding year; 

6 (II) be completed on a form pro7 vided by the Secretary; 

8 (III) be posted for 3 months be9 ginning February 1 of each year in a 

10 manner consistent with the require11 ments of section 1904 of title 29, 

12 Code of Federal Regulations (as such 

13 section is in effect on the date of en14 actment of this Act), relating to the 

15 posting of summaries of injury and ill16 ness logs; 

17 (IV) be located in a conspicuous 

18 place or places where notices to em19 ployees are customarily posted; and 

20 (V) not be altered, defaced, or 

21 covered by other material. 

22 (ii) SECRETARY.—Not later than 1 

23 year after the promulgation of the interim 

24 final standard under section 101(a), the 

25 Secretary shall make available a platform 


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1 for the electronic submission of annual 

2 summaries required under this paragraph. 

3 (5) ANNUAL REPORT.—Not later than Feb4 ruary 15 of each year, each covered employer shall 

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

6 severity of workplace violence, and any incident re7 sponse and post-incident investigation (including 

8 abatement measures) for the incidents set forth in 

9 the annual summary of the violent incident log de10 scribed in paragraph (4)(C). Not later than May 15 

11 of each year, the Secretary shall provide to Congress 

12 a report containing statistical data with respect to, 

13 and a summary of, reports submitted to the Sec14 retary under this paragraph. The contents of the re15 port of the Secretary shall not disclose any confiden16 tial information. 

17 (6) ANNUAL EVALUATION.—Each covered em18 ployer shall conduct an annual written evaluation, 

19 conducted with the full, active participation of cov20 ered employees and employee representatives, of— 

21 (A) the implementation and effectiveness 

22 of the Plan, including a review of the violent in23 cident log; and 


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1 (B) compliance with training required by 

2 each standard described in section 101, and 

3 specified in the Plan. 

4 (7) PLAN UPDATES.—Each covered employer 

5 shall incorporate changes to the Plan, in a manner 

6 consistent with paragraph (1)(A)(i) and based on 

7 findings from the most recent annual evaluation con8 ducted under paragraph (6), as appropriate. 

9 (8) ANTI-RETALIATION.— 

10 (A) POLICY.—Each covered employer shall 

11 adopt a policy prohibiting any person (including 

12 an agent of the employer) from discriminating 

13 or retaliating against any employee for report14 ing, or seeking assistance or intervention from, 

15 a workplace violence incident, threat, or concern 

16 to the employer, law enforcement, local emer17 gency services, or a government agency, or par18 ticipating in an incident investigation. 

19 (B) PROHIBITION.—No covered employer 

20 shall discriminate or retaliate against any em21 ployee for— 

22 (i) reporting a workplace violence inci23 dent, threat, or concern to, or seeking as24 sistance or intervention with respect to 

25 such incident, threat, or concern from, the 


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1 employer, law enforcement, local emer2 gency services, or a local, State, or Federal 

3 government agency; or 

4 (ii) exercising any other rights under 

5 this paragraph. 

6 (C) ENFORCEMENT.—This paragraph shall 

7 be enforced in the same manner and to the 

8 same extent as any standard promulgated 

9 under section 6(b) of the Occupational Safety 

10 and Health Act (29 U.S.C. 655(b)). 

11 SEC. 104. RULES OF CONSTRUCTION. 

12 Notwithstanding section 18 of the Occupational Safe13 ty and Health Act of 1970 (29 U.S.C. 667)— 

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

15 curtail or limit authority of the Secretary under any 

16 other provision of the law; 

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

18 employees shall be in addition to the rights, privi19 leges, or remedies provided under any Federal or 

20 State law, or any collective bargaining agreement; 

21 (3) nothing in this Act shall be construed to 

22 limit or prevent health care workers, social service 

23 workers, and other personnel from reporting violent 

24 incidents to appropriate law enforcement; and 


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1 (4) nothing in this Act shall be construed to 

2 limit or diminish any protections in relevant Federal, 

3 State, or local law related to— 

4 (A) domestic violence; 

5 (B) stalking; 

6 (C) dating violence; and 

7 (D) sexual assault. 

8 SEC. 105. OTHER DEFINITIONS. 

9 In this title: 

10 (1) WORKPLACE VIOLENCE.— 

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

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

13 violence, without regard to intent, that occurs 

14 at a covered facility or while a covered employee 

15 performs a covered service. 

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

17 violence’’ does not include lawful acts of self-de18 fense or lawful acts of defense of others. 

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

20 violence’’ includes— 

21 (i) the threat or use of physical force 

22 against a covered employee that results in 

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1 ployee sustains an injury, psychological 

2 trauma, or stress; and 

3 (ii) an incident involving the threat or 

4 use of a firearm or a dangerous weapon, 

5 including the use of common objects as 

6 weapons, without regard to whether the 

7 employee sustains an injury, psychological 

8 trauma, or stress. 

9 (2) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio10 lence’’— 

11 (A) means workplace violence directed at a 

12 covered employee at a covered facility or while 

13 performing a covered service by an individual 

14 who has no legitimate business at the covered 

15 facility or with respect to such covered service; 

16 and 

17 (B) includes violent acts by any individual 

18 who enters the covered facility or worksite 

19 where a covered service is being performed with 

20 the intent to commit a crime. 

21 (3) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio22 lence’’ means workplace violence directed at a cov23 ered employee by customers, clients, patients, stu24 dents, inmates, or any individual for whom a covered 


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1 facility provides services or for whom the employee 

2 performs covered services. 

3 (4) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio4 lence’’ means workplace violence directed at a cov5 ered employee by a present or former employee, su6 pervisor, or manager. 

7 (5) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio8 lence’’ means workplace violence directed at a cov9 ered employee by an individual who is not an em10 ployee, but has or is known to have had a personal 

11 relationship with such employee, or with a customer, 

12 client, patient, student, inmate, or any individual for 

13 whom a covered facility provides services or for 

14 whom the employee performs covered services. 

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

16 of violence’’ means a statement or conduct that— 

17 (A) causes an individual to fear for such 

18 individual’s safety because there is a reasonable 

19 possibility the individual might be physically in20 jured; and 

21 (B) serves no legitimate purpose. 

22 (7) ALARM.—The term ‘‘alarm’’ means a me23 chanical, electrical, or electronic device that does not 

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

25 others. 


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1 (8) DANGEROUS WEAPON.—The term ‘‘dan2 gerous weapon’’ means an instrument capable of in3 flicting death or serious bodily injury, without re4 gard to whether such instrument was designed for 

5 that purpose. 

6 (9) ENGINEERING CONTROLS.— 

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

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

9 a device that removes a hazard from the work10 place or creates a barrier between a covered 

11 employee and the hazard. 

12 (B) INCLUSIONS.—For purposes of reduc13 ing workplace violence hazards, the term ‘‘engi14 neering controls’’ includes electronic access con15 trols to employee occupied areas, weapon detec16 tors (installed or handheld), enclosed work17 stations with shatter-resistant glass, deep serv18 ice counters, separate rooms or areas for high19 risk patients, locks on doors, removing access to 

20 or securing items that could be used as weap21 ons, furniture affixed to the floor, opaque glass 

22 in patient rooms (which protects privacy, but 

23 allows the health care provider to see where the 

24 patient is before entering the room), closed-cirVerDate Sep 11 2014 23:59 Nov 21, 2019 Jkt 099200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.RFS H1309

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1 cuit television monitoring and video recording, 

2 sight-aids, and personal alarm devices. 

3 (10) ENVIRONMENTAL RISK FACTORS.— 

4 (A) IN GENERAL.—The term ‘‘environ5 mental risk factors’’ means factors in the cov6 ered facility or area in which a covered service 

7 is performed that may contribute to the likeli8 hood or severity of a workplace violence inci9 dent. 

10 (B) CLARIFICATION.—Environmental risk 

11 factors may be associated with the specific task 

12 being performed or the work area, such as 

13 working in an isolated area, poor illumination 

14 or blocked visibility, and lack of physical bar15 riers between individuals and persons at risk of 

16 committing workplace violence. 

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

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

19 specific to a patient that may increase the likelihood 

20 or severity of a workplace violence incident, includ21 ing— 

22 (A) a patient’s treatment and medication 

23 status, and history of violence and use of drugs 

24 or alcohol; and 


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1 (B) any conditions or disease processes of 

2 the patient that may cause the patient to expe3 rience confusion or disorientation, be non-re4 sponsive to instruction, behave unpredictably, or 

5 engage in disruptive, threatening, or violent be6 havior. 

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

8 means the Secretary of Labor. 

9 (13) WORK PRACTICE CONTROLS.— 

10 (A) IN GENERAL.—The term ‘‘work prac11 tice controls’’ means procedures and rules that 

12 are used to effectively reduce workplace violence 

13 hazards. 

14 (B) INCLUSIONS.—The term ‘‘work prac15 tice controls’’ includes— 

16 (i) assigning and placing sufficient 

17 numbers of staff to reduce patient-specific 

18 Type 2 workplace violence hazards; 

19 (ii) provision of dedicated and avail20 able safety personnel such as security 

21 guards; 

22 (iii) employee training on workplace 

23 violence prevention methods and tech24 niques to de-escalate and minimize violent 

25 behavior; and 


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1 (iv) employee training on procedures 

2 for response in the event of a workplace vi3 olence incident and for post-incident re4 sponse. 

5 TITLE II—AMENDMENTS TO THE 

6 SOCIAL SECURITY ACT 

7 SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE 

8 PREVENTION STANDARD TO CERTAIN FACILI9 TIES RECEIVING MEDICARE FUNDS. 

10 (a) IN GENERAL.—Section 1866 of the Social Secu11 rity Act (42 U.S.C. 1395cc) is amended— 

12 (1) in subsection (a)(1)— 

13 (A) in subparagraph (X), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (Y), by striking at 

16 the end the period and inserting ‘‘; and’’; and 

17 (C) by inserting after subparagraph (Y) 

18 the following new subparagraph: 

19 ‘‘(Z) in the case of hospitals that are not other20 wise subject to the Occupational Safety and Health 

21 Act of 1970 (or a State occupational safety and 

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

23 Act) and skilled nursing facilities that are not other24 wise subject to such Act (or such a State occupa25 tional safety and health plan), to comply with the 


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1 Workplace Violence Prevention Standard (as pro2 mulgated under section 101 of the Workplace Vio3 lence Prevention for Health Care and Social Service 

4 Workers Act).’’; and 

5 (2) in subsection (b)(4)— 

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

7 ‘‘and a hospital or skilled nursing facility that 

8 fails to comply with the requirement of sub9 section (a)(1)(Z) (relating to the Workplace Vi10 olence Prevention Standard)’’ after 

11 ‘‘Bloodborne Pathogens standard)’’; and 

12 (B) in subparagraph (B)— 

13 (i) by striking ‘‘(a)(1)(U)’’ and insert14 ing ‘‘(a)(1)(V)’’; and 

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

16 failure to comply with the requirement of 

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

18 Workplace Violence Prevention standard 

19 referred to in such subsection by a hospital 

20 or skilled nursing facility, as applicable, 

21 that is subject to the provisions of such 

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

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

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

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1 ard on workplace violence prevention required under sec2 tion 101. 

Passed the House of Representatives November 21, 

2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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