I 

116TH CONGRESS 

1ST SESSION H. R. 1309 

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 HOUSE OF REPRESENTATIVES 

FEBRUARY 19, 2019 

Mr. COURTNEY (for himself, Mr. SCOTT of Virginia, Ms. ADAMS, Ms. WILSON

of Florida, Ms. BONAMICI, Mr. DESAULNIER, Ms. WILD, Ms. OMAR, Mr. 

GARAMENDI, Mr. ESPAILLAT, Mr. KHANNA, Ms. PINGREE, Ms. NORTON, 

Mr. HIMES, Mr. POCAN, Ms. SCHAKOWSKY, Ms. CLARKE of New York, 

Ms. OCASIO-CORTEZ, Ms. VELA ́ZQUEZ, Ms. MCCOLLUM, Mr. LIPINSKI, 

Mr. SIRES, Mr. PETERSON, Mr. RASKIN, Mr. ENGEL, Mr. LARSON of 

Connecticut, and Ms. HAALAND) introduced the following bill; which was 

referred to the Committee on Education and Labor, and in addition to 

the Committees on Energy and Commerce, and Ways and Means, for a 

period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

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, 


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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. FINDINGS. 

6 Congress finds the following: 

7 (1) In a 2016 report entitled, ‘‘Workplace Safe8 ty and Health: Additional Efforts Needed to Help 

9 Protect Health Care Workers from Workplace Vio10 lence’’, the Government Accountability Office re11 ported over 730,000 cases of health care workplace 

12 assaults over the 5-year span from 2009 through 

13 2013, based on Bureau of Justice Statistics data. 

14 (2) The health care and social service industries 

15 experience the highest rates of injuries caused by 

16 workplace violence. Nurses, social workers, psy17 chiatric, home health, and personal care aides are all 

18 at increased risk for injury caused by workplace vio19 lence. The Bureau of Labor Statistics reported that 

20 in 2017, rates of violence and injury caused by per21 sons in these workplaces ranged from 3 times to as 

22 high as 61.9 times the average American workplace. 

23 (3) The Bureau of Labor Statistics reports that 

24 health care and social service workers suffered 69 

25 percent of all workplace violence injuries caused by 

26 persons in 2017 and are nearly 5 times as likely to 


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1 suffer a workplace violence injury than workers over2 all. 

3 (4) According to a survey of 3,500 American 

4 emergency physicians conducted by the American 

5 College of Emergency Physicians, 47 percent of 

6 emergency room doctors have been physically as7 saulted at work, and 8 in 10 report that this vio8 lence is affecting patient care. 

9 (5) Workplace violence in health care and social 

10 service sectors is increasing. Bureau of Labor Statis11 tics data show that private sector injury rates of 

12 workplace violence in health care and social service 

13 sectors increased by 63 percent between 2006 and 

14 2016. Due to under-reporting, actual injury rates 

15 from workplace violence are widely recognized to be 

16 higher than reported levels. 

17 (6) Violence in health care settings has adverse 

18 impacts on workers and patients, compromising 

19 quality of care. 

20 (7) Studies have demonstrated that workplace 

21 violence prevention programs tailored to the needs of 

22 specific work areas and State-based workplace vio23 lence prevention legislation are strongly associated 

24 with reductions in workplace violence. 


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1 (8) Studies have found that proper staff train2 ing, appropriate staffing levels, sufficient resources, 

3 and the use of evidence based interventions (such as 

4 effective communication with patients using de-esca5 lation techniques and noncoercive use of medica6 tions) can reduce the risks to the safety of both pa7 tients and staff, using least-restrictive measures. 

8 (9) The Occupational Safety and Health Ad9 ministration has issued ‘‘Guidelines for Preventing 

10 Workplace Violence for Healthcare and Social Serv11 ice Workers’’, however, this guidance is not enforce12 able. Absent an enforceable standard, employers lack 

13 mandatory requirements to implement an effective 

14 and ongoing violence prevention program that pro15 vides protection of workers from workplace violence. 

16 (10) Nine States have mandated that certain 

17 types of health care facilities implement workplace 

18 violence prevention programs. On April 1, 2018, the 

19 Division of Occupational Safety and Health of the 

20 State of California issued a comprehensive standard 

21 (‘‘Workplace Violence Prevention in Health Care’’) 

22 that requires health care facilities to implement a 

23 workplace violence prevention plan. 

24 (11) Employer organizations have challenged 

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1 tion’s authority to utilize the General Duty Clause 

2 of the Occupational Safety and Health Act of 1970 

3 to enforce against workplace violence hazards, argu4 ing that Congress did not intend to cover workplace 

5 violence under such clause when the Act was enacted 

6 in 1970. 

7 (12) The Occupational Safety and Health Ad8 ministration (OSHA) received two petitions for rule9 making in July of 2016, calling on OSHA to pro10 mulgate a violence prevention standard for health 

11 care and social service sectors. On December 6, 

12 2016, OSHA issued a Request for Information 

13 (RFI) soliciting information on this issue. On Janu14 ary 10, 2017, OSHA conducted a public meeting to 

15 receive stakeholder input and to supplement the on16 line comments submitted in response to the RFI. At 

17 that meeting, OSHA announced it accepted the peti18 tions and would develop a Federal standard to pre19 vent workplace violence in health care and social 

20 service settings. OSHA’s efforts to move forward 

21 with rulemaking have been halting, inconsistent, and 

22 slow. Therefore, legislation is necessary to ensure 

23 the timely development of a standard to protect 

24 workers in health care and social service settings. 


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1 SEC. 3. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Findings. 

Sec. 3. 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 healthcare and social service sectors, and cer13 tain employers in sectors that conduct activities 

14 similar to the activities in the healthcare and 

15 social service sectors, to develop and implement 

16 a comprehensive workplace violence prevention 

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1 ice workers, and other personnel from work2 place violence; and 

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

4 the Guidelines for Preventing Workplace Vio5 lence for Healthcare and Social Service Work6 ers published by the Occupational Safety and 

7 Health Administration of the Department of 

8 Labor in 2015 and adhere to the requirements 

9 of this title. 

10 (2) APPLICABILITY OF OTHER STATUTORY RE11 QUIREMENTS.—The following shall not apply to the 

12 promulgation of the interim final standard under 

13 this subsection: 

14 (A) The requirements applicable to occupa15 tional safety and health standards under section 

16 6(b) of the Occupational Safety and Health Act 

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

18 (B) The requirements of chapters 5 and 6 

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

20 42, United States Code. 

21 (3) EFFECTIVE DATE OF INTERIM STAND22 ARD.—The interim final standard shall— 

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

24 than 30 days after promulgation, except that 

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1 sonable phase-in period for the implementation 

2 of required engineering controls that take effect 

3 after such date; 

4 (B) be enforced in the same manner and 

5 to the same extent as any standard promul6 gated under section 6(b) of the Occupational 

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

8 655(b)); and 

9 (C) be in effect until the final standard de10 scribed in subsection (b) becomes effective and 

11 enforceable. 

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

13 final standard described in paragraph (1) is not pro14 mulgated not later than 1 year of the date of enact15 ment of this Act, the provisions of this title shall be 

16 in effect and enforced in the same manner and to 

17 the same extent as any standard promulgated under 

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

19 Act (29 U.S.C. 655(b)) until such provisions are su20 perseded in whole by an interim final standard pro21 mulgated by the Secretary that meets the require22 ments of paragraph (1). 

23 (b) FINAL STANDARD.— 

24 (1) PROPOSED FINAL STANDARD.—Not later 

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


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1 the Secretary of Labor shall, pursuant to section 6 

2 of the Occupational Safety and Health Act (29 

3 U.S.C. 655), promulgate a proposed final standard 

4 on workplace violence prevention— 

5 (A) for the purposes described in sub6 section (a)(1)(A); and 

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

8 elements contained in the interim final standard 

9 promulgated under subsection (a). 

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

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

12 Secretary shall promulgate a final standard on such 

13 proposed standard that shall— 

14 (A) provide no less protection than any 

15 workplace violence standard adopted by a State 

16 plan that has been approved by the Secretary 

17 under section 18 of the Occupational Safety 

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

19 (B) be effective and enforceable in the 

20 same manner and to the same extent as any 

21 standard promulgated under section 6(b) of the 

22 Occupational Safety and Health Act of 1970 

23 (29 U.S.C. 655(b)). 

24 SEC. 102. SCOPE AND APPLICATION. 

25 In this title: 


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

2 facility’’ includes the following: 

3 (A) Any hospital, including any specialty 

4 hospital, in-patient or outpatient setting, or 

5 clinic operating within a hospital license, or any 

6 setting that provides outpatient services. 

7 (B) Any residential treatment facility, in8 cluding any nursing home, skilled nursing facil9 ity, hospice facility, and long-term care facility. 

10 (C) Any non-residential treatment or serv11 ice setting. 

12 (D) Any medical treatment or social serv13 ice setting or clinic at a correctional or deten14 tion facility. 

15 (E) Any community care setting, including 

16 a community-based residential facility, group 

17 home, and mental health clinic. 

18 (F) Any psychiatric treatment facility. 

19 (G) Any drug abuse or substance use dis20 order treatment center. 

21 (H) Any independent freestanding emer22 gency centers. 

23 (I) Any facility described in subparagraphs 

24 (A) through (H) operated by a Federal Govern25 ment agency and required to comply with occuVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 pational safety and health standards pursuant 

2 to section 1960 of title 29, Code of Federal 

3 Regulations. 

4 (J) Any other facility the Secretary deter5 mines should be covered under the standards 

6 promulgated under section 101. 

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

8 service’’ includes the following services and oper9 ations: 

10 (A) Any services and operations provided 

11 in any field work setting, including home health 

12 care, home-based hospice, and home-based so13 cial work. 

14 (B) Any emergency services and transport, 

15 including such services provided by firefighters 

16 and emergency responders. 

17 (C) Any services described in subpara18 graphs (A) and (B) performed by a Federal 

19 Government agency and required to comply 

20 with occupational safety and health standards 

21 pursuant to section 1960 of title 29, Code of 

22 Federal Regulations. 

23 (D) Any other services and operations the 

24 Secretary determines should be covered under 

25 the standards promulgated under section 101. 


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1 (3) COVERED EMPLOYER.— 

2 (A) IN GENERAL.—The term ‘‘covered em3 ployer’’ includes a person (including a con4 tractor, subcontractor, a temporary service 

5 firm, or an employee leasing entity) that em6 ploys an individual to work at a covered facility 

7 or to perform covered services. 

8 (B) EXCLUSION.—The term ‘‘covered em9 ployer’’ does not include an individual who pri10 vately employs, in the individual’s residence, a 

11 person to perform covered services for the indi12 vidual or a family member of the individual. 

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

14 employee’’ includes an individual employed by a cov15 ered employer to work at a covered facility or to per16 form covered services. 

17 SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 

18 PREVENTION STANDARD. 

19 Each standard described in section 101 shall include, 

20 at a minimum, the following requirements: 

21 (1) WORKPLACE VIOLENCE PREVENTION

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

23 promulgation of the interim final standard under 

24 section 101(a), a covered employer shall develop, im25 plement, and maintain an effective written workplace 


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1 violence prevention plan for covered employees at 

2 each covered facility and for covered employees per3 forming a covered service on behalf of such em4 ployer, which meets the following: 

5 (A) PLAN DEVELOPMENT.—Each Plan 

6 shall— 

7 (i) be developed and implemented with 

8 the meaningful participation of direct care 

9 employees and, where applicable, employee 

10 representatives and collective bargaining 

11 representatives, for all aspects of the Plan; 

12 (ii) be tailored and specific to condi13 tions and hazards for the covered facility 

14 or the covered service, including patient15 specific risk factors and risk factors spe16 cific to each work area or unit; and 

17 (iii) be suitable for the size, com18 plexity, and type of operations at the cov19 ered facility or for the covered service, and 

20 remain in effect at all times. 

21 (B) PLAN CONTENT.—Each Plan shall in22 clude procedures and methods for the following: 

23 (i) Identification of the individual re24 sponsible for implementation of the Plan. 


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1 (ii) With respect to each work area 

2 and unit at the covered facility or while 

3 covered employees are performing the cov4 ered service, risk assessment and identi5 fication of workplace violence risks and 

6 hazards to employees exposed to such risks 

7 and hazards (including environmental risk 

8 factors and patient-specific risk factors), 

9 which shall be— 

10 (I) informed by past violent inci11 dents specific to such covered facility 

12 or such covered service; and 

13 (II) conducted with, at a min14 imum— 

15 (aa) direct care employees; 

16 (bb) where applicable, the 

17 representatives of such employ18 ees; and 

19 (cc) the employer. 

20 (iii) Hazard prevention, engineering 

21 controls, or work practice controls to cor22 rect, in a timely manner, hazards that the 

23 employer creates or controls applying in24 dustrial hygiene principles of the hierarchy 

25 of controls, which— 


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1 (I) may include security and 

2 alarm systems, adequate exit routes, 

3 monitoring systems, barrier protec4 tion, established areas for patients 

5 and clients, lighting, entry procedures, 

6 staffing and working in teams, and 

7 systems to identify and flag clients 

8 with a history of violence; and 

9 (II) shall ensure that employers 

10 correct, in a timely manner, hazards 

11 identified in the annual report de12 scribed in paragraph (5) that the em13 ployer creates or controls. 

14 (iv) Reporting, incident response, and 

15 post-incident investigation procedures, in16 cluding procedures— 

17 (I) for employees to report work18 place violence risks, hazards, and inci19 dents; 

20 (II) for employers to respond to 

21 reports of workplace violence; 

22 (III) for employers to perform a 

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1 olence with the participation of em2 ployees and their representatives; and 

3 (IV) to provide medical care or 

4 first aid to affected employees. 

5 (v) Procedures for emergency re6 sponse, including procedures for threats of 

7 mass casualties and procedures for inci8 dents involving a firearm or a dangerous 

9 weapon. 

10 (vi) Procedures for communicating 

11 with and training of covered employees on 

12 workplace violence hazards, threats, and 

13 work practice controls, the employer’s plan, 

14 and procedures for confronting, responding 

15 to, and reporting workplace violence 

16 threats, incidents, and concerns, and em17 ployee rights. 

18 (vii) Procedures for coordination of 

19 risk assessment efforts, Plan development, 

20 and implementation of the Plan with other 

21 employers who have employees who work 

22 at the covered facility or who are per23 forming the covered service. 

24 (viii) Procedures for conducting the 

25 annual evaluation under paragraph (6). 


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1 (C) AVAILABILITY OF PLAN.—Each Plan 

2 shall be made available at all times to the cov3 ered employees who are covered under such 

4 Plan. 

5 (2) VIOLENT INCIDENT INVESTIGATION.— 

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

7 after a workplace violence incident, risk, or haz8 ard of which a covered employer has knowledge, 

9 the employer shall conduct an investigation of 

10 such incident, risk, or hazard under which the 

11 employer shall— 

12 (i) review the circumstances of the in13 cident, risk, or hazard, and whether any 

14 controls or measures implemented pursu15 ant to the Plan of the employer were effec16 tive; and 

17 (ii) solicit input from involved employ18 ees, their representatives, and supervisors, 

19 about the cause of the incident, risk, or 

20 hazard, and whether further corrective 

21 measures (including system-level factors) 

22 could have prevented the incident, risk, or 

23 hazard. 

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1 ommendations, and corrective measures taken 

2 for each investigation conducted under this 

3 paragraph. 

4 (3) TRAINING AND EDUCATION.—With respect 

5 to the covered employees covered under a Plan of a 

6 covered employer, the employer shall provide train7 ing and education to such employees who may be ex8 posed to workplace violence hazards and risks, which 

9 meet the following requirements: 

10 (A) Annual training and education includes 

11 information on the Plan, including identified 

12 workplace violence hazards, work practice con13 trol measures, reporting procedures, record 

14 keeping requirements, response procedures, and 

15 employee rights. 

16 (B) Additional hazard recognition training 

17 for supervisors and managers to ensure they 

18 can recognize high-risk situations and do not 

19 assign employees to situations that predictably 

20 compromise their safety. 

21 (C) Additional training for each such cov22 ered employee whose job circumstances has 

23 changed, within a reasonable timeframe after 

24 such change. 


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1 (D) New employee training prior to assign2 ment. 

3 (E) All training provides such employees 

4 opportunities to ask questions, give feedback on 

5 such training, and request additional instruc6 tion, clarification, or other followup. 

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

8 by an individual with knowledge of workplace 

9 violence prevention and of the Plan. 

10 (G) All training is appropriate in content 

11 and vocabulary to the language, educational 

12 level, and literacy of such covered employees. 

13 (4) RECORDKEEPING AND ACCESS TO PLAN

14 RECORDS.— 

15 (A) IN GENERAL.—Each covered employer 

16 shall— 

17 (i) maintain at all times— 

18 (I) records related to each Plan 

19 of the employer, including workplace 

20 violence risk and hazard assessments, 

21 and identification, evaluation, correc22 tion, and training procedures; 

23 (II) a violent incident log de24 scribed in subparagraph (B) for reVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 cording all workplace violence inci2 dents; and 

3 (III) records of all incident inves4 tigations as required under paragraph 

5 (2)(B); and 

6 (ii) make such records and logs avail7 able, upon request, to covered employees 

8 and their representatives for examination 

9 and copying in accordance with section 

10 1910.1020 of title 29, Code of Federal 

11 Regulations, and in a manner consistent 

12 with HIPAA privacy regulations (defined 

13 in section 1180(b)(3) of the Social Security 

14 Act (42 U.S.C. 1320d–9(b)(3))) and part 

15 2 of title 42, Code of Federal Regulations, 

16 and ensure that any such records and logs 

17 removed from the employer’s control for 

18 purposes of this clause omit any element of 

19 personal identifying information sufficient 

20 to allow identification of any patient, resi21 dent or client alleged to have committed a 

22 violent incident (including the person’s 

23 name, address, electronic mail address, 

24 telephone number, or social security num25 ber, or other information that, alone or in 


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1 combination with other publicly available 

2 information, reveals such person’s iden3 tity). 

4 (B) VIOLENT INCIDENT LOG DESCRIP5 TION.—Each violent incident log shall— 

6 (i) be maintained by a covered em7 ployer for each covered facility controlled 

8 by the employer and for each covered serv9 ice being performed by a covered employee 

10 on behalf of such employer; 

11 (ii) be based on a template developed 

12 by the Secretary not later than 1 year 

13 after the date of enactment of this Act; 

14 (iii) include, at a minimum, a descrip15 tion of— 

16 (I) the violent incident (including 

17 environmental risk factors present at 

18 the time of the incident); 

19 (II) the date, time, and location 

20 of the incident, names and job titles 

21 of involved employees; 

22 (III) the nature and extent of in23 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) not later than 7 days after the 

2 employer learns of such incident, contain a 

3 record of each violent incident, which is 

4 updated to ensure completeness of such 

5 record; 

6 (v) be maintained for not less than 5 

7 years; and 

8 (vi) in the case of a violent incident 

9 involving a privacy concern case, protect 

10 the identity of employees in a manner con11 sistent with section 1904.29(b) of title 29, 

12 Code of Federal Regulations. 

13 (C) ANNUAL SUMMARY.— 

14 (i) COVERED EMPLOYERS.—Each cov15 ered employer shall prepare an annual 

16 summary of each violent incident log for 

17 the preceding calendar year that shall— 

18 (I) with respect to each covered 

19 facility, and each covered service, for 

20 which such a log has been maintained, 

21 include the total number of violent in22 cidents, the number of recordable in23 juries related to such incidents, and 

24 the total number of hours worked by 


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1 the covered employees for such pre2 ceding year; 

3 (II) be completed on a form pro4 vided by the Secretary; 

5 (III) be posted for three months 

6 beginning February 1 of each year in 

7 a manner consistent with the require8 ments of section 1904 of title 29, 

9 Code of Federal Regulations, relating 

10 to the posting of summaries of injury 

11 and illness logs; 

12 (IV) be located in a conspicuous 

13 place or places where notices to em14 ployees are customarily posted; and 

15 (V) not be altered, defaced, or 

16 covered by other material. 

17 (ii) SECRETARY.—Not later than 1 

18 year after the promulgation of the interim 

19 final standard under section 101(a), the 

20 Secretary shall make available a platform 

21 for the electronic submission of annual 

22 summaries required under this paragraph. 

23 (5) ANNUAL REPORT.—Not later than Feb24 ruary 15 of each year, each covered employer shall 

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


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1 severity of workplace violence, and any incident re2 sponse and post-incident investigation (including 

3 abatement measures for the incidents) set forth in 

4 the annual summary of the violent incident log de5 scribed in paragraph (4)(C). 

6 (6) ANNUAL EVALUATION.—Each covered em7 ployer shall conduct an annual written evaluation, 

8 conducted with the full, active participation of cov9 ered employees and employee representatives, of— 

10 (A) the implementation and effectiveness 

11 of the Plan, including a review of the violent in12 cident log; and 

13 (B) compliance with training required by 

14 each standard described in section 101, and 

15 specified in the Plan. 

16 (7) ANTI-RETALIATION.— 

17 (A) POLICY.—Each covered employer shall 

18 adopt a policy prohibiting any person (including 

19 an agent of the employer) from discriminating 

20 or retaliating against any employee for report21 ing, or seeking assistance or intervention from, 

22 a workplace violence incident, threat, or concern 

23 to the employer, law enforcement, local emer24 gency services, or a government agency, or par25 ticipating in an incident investigation. 


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1 (B) PROHIBITION.—No covered employer 

2 shall discriminate or retaliate against any em3 ployee for reporting, or seeking assistance or 

4 intervention from, a workplace violence incident, 

5 threat, or concern to the employer, law enforce6 ment, local emergency services, or a government 

7 agency, or for exercising any other rights under 

8 this paragraph. 

9 (C) ENFORCEMENT.—This paragraph shall 

10 be enforced in the same manner and to the 

11 same extent as any standard promulgated 

12 under section 6(b) of the Occupational Safety 

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

14 SEC. 104. RULES OF CONSTRUCTION. 

15 Notwithstanding section 18 of the Occupational Safe16 ty and Health Act of 1970 (29 U.S.C. 667)— 

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

18 curtail or limit authority of the Secretary under any 

19 other provision of the law; and 

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

21 employees shall be in addition to the rights, privi22 leges, or remedies provided under any Federal or 

23 State law, or any collective bargaining agreement. 

24 SEC. 105. OTHER DEFINITIONS. 

25 In this title: 


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1 (1) WORKPLACE VIOLENCE.— 

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

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

4 violence, without regard to intent, that occurs 

5 at a covered facility or while a covered employee 

6 performs a covered service. 

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

8 violence’’ does not include lawful acts of self-de9 fense or defense of others. 

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

11 violence’’ includes— 

12 (i) the threat or use of physical force 

13 against a covered employee that results in 

14 or has a high likelihood of resulting in in15 jury, psychological trauma, or stress, with16 out regard to whether the covered em17 ployee sustains an injury, psychological 

18 trauma, or stress; and 

19 (ii) an incident involving the threat or 

20 use of a firearm or a dangerous weapon, 

21 including the use of common objects as 

22 weapons, without regard to whether the 

23 employee sustains an injury, psychological 

24 trauma, or stress. 


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1 (2) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio2 lence’’— 

3 (A) means workplace violence directed at a 

4 covered employee at a covered facility or while 

5 performing a covered service by an individual 

6 who has no legitimate business at the covered 

7 facility or with respect to such covered service; 

8 and 

9 (B) includes violent acts by any individual 

10 who enters the covered facility or worksite 

11 where a covered service is being performed with 

12 the intent to commit a crime. 

13 (3) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio14 lence’’ means workplace violence directed at a cov15 ered employee by customers, clients, patients, stu16 dents, inmates, or any individual for whom a covered 

17 facility provides services or for whom the employee 

18 performs covered services. 

19 (4) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio20 lence’’ means workplace violence directed at a cov21 ered employee by a present or former employee, su22 pervisor, or manager. 

23 (5) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio24 lence’’ means workplace violence directed at a cov25 ered employee by an individual who is not an emVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 ployee, but has or is known to have had a personal 

2 relationship with such employee. 

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

4 of violence’’ means a statement or conduct that 

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

6 there is a reasonable possibility the person might be 

7 physically injured, and that serves no legitimate pur8 pose. 

9 (7) ALARM.—The term ‘‘alarm’’ means a me10 chanical, electrical, or electronic device that does not 

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

12 others. 

13 (8) DANGEROUS WEAPON.—The term ‘‘dan14 gerous weapon’’ means an instrument capable of in15 flicting death or serious bodily injury, regardless of 

16 whether such instrument was designed for that pur17 pose. 

18 (9) ENGINEERING CONTROLS.— 

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

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

21 a device that removes a hazard from the work22 place or creates a barrier between a covered 

23 employee and the hazard. 

24 (B) INCLUSIONS.—For purposes of reduc25 ing workplace violence hazards, the term ‘‘engiVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 neering controls’’ includes electronic access con2 trols to employee occupied areas, weapon detec3 tors (installed or handheld), enclosed work4 stations with shatter-resistant glass, deep serv5 ice counters, separate rooms or areas for high6 risk patients, locks on doors, removing access to 

7 or securing items that could be used as weap8 ons, furniture affixed to the floor, opaque glass 

9 in patient rooms (which protects privacy, but 

10 allows the health care provider to see where the 

11 patient is before entering the room), closed-cir12 cuit television monitoring and video recording, 

13 sight-aids, and personal alarm devices. 

14 (10) ENVIRONMENTAL RISK FACTORS.— 

15 (A) IN GENERAL.—The term ‘‘environ16 mental risk factors’’ means factors in the cov17 ered facility or area in which a covered service 

18 is performed that may contribute to the likeli19 hood or severity of a workplace violence inci20 dent. 

21 (B) CLARIFICATION.—Environmental risk 

22 factors may be associated with the specific task 

23 being performed or the work area, such as 

24 working in an isolated area, poor illumination 

25 or blocked visibility, and lack of physical barVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 riers between employees and persons at risk of 

2 committing workplace violence. 

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

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

5 specific to a patient that may increase the likelihood 

6 or severity of a workplace violence incident, includ7 ing— 

8 (A) a patient’s psychiatric condition, treat9 ment and medication status, history of violence, 

10 and use of drugs or alcohol; and 

11 (B) any conditions or disease processes of 

12 the patient that may cause the patient to expe13 rience confusion or disorientation, to be non-re14 sponsive to instruction, or to behave unpredict15 ably. 

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

17 means the Secretary of Labor. 

18 (13) WORK PRACTICE CONTROLS.— 

19 (A) IN GENERAL.—The term ‘‘work prac20 tice controls’’ means procedures and rules that 

21 are used to effectively reduce workplace violence 

22 hazards. 

23 (B) INCLUSIONS.—The term ‘‘work prac24 tice controls’’ includes assigning and placing 

25 sufficient numbers of staff to reduce patientVerDate Sep 11 2014 23:29 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H1309.IH H1309

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1 specific Type 2 workplace violence hazards, pro2 vision of dedicated and available safety per3 sonnel such as security guards, employee train4 ing on workplace violence prevention method 

5 and techniques to de-escalate and minimize vio6 lent behavior, and employee training on proce7 dures for response in the event of a workplace 

8 violence incident and for post-incident response. 

9 TITLE II—AMENDMENTS TO THE 

10 SOCIAL SECURITY ACT 

11 SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE 

12 PREVENTION STANDARD TO CERTAIN FACILI13 TIES RECEIVING MEDICARE FUNDS. 

14 (a) IN GENERAL.—Section 1866 of the Social Secu15 rity Act (42 U.S.C. 1395cc) is amended— 

16 (1) in subsection (a)(1)— 

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

18 ‘‘and’’ at the end; 

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

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

21 (C) by inserting after subparagraph (Y) 

22 the following new subparagraph: 

23 ‘‘(Z) in the case of hospitals that are not other24 wise subject to the Occupational Safety and Health 

25 Act of 1970 (or a State occupational safety and 


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

2 Act) and skilled nursing facilities that are not other3 wise subject to such Act (or such a State occupa4 tional safety and health plan), to comply with the 

5 Workplace Violence Prevention Standard (as pro6 mulgated under section 101 of the Health Care 

7 Workplace Violence Prevention Act of 2018).’’; 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 ‘‘Blood14 borne 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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