workp ace vio ence

Guidelines for Preventing

for Healthcare 

and Social Service 

Workers

OSHA 3148-06R 2016 U.S. Department of Labor

www.osha.gov

www.osha.gov
Occupational Safety and Health Act of 1970

“To assure safe and healthful working conditions for 

working men and women; by authorizing enforcement 

of the standards developed under the Act; by assisting 

and encouraging the States in their efforts to assure 

safe and healthful working conditions; by providing for 

research, information, education, and training in the field 

of occupational safety and health...”

This publication provides a general overview of worker rights 

under the Occupational Safety and Health Act (OSH Act). 

This publication does not alter or determine compliance 

responsibilities which are set forth in OSHA standards and the 

OSH Act. Moreover, because interpretations and enforcement 

policy may change over time, for additional guidance on OSHA 

compliance requirements the reader should consult current 

administrative interpretations and decisions by the Occupational 

Safety and Health Review Commission and the courts.

Material contained in this publication is in the public domain 

and may be reproduced, fully or partially, without permission. 

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individuals upon request. Voice phone: (202) 693-1999; 

teletypewriter (TTY) number: 1-877-889-5627. 
Guidelines for Preventing 

Workplace Violence 

for Healthcare and Social 

Service Workers

U.S. Department of Labor

Occupational Safety and Health Administration

OSHA 3148-06R 2016
This guidance document is advisory in nature and informational 

in content. It is not a standard or regulation, and it neither creates 

new legal obligations nor alters existing obligations created by the 

Occupational Safety and Health Administration (OSHA) standards 

or the Occupational Safety and Health Act of 1970 (OSH Act or Act). 

Pursuant to the OSH Act, employers must comply with safety and 

health standards and regulations issued and enforced either by 

OSHA or by an OSHA-approved state plan. In addition, the Act’s 

General Duty Clause, Section 5(a)(1), requires employers to provide 

their workers with a workplace free from recognized hazards that 

are causing or likely to cause death or serious physical harm. In 

addition, Section 11(c)(1) of the Act provides that “No person shall 

discharge or in any manner discriminate against any employee 

because such employee has filed any complaint or instituted or 

caused to be instituted any proceeding under or related to this 

Act or has testified or is about to testify in any such proceeding or 

because of the exercise by such employee on behalf of himself or 

others of any right afforded by this Act.” Reprisal or discrimination 

against an employee for reporting an incident or injury related 

to workplace violence, related to this guidance, to an employer 

or OSHA would constitute a violation of Section 11(c) of the Act. 

In addition, 29 CFR 1904.36 provides that Section 11(c) of the Act 

prohibits discrimination against an employee for reporting a workrelated fatality, injury or illness.
Table of Contents

Overview of the Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Violence in the Workplace: The Impact of Workplace Violence 

on Healthcare and Social Service Workers . . . . . . . . . . . . . . . . 2

Risk Factors: Identifying and Assessing Workplace 

Violence Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Violence Prevention Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1. Management Commitment and Worker Participation. . . . . 6

2. Worksite Analysis and Hazard Identification . . . . . . . . . . . . 8

3. Hazard Prevention and Control. . . . . . . . . . . . . . . . . . . . . . . 12

4. Safety and Health Training. . . . . . . . . . . . . . . . . . . . . . . . . . . 24

5. Recordkeeping and Program Evaluation. . . . . . . . . . . . . . . 27

Workplace Violence Program Checklists . . . . . . . . . . . . . . . . . 30

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Workers’ Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

OSHA Assistance, Services and Programs . . . . . . . . . . . . . . . . 46

NIOSH Health Hazard Evaluation Program . . . . . . . . . . . . . . . 50

OSHA Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

How to Contact OSHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1

Overview of the Guidelines

Healthcare and social service workers face significant risks of 

job-related violence and it is OSHA’s mission to help employers 

address these serious hazards. This publication updates 

OSHA’s 1996 and 2004 voluntary guidelines for preventing 

workplace violence for healthcare and social service workers. 

OSHA’s violence prevention guidelines are based on industry 

best practices and feedback from stakeholders, and provide 

recommendations for developing policies and procedures to 

eliminate or reduce workplace violence in a range of healthcare 

and social service settings. 

These guidelines reflect the variations that exist in different 

settings and incorporate the latest and most effective ways to 

reduce the risk of violence in the workplace. Workplace setting 

determines not only the types of hazards that exist, but also the 

measures that will be available and appropriate to reduce or 

eliminate workplace violence hazards. 

For the purpose of these guidelines, we have identified five 

different settings:

■ Hospital settings represent large institutional medical facilities;

■ Residential Treatment settings include institutional facilities 

such as nursing homes, and other long-term care facilities;

■ Non-residential Treatment/Service settings include small 

neighborhood clinics and mental health centers; 

■ Community Care settings include community-based 

residential facilities and group homes; and

■ Field work settings include home healthcare workers or 

social workers who make home visits. 

Indeed, these guidelines are intended to cover a broad spectrum 

of workers, including those in: psychiatric facilities, hospital 

emergency departments, community mental health clinics, drug 

abuse treatment centers, pharmacies, community-care centers, 

and long-term care facilities. Healthcare and social service 

workers covered by these guidelines include: registered nurses, 

nurses’ aides, therapists, technicians, home healthcare workers, 
Occupational Safety and Health Administration

2

social workers, emergency medical care personnel, physicians, 

pharmacists, physicians’ assistants, nurse practitioners, and 

other support staff who come in contact with clients with known 

histories of violence. Employers should use these guidelines to 

develop appropriate workplace violence prevention programs, 

engaging workers to ensure their perspective is recognized and 

their needs are incorporated into the program. 

Violence in the Workplace: The Impact 

of Workplace Violence on Healthcare 

and Social Service Workers 

Healthcare and social service workers face a significant risk of 

job-related violence. The National Institute for Occupational 

Safety and Health (NIOSH) defines workplace violence as 

“violent acts (including physical assaults and threats of 

assaults) directed toward persons at work or on duty.”1

According to the Bureau of Labor Statistics (BLS), 27 out of 

the 100 fatalities in healthcare and social service settings that 

occurred in 2013 were due to assaults and violent acts.

While media attention tends to focus on reports of workplace 

homicides, the vast majority of workplace violence incidents 

result in non-fatal, yet serious injuries. Statistics based on 

the Bureau of Labor Statistics (BLS) and National Crime 

Victimization Survey (NCVS)2

 data both reveal that workplace 

violence is a threat to those in the healthcare and social service 

settings. BLS data show that the majority of injuries from 

assaults at work that required days away from work occurred 

in the healthcare and social services settings. Between 2011 

and 2013, workplace assaults ranged from 23,540 and 25,630 

annually, with 70 to 74% occurring in healthcare and social 

service settings. For healthcare workers, assaults comprise 

10-11% of workplace injuries involving days away from work, as 

compared to 3% of injuries of all private sector employees. 

1 CDC/NIOSH. Violence. Occupational Hazards in Hospitals. 2002.

2 Cited in the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice 

Statistics report, Workplace Violence, 1993-2009 National Crime Victimization Survey and the 

Census of Fatal Occupational Injuries. March 2011. (www.bjs.gov/content/pub/pdf/wv09.pdf)
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3

In 2013, a large number of the assaults involving days away 

from work occurred at healthcare and social assistance facilities 

(ranging from 13 to 36 per 10,000 workers). By comparison, the 

days away from work due to violence for the private sector as 

a whole in 2013 were only approximately 3 per 10,000 full-time 

workers. The workplace violence rates highlighted in BLS data 

are corroborated by the NCVS, which estimates that between 

1993 and 2009 healthcare workers had a 20% (6.5 per 1,000) 

overall higher rate of workplace violence than all other workers 

(5.1 per 1,000).3

 In addition, workplace violence in the medical 

occupations represented 10.2% of all workplace violence 

incidents. It should also be noted that research has found that 

workplace violence is underreported—suggesting that the 

actual rates may be much higher. 

Risk Factors: Identifying and Assessing 

Workplace Violence Hazards 

Healthcare and social service workers face an increased 

risk of work-related assaults resulting primarily from violent 

behavior of their patients, clients and/or residents. While no 

specific diagnosis or type of patient predicts future violence, 

epidemiological studies consistently demonstrate that inpatient 

and acute psychiatric services, geriatric long term care settings, 

3 The report defined medical occupations as: physicians, nurses, technicians, and other 

medical professionals.
Occupational Safety and Health Administration

4

high volume urban emergency departments and residential and 

day social services present the highest risks. Pain, devastating 

prognoses, unfamiliar surroundings, mind and mood altering 

medications and drugs, and disease progression can also cause 

agitation and violent behaviors. 

While the individual risk factors will vary, depending on the type 

and location of a healthcare or social service setting, as well as 

the type of organization, some of the risk factors include:

Patient, Client and Setting-Related Risk Factors

■ Working directly with people who have a history of violence, 

abuse drugs or alcohol, gang members, and relatives of 

patients or clients;

■ Transporting patients and clients;

■ Working alone in a facility or in patients’ homes;

■ Poor environmental design of the workplace that may 

block employees’ vision or interfere with their escape from 

a violent incident;

■ Poorly lit corridors, rooms, parking lots and other areas;4

■ Lack of means of emergency communication;

■ Prevalence of firearms, knives and other weapons among 

patients and their families and friends; and

■ Working in neighborhoods with high crime rates.

Organizational Risk Factors

■ Lack of facility policies and staff training for recognizing and 

managing escalating hostile and assaultive behaviors from 

patients, clients, visitors, or staff; 

■ Working when understaffed—especially during mealtimes 

and visiting hours;

■ High worker turnover;

■ Inadequate security and mental health personnel on site;

4 CDC/NIOSH. Violence. Occupational Hazards in Hospitals. 2002.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

5

■ Long waits for patients or clients and overcrowded, 

uncomfortable waiting rooms;

■ Unrestricted movement of the public in clinics and 

hospitals; and

■ Perception that violence is tolerated and victims will not be 

able to report the incident to police and/or press charges.

Violence Prevention Programs

A written program for workplace violence prevention, 

incorporated into an organization’s overall safety and health 

program, offers an effective approach to reduce or eliminate 

the risk of violence in the workplace. The building blocks 

for developing an effective workplace violence prevention 

program include:

(1) Management commitment and employee participation,

(2) Worksite analysis,

(3) Hazard prevention and control, 

(4) Safety and health training, and 

(5) Recordkeeping and program evaluation. 

A violence prevention program focuses on developing processes 

and procedures appropriate for the workplace in question. 

Specifically, a workplace’s violence prevention program should 

have clear goals and objectives for preventing workplace 

violence, be suitable for the size and complexity of operations 

and be adaptable to specific situations and specific facilities or 

units. The components are interdependent and require regular 

reassessment and adjustment to respond to changes occurring 

within an organization, such as expanding a facility or changes in 

managers, clients, or procedures. And, as with any occupational 

safety and health program, it should be evaluated and 

reassessed on a regular basis. Those developing a workplace 

violence prevention program should also check for applicable 

state requirements. Several states have passed legislation and 

developed requirements that address workplace violence. 
Occupational Safety and Health Administration

6

1. Management Commitment and 

Worker Participation

Management commitment and worker participation are essential 

elements of an effective violence prevention program. The 

leadership of management in providing full support for the 

development of the workplace’s program, combined with worker 

involvement is critical for the success of the program. Developing 

procedures to ensure that management 

and employees are involved in the 

creation and operation of a workplace 

violence prevention program can be 

achieved through regular meetings—

possibly as a team or committee.5

Effective management leadership 

begins by recognizing that workplace 

violence is a safety and health hazard. 

Management commitment, including the endorsement and 

visible involvement of top management, provides the motivation 

and resources for workers and employers to deal effectively with 

workplace violence. This commitment should include:

■ Acknowledging the value of a safe and healthful, violence-free 

workplace and ensuring and exhibiting equal commitment to 

the safety and health of workers and patients/clients;

■ Allocating appropriate authority and resources to all 

responsible parties. Resource needs often go beyond 

financial needs to include access to information, personnel, 

time, training, tools, or equipment; 

■ Assigning responsibility and authority for the various aspects 

of the workplace violence prevention program to ensure that 

all managers and supervisors understand their obligations;

■ Maintaining a system of accountability for involved 

managers, supervisors and workers;

■ Supporting and implementing appropriate 

recommendations from safety and health committees;

5 If employers take this approach, they should consult and follow the applicable provisions 

of the National Labor Relations Act—29 U.S.C. 151-169. 

Effective management 

leadership begins 

by recognizing that 

workplace violence 

is a safety and health 

hazard.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

7

■ Establishing a comprehensive program of medical and 

psychological counseling and debriefing for workers who have 

experienced or witnessed assaults and other violent incidents 

and ensuring that trauma-informed care is available; and

■ Establishing policies that ensure the reporting, recording, and 

monitoring of incidents and near misses and that no reprisals 

are made against anyone who does so in good faith.

Additionally, management should: (1) articulate a policy and 

establish goals; (2) allocate sufficient resources; and (3) uphold 

program performance expectations.

Through involvement and feedback, workers can provide useful 

information to employers to design, implement and evaluate 

the program. In addition, workers with different functions 

and at various organizational levels bring a broad range of 

experience and skills to program design, implementation, 

and assessment. Mental health specialists have the ability to 

appropriately characterize disease characteristics but may need 

training and input from threat assessment professionals. Direct 

care workers, in emergency departments or mental health, may 

bring very different perspectives to committee work. The range 

of viewpoints and needs should be reflected in committee 

composition. This involvement should include:

■ Participation in the development, implementation, 

evaluation, and modification of the workplace violence 

prevention program;

■ Participation in safety and health committees that receive 

reports of violent incidents or security problems, making 

facility inspections and responding to recommendations for 

corrective strategies;

■ Providing input on additions to or redesigns of facilities;

■ Identifying the daily activities that employees believe put 

them most at risk for workplace violence;

■ Discussions and assessments to improve policies and 

procedures—including complaint and suggestion programs 

designed to improve safety and security;
Occupational Safety and Health Administration

8

■ Ensuring that there is a way to report and record 

incidents and near misses, and that issues are addressed 

appropriately;

■ Ensuring that there are procedures to ensure that employees 

are not retaliated against for voicing concerns or reporting 

injuries; and

■ Employee training and continuing education programs.

2. Worksite Analysis and Hazard Identification 

A worksite analysis involves a mutual step-by-step 

assessment of the workplace to find existing or potential 

hazards that may lead to incidents of workplace violence. 

Cooperation between workers 

and employers in identifying and 

assessing hazards is the foundation 

of a successful violence prevention 

program. The assessment should be 

made by a team that includes senior 

management, supervisors and 

workers. Although management is 

responsible for controlling hazards, 

workers have a critical role to play 

in helping to identify and assess 

workplace hazards, because of their 

knowledge and familiarity with facility operations, process 

activities and potential threats. Depending on the size and 

structure of the organization, the team may also include 

representatives from operations; employee assistance; 

security; occupational safety and health; legal; and human 

resources staff. The assessment should include a records 

review, a review of the procedures and operations for different 

jobs, employee surveys and workplace security analysis. 

Once the worksite analysis is complete, it should be used to 

identify the types of hazard prevention and control measures 

needed to reduce or eliminate the possibility of a workplace 

violence incident occurring. In addition, it should assist in the 

identification or development of appropriate training. The 

assessment team should also determine how often and under 

Cooperation between 

workers and employers 

in identifying and 

assessing hazards is 

the foundation of a 

successful violence 

prevention program.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

9

what circumstances worksite analyses should be conducted. 

For example, the team may determine that a comprehensive 

annual worksite analysis should be conducted, but require that 

an investigative analysis occur after every incident or near miss. 

Additionally, those conducting the worksite analysis should 

periodically inspect the workplace and evaluate worker tasks in 

order to identify hazards, conditions, operations and situations 

that could lead to potential violence. The advice of independent 

reviewers, such as safety and health professionals, law 

enforcement or security specialists, and insurance safety 

auditors may be solicited to strengthen programs. These 

experts often provide a different perspective that serves to 

improve a program. 

Information is generally collected through: (1) records analysis; 

(2) job hazard analysis; (3) employee surveys; and (4) patient/

client surveys. 

Records analysis and tracking

Records review is important to identify patterns of assaults or 

near misses that could be prevented or reduced through the 

implementation of appropriate controls. Records review should 

include medical, safety, specific threat assessments, workers’ 

compensation and insurance records. The review should also 

include the OSHA Log of Work-Related Injuries and Illnesses 

(OSHA Form 300) if the employer is required to maintain one. 

In addition, incident/near-miss logs, a facility’s general event 

or daily log and police reports should be reviewed to identify 

assaults relative to particular:

■ Departments/Units;

■ Work areas;

■ Job titles;

■ Activities—such as transporting patients between units or 

facilities, patient intake; and

■ Time of day.
Occupational Safety and Health Administration

1 0

Possible Findings from Records Review:

Hospital

Residential 

Treatment

Nonresidential 

Treatment/

Service

Community 

Care

Field Workers 

(Home 

Healthcare and 

Social Service)

Departments/

Units

x Emergency 

Department

x Psychiatric 

Unit

x Geriatric Unit

x Dementia Unit

x Adolescent 

Unit

Work areas

x Waiting room

x Nurses’ 

station

x Hallway

x Treatment 

rooms

x Therapy room

x Patient’s 

room

x Dining area

x Van/Car 

transport

x Waiting area

x Therapy room

x Kitchen

x Car

x Kitchen

x Car

x Bedroom

Job titles

x Security 

guard

x Nurse

x Therapist

x Doctor

x Receptionist

x Health aide

x Technician

x Social worker

x Therapist

x Nurse

x Health aide

x Security 

guard

x Driver

x Technician

x Social worker

x Behavioral 

health 

specialist

x Nurse

x Technician

x Social worker

x Therapist

x Health aide

x Social worker

x Health aide

x Child Support 

services

x Emergency 

medical 

personnel

Activities

x Patient intake

x Transferring 

patients from 

one floor to 

another

x Meal time

x Bathing

x Changing of 

staff

x Scanning for 

weapons

x Conducting 

therapy

x Transitioning 

patients from 

one area to 

another

x Driving 

patients

x Feeding 

patient

x Therapy room

x Client intake

x Conducting 

therapy

x Bathing/ 

changing/ 

feeding client

x Administering 

meds

x Driving 

patient

x Bathing/ 

changing/ 

feeding client

x Administering 

meds

x Driving 

patient

x Interacting 

with clients’ 

families

Time of 

day

x After 10 PM

x Meal times

x Late 

afternoon and 

evening

x No pattern x Entry or exit x Entry or exit

x Meal times
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1 1

Job Hazard Analysis

A job hazard analysis is an assessment that focuses on job 

tasks to identify hazards. Through review of procedures and 

operations connected to specific tasks or positions to identify 

if they contribute to hazards related to workplace violence 

and/or can be modified to reduce the likelihood of violence 

occurring, it examines the relationship between the employee, 

the task, tools, and the work environment. Worker participation 

is an essential component of the analysis. As noted in OSHA’s 

publication on job hazard analyses,6

 priority should be given to 

specific types of job. For example, priority should be given to:

■ Jobs with high assault rates due to workplace violence;

■ Jobs that are new to an operation or have undergone 

procedural changes that may increase the potential for 

workplace violence; and

■ Jobs that require written instructions, such as procedures 

for administering medicine, and steps required for 

transferring patients.

After an incident or near miss, the analysis should focus on:

■ Analyzing those positions that were affected;

■ Identifying if existing procedures and operations were 

followed and if not, why not (in some instances, not following 

procedures could result in more effective protections); 

■ Identifying if staff were adequately qualified and/or trained 

for the tasks required; and

■ Developing, if necessary, new procedures and operations to 

improve staff safety and security. 

Employee surveys

Employee questionnaires or surveys are effective ways for 

employers to identify potential hazards that may lead to 

violent incidents, identify the types of problems workers face 

in their daily activities, and assess the effects of changes in 

6 OSHA 3071-2002 (Revised). Job Hazard Analysis.
Occupational Safety and Health Administration

1 2

work processes. Detailed baseline screening surveys can help 

pinpoint tasks that put workers at risk. Periodic surveys—

conducted at least annually or whenever operations change or 

incidents of workplace violence occur—help identify new or 

previously unnoticed risk factors and deficiencies or failures in 

work practices. The periodic review process should also include 

feedback and follow-up. The following are sample questions:

■ What daily activities, if any, expose you to the greatest risk 

of violence? 

■ What, if any, work activities make you feel unprepared to 

respond to a violent action?

■ Can you recommend any changes or additions to the 

workplace violence prevention training you received? 

■ Can you describe how a change in a patient’s daily routine 

affected the precautions you take to address the potential for 

workplace violence?

Client/Patient Surveys

Clients and patients may also have valuable feedback that may 

enable those being served by the facility to provide useful 

information to design, implement, and evaluate the program. 

Clients and patients may be able to participate in identifying 

triggers to violence, daily activities that may lead to violence, 

and effective responses.

3. Hazard Prevention and Control

After the systematic worksite analysis is complete, the 

employer should take the appropriate steps to prevent or 

control the hazards that were identified. To do this, the 

employer should: (1) identify and evaluate control options for 

workplace hazards; (2) select effective and feasible controls 

to eliminate or reduce hazards; (3) implement these controls 

in the workplace; (4) follow up to confirm that these controls 

are being used and maintained properly; and (5) evaluate the 

effectiveness of controls and improve, expand, or update them 

as needed.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1 3

In the field of industrial hygiene, these steps are generally 

categorized, in order of effectiveness, as (1) substitution; (2) 

engineering controls; and (3) administrative and work practice 

controls. These principles, which are described in more detail 

below, can also be applied to the field of workplace violence. 

In addition, employers should ensure that, if an incident of 

workplace violence occurs, post-incident procedures and 

services are in place and/or immediately made available.

Substitution

The best way to eliminate a hazard is to eliminate it or substitute 

a safer work practice. While these substitutions may be difficult 

in the therapeutic healthcare environment, an example may 

be transferring a client or patient to a more appropriate facility 

if the client has a history of violent behavior that may not be 

appropriate in a less secure therapeutic environment. 

Engineering controls and workplace adaptations to 

minimize risk

Engineering controls are physical changes that either remove 

the hazard from the workplace or create a barrier between 

the worker and the hazard. In facilities where it is appropriate, 

there are several engineering control measures that can 

effectively prevent or control workplace hazards. Engineering 

control strategies include: (a) using physical barriers (such 

as enclosures or guards) or door locks to reduce employee 

exposure to the hazard; (b) metal detectors; (c) panic buttons, 

(d) better or additional lighting; and (e) more accessible exits 

(where appropriate). The measures taken should be sitespecific and based on the hazards identified in the worksite 

analysis appropriate to the specific therapeutic setting. For 

example, closed circuit videos and bulletproof glass may be 

appropriate in a hospital or other institutional setting, but 

not in a community care facility. Similarly, it should be noted 

that services performed in the field (e.g., home health or 

social services) often occur in private residences where some 

engineering controls may not be possible or appropriate. 
Occupational Safety and Health Administration

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If new construction or modifications are planned for a facility, 

assess any plans to eliminate or reduce security hazards. 

The following are possible engineering controls that could apply 

in different settings. Note that this is a list of suggested measures 

whose appropriateness will depend on a number of factors.

Possible engineering controls for different healthcare and social 

service settings

Hospital

Residential 

Treatment

Non-residential 

Treatment/

Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Security/

silenced 

alarm systems

x Panic buttons or paging system at workstations or 

personal alarm devices worn by employees

x Paging system

x GPS tracking7

x Cell phones

x Security/silenced alarm systems should be regularly maintained and managers and staff 

should fully understand the range and limitations of the system.

Exit routes x Where possible, rooms should 

have two exits

x Provide employee ‘safe room’ 

for emergencies

x Arrange furniture so workers 

have a clear exit route

x Where possible, 

counseling 

rooms should 

have two exits

x Arrange 

furniture so 

workers have a 

clear exit route

x Managers and workers should 

assess homes for exit routes

x Workers should be familiar with a site and identify the different exit routes available.

Metal 

detectors – 

hand-held or 

installed

x Employers and workers will have to determine the appropriate balance of creating the 

suitable atmosphere for services being provided and the types of barriers put in place.

x Metal detectors should be regularly maintained and assessed for effectiveness in 

reducing the weapons brought into a facility.

x Staff should be appropriately assigned, and trained to use the equipment and remove 

weapons.

Monitoring 

systems 

& natural 

surveillance

x Closed-circuit video – inside 

and outside

x Curved mirrors

x Proper placement of nurses’ 

stations to allow visual 

scanning of areas

x Glass panels in doors/walls for 

better monitoring

x Closed-circuit 

video – inside 

and outside

x Curved mirrors

x Glass panels in 

doors for better 

monitoring

x Employers and workers will have to determine the appropriate balance of creating the 

suitable atmosphere for services being provided and the types of barriers put in place.

x Staff should know if video monitoring is in use or not and whether someone is always 

monitoring the video or not.

7 Employers and workers should determine the most effective method for ensuring the 

safety of workers without negatively impacting working conditions.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1 5

Hospital

Residential 

Treatment

Non-residential 

Treatment/

Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Barrier 

protection

x Enclosed 

receptionist 

desk with 

bulletproof 

glass

x Deep 

counters 

at nurses’ 

stations

x Lock doors 

to staff 

counseling 

and treatment 

rooms

x Provide 

lockable (or 

keyless door 

systems) 

and secure 

bathrooms 

for staff 

members 

(with locks on 

the inside)—

separated 

from patient/

client and 

visitor 

facilities

x Lock all 

unused 

doors to limit 

access, in 

accord with 

local fire 

codes

x Deep 

counters in 

offices

x Provide 

lockable (or 

keyless door 

systems) 

and secure 

bathrooms 

for staff 

members 

(with locks on 

the inside)—

separated 

from patient/

client and 

visitor 

facilities

x Lock all 

unused 

doors to limit 

access, in 

accord with 

local fire 

codes

x Deep counters

x Provide lockable 

(or keyless 

door systems) 

and secure 

bathrooms for 

staff members 

(with locks on 

the inside)—

separated from 

patient/client 

and visitor 

facilities

x Employers and workers will have to determine the appropriate balance of creating the 

suitable atmosphere for the services being provided and the types of barriers put in place.
Occupational Safety and Health Administration

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Hospital

Residential 

Treatment

Non-residential 

Treatment/

Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Patient/client 

areas

x Establish 

areas for 

patients/ 

clients to 

de-escalate

x Provide 

comfortable 

waiting areas 

to reduce 

stress

x Divide 

waiting areas 

to limit the 

spreading 

of agitation 

among 

clients/

visitors

x Establish 

areas for 

patients/ 

clients to 

de-escalate

x Provide 

comfortable 

waiting areas 

to reduce 

stress

x Assess staff 

rotations 

in facilities 

where clients 

become 

agitated by 

unfamiliar 

staff

x Provide 

comfortable 

waiting areas to 

reduce stress

x Establish 

areas for 

patients/ 

clients to 

de-escalate

x Establish areas 

for patients/ 

clients to 

de-escalate

x Employers and workers will have to determine the appropriate balance of creating the 

suitable atmosphere for the services being provided and the types of barriers put in place.

Furniture, 

materials & 

maintenance

x Secure furniture and other items that could be used 

as weapons

x Replace open hinges on doors with continuous 

hinges to reduce pinching hazards

x Ensure cabinets and syringe drawers have working 

locks

x Pad or replace sharp edged objects (such as metal 

table frames)

x Consider changing or adding materials to reduce 

noise in certain areas

x Recess any hand rails, drinking fountains and any 

other protrusions

x Smooth down or cover any sharp surfaces

x When feasible, 

secure 

furniture or 

other items 

that could 

be used as 

weapons

x Ensure 

cabinets 

and syringe 

drawers have 

working locks

x Pad or replace 

sharp edged 

objects (such 

as metal table 

frames)

x Ensure 

carrying 

equipment 

for medical 

equipment, 

medicines and 

valuables have 

working locks

x Ensure carrying 

equipment 

for medical 

equipment, 

medicines and 

valuables have 

working locks

x Employers and workers will have to establish a balance between creating the appropriate 

atmosphere for the services being provided and securing furniture.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1 7

Hospital

Residential 

Treatment

Non-residential 

Treatment/

Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Lighting x Install bright, effective lighting—both indoors 

and outdoors on the grounds, in parking areas 

and walkways

x Ensure 

lighting is 

adequate 

in both the 

indoor and 

outdoor areas

x Work with 

client to ensure 

lighting is 

adequate in both 

the indoor and 

outdoor areas

x Ensure burned out lights are replaced immediately.

x While lighting should be effective it should not be harsh or cause undue glare.

Travel 

vehicles

x Ensure vehicles are properly 

maintained

x Where appropriate, consider 

physical barrier between driver 

and patients

x Ensure vehicles are properly 

maintained

Administrative and work practice controls 

Administrative and work practice controls are appropriate 

when engineering controls are not feasible or not completely 

protective. These controls affect the way staff perform jobs or 

tasks. Changes in work practices and administrative procedures 

can help prevent violent incidents. As with engineering 

controls, the practices chosen to abate workplace violence 

should be appropriate to the type of site and in response to 

hazards identified. 

In addition to the specific measures listed below, training for 

administrative and treatment staff should include therapeutic 

procedures that are sensitive to the cause and stimulus of 

violence. For example, research has shown that Trauma Informed 

Care is a treatment technique that has been successfully 

instituted in inpatient psychiatric units as a way to reduce 

patient violence, and the need for seclusion and restraint. As 

explained by the Substance Abuse and Mental Health Services 

Administration, trauma-informed services are based on an 

understanding of the vulnerabilities or triggers of trauma for 

survivors and can be more supportive than traditional service 

delivery approaches, thus avoiding re-traumatization.8

8 Referenced on the Substance Abuse and Mental Health Services Administration’s website 

on February 25, 2013 (www.samhsa.gov/nctic).
Occupational Safety and Health Administration

1 8

The following are possible administrative controls that could 

apply in different settings.

Possible administrative and work practice controls for different 

healthcare and social service settings

Hospital Residential 

Treatment

Non-residential 

Treatment/Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Workplace 

violence 

response 

policy

x Clearly state to patients, clients, visitors and workers that violence is not permitted and 

will not be tolerated.

x Such a policy makes it clear to workers that assaults are not considered part of the job or 

acceptable behavior.

Tracking 

workers9

Traveling 

workers 

should:

x have specific 

log-in and 

log-out 

procedures

x be required 

to contact 

the office 

after each 

visit and 

managers 

should have 

procedures 

to follow-up 

if workers 

fail to do so

Workers should: 

x have specific log-in and log-out 

procedures

x be required to contact the office 

after each visit and managers 

should have procedures to followup if workers fail to do so

x be given discretion as to whether 

or not they begin or continue a 

visit if they feel threatened or 

unsafe

x Log-in/log-out procedures should include:

x the name and address of client visited;

x the scheduled time and duration of visit;

x a contact number;

x a code word used to inform someone of an incident/threat;

x worker’s vehicle description and license plate number;

x details of any travel plans with client;

x contacting office/supervisor with any changes.

Tracking 

clients with a 

known history 

of violence

x Supervise the movement of 

patients throughout the facility

x Update staff in shift report 

about violent history or incident

x Update staff in 

shift report about 

violent history or 

incident

x Report all violent incidents to 

employer

9 Massachusetts Department of Mental Health Task Force on Staff and Client Safety. (2011). Report 

of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. 
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

1 9

Hospital Residential 

Treatment

Non-residential 

Treatment/Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

x Determine the behavioral history of new and transferred patients and clients to learn 

about any past violent or assaultive behaviors.

x Identify any event triggers for clients, such as certain dates or visitors.

x Identify the type of violence including severity, pattern and intended purpose.

x Information gained should be used to formulate individualized plans for early 

identification and prevention of future violence.

x Establish a system—such as chart tags, log books or verbal census reports—to identify 

patients and clients with a history of violence and identify triggers and the best responses 

and means of de-escalation.

x Ensure workers know and follow procedures for updates to patients’ and clients’ behavior. 

x Ensure patient and client confidentiality is maintained. 

x Update as needed.

x If stalking is suspected, consider varying check-in and check-out times for affected 

workers and plan different travel routes for those workers.

Working 

alone or in 

secure areas

x Treat and interview 

aggressive or agitated clients 

in relatively open areas that 

still maintain privacy and 

confidentiality

x Ensure workers are not alone 

when performing intimate 

physical examinations of 

patients

x Advise staff to exercise 

extra care in elevators and 

stairwells

x Provide staff members with 

security escorts to parking 

areas during evening/ late 

hours— Ensure these areas 

are well lit and highly visible

x Advise staff to 

exercise extra 

care in elevators, 

stairwells

x Provide staff 

members with 

security escorts 

to parking areas 

during evening/ 

late hours. 

Ensure these 

areas are well lit 

and highly visible

x Ensure 

workers have 

means of 

communication—either 

cell phones of 

panic buttons

x Develop 

policy to 

determine 

when a 

buddy system 

should be 

implemented

x Advise staff to 

exercise extra 

care in unfamiliar 

residences

x Workers 

should be given 

discretion to 

receive backup 

assistance by 

another worker or 

law enforcement 

officer

x Workers should 

be given discretion as to whether 

or not they begin 

or continue a 

visit if they feel 

threatened or 

unsafe

x Ensure workers 

have means of 

communication—either cell 

phones or panic 

buttons

x Limit workers from working alone in emergency areas or walk-in clinics, particularly at 

night or when assistance is unavailable. 

x Establish policies and procedures for secured areas and emergency evacuations.

x Use the “buddy system,” especially when personal safety may be threatened.

Reporting x Require workers to report all assaults or threats to a supervisor or manager (for example, 

through a confidential interview). Keep logbooks and reports of such incidents to help 

determine any necessary actions to prevent recurrences.

x Establish a liaison with local police, service providers who can assist (e.g., counselors) 

and state prosecutors. When needed, give police physical layouts of facilities to expedite 

investigations.
Occupational Safety and Health Administration

2 0

Hospital Residential 

Treatment

Non-residential 

Treatment/Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Entry 

procedures

x Provide 

responsive, 

timely 

information 

to those 

waiting; 

adopt 

measures 

to reduce 

waiting times

x Institute 

sign-in 

procedures 

and visitor 

passes

x Enforce 

visitor 

hours and 

procedures 

for being in 

the hospital

x Have a 

“restricted 

visitors” list 

for patients 

with a history 

of violence/ 

gang activity; 

make copies 

available 

to security, 

nurses, and 

sign-in clerk

x Institute 

sign-in 

procedures 

with passes 

for visitors

x Enforce 

visitor 

hours and 

procedures

x Establish 

a list of 

“restricted 

visitors” for 

patients with 

a history of 

violence or 

gang activity; 

make copies 

available 

at security 

checkpoints, 

nurses’ 

stations and 

visitor sign-in 

areas

x Provide 

responsive, timely 

information to 

those waiting; 

adopt measures 

to reduce waiting 

times

x Ensure 

workers 

determine 

how best to 

enter facilities

x Ensure workers 

determine how 

best to enter 

clients’ homes

Incident 

response/ 

high risk 

activities

x Use properly trained security 

officers and counselors 

to respond to aggressive 

behavior; follow written 

security procedures

x Ensure that adequate and 

qualified staff members 

are available at all times, 

especially during highrisk times such as patient 

transfers, emergency 

responses, mealtimes and 

at night

x Ensure that adequate and 

qualified staff members are 

available to disarm and deescalate patients if necessary

x Assess changing client 

routines and activities to 

reduce or eliminate the 

possibility of violent outbursts

x Use properly 

trained security 

officers and 

counselors 

to respond to 

aggressive 

behavior; follow 

written security 

procedures

x Ensure 

assistance if 

children will be 

removed from 

the home
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

2 1

Hospital Residential 

Treatment

Non-residential 

Treatment/Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

x Advise workers of company procedures for requesting police assistance or filing charges 

when assaulted—and assist them in doing so if necessary.

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

x Ensure that adequately trained staff members and counselors are available to de-escalate 

a situation and counsel patients.

x Prepare contingency plans to treat clients who are “acting out” or making verbal or 

physical attacks or threats.

x Emergency action plans should be developed to ensure that workers know how to call for 

help or medical assistance.

Employee 

uniforms/

dress

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

employment.

x Discourage workers from wearing necklaces or chains to help prevent possible 

strangulation in confrontational situations.

x Discourage workers from wearing expensive jewelry or carrying large sums of money.

x Discourage workers from carrying keys or other items that could be used as weapons.

x Encourage the use of head netting/cap so hair cannot be grabbed and used to pull or shove 

workers.

Facility 

& work 

procedures 

x Survey facility periodically to 

remove tools or possessions 

left by visitors or staff that 

could be used inappropriately 

by patients

x Survey facilities regularly to 

ensure doors that should be 

locked are locked—smoking 

policies should not allow these 

doors to be propped open

x Keep desks and work areas 

free of items, including extra 

pens and pencils, glass photo 

frames, etc.

x Survey facility 

periodically to 

remove tools 

or possessions 

left by visitors 

or staff that 

could be used 

inappropriately 

by patients

x Keep desks 

and work areas 

free of items, 

including extra 

pens and pencils, 

glass photo 

frames, etc.

x Survey 

facility 

periodically 

to remove 

tools or 

possessions 

left by visitors 

or staff that 

could be used 

inappropriately by 

patients

x Establish 

daily work 

plans to keep 

a designated 

contact 

person 

informed 

about 

employees’ 

whereabouts 

throughout 

the workday; 

have a 

contact 

person 

follow up if 

an employee 

does not 

report in as 

expected

x Have clear 

contracts on 

how home 

visits will be 

conducted, the 

presence of 

others in the 

home during 

visits and 

the refusal to 

provide services 

in clearly 

hazardous 

situations

x Establish 

daily work 

plans to keep 

a designated 

contact person 

informed about 

employees’ 

whereabouts 

throughout the 

workday; have a 

contact person 

follow up if an 

employee does 

not report in as 

expected
Occupational Safety and Health Administration

2 2

Hospital Residential 

Treatment

Non-residential 

Treatment/Service

Community 

Care

Field Workers 

(Home Healthcare, 

Social Service)

Transportation 

procedures

x Develop safety procedures 

that specifically address the 

transport of patients.

x Ensure that workers 

transporting patients have an 

effective and reliable means 

of communicating with their 

home office

x Develop safety procedures that 

specifically address the transport 

of patients.

x Ensure that workers transporting 

patients have an effective and 

reliable means of communicating 

with their home office

Post-incident procedures and services

Post-incident response and evaluation are important 

components to an effective violence prevention program. 

Investigating incidents of workplace violence thoroughly will 

provide a roadmap to avoiding fatalities and injuries associated 

with future incidents. The purpose of the investigation should 

be to identify the “root cause” of the incident. Root causes, if 

not corrected, will inevitably recreate the conditions for another 

incident to occur. 

When an incident occurs, the immediate first steps are to 

provide first aid and emergency care for the injured worker(s) 

and to take any measures necessary to prevent others from 

being injured. All workplace violence programs should provide 

comprehensive treatment for workers who are victimized 

personally or may be traumatized by witnessing a workplace 

violence incident. Injured staff should receive prompt treatment 

and psychological evaluation whenever an assault takes place, 

regardless of its severity—free of charge. Also, injured workers 

should be provided transportation to medical care if not 

available on site.

Victims of workplace violence could suffer a variety of 

consequences in addition to their actual physical injuries. These 

may include: 

■ Short- and long-term psychological trauma; 

■ Fear of returning to work; 

■ Changes in relationships with coworkers and family; 

■ Feelings of incompetence, guilt, powerlessness; and 

■ Fear of criticism by supervisors or managers. 
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

2 3

Consequently, a strong follow-up program for these workers will 

not only help them address these problems but also help prepare 

them to confront or prevent future incidents of violence.

Several types of assistance can be incorporated into the postincident response. For example, trauma-crisis counseling, 

critical-incident stress debriefing or employee assistance 

programs may be provided to assist victims. As explained by the 

Substance Abuse and Mental Health Services Administration, 

trauma-informed services are based on an understanding of 

the vulnerabilities or triggers of trauma for survivors and can be 

more supportive than traditional service delivery approaches, 

thus avoiding re-traumatization.10 Whether the support is traumainformed or not, certified employee assistance professionals, 

psychologists, psychiatrists, clinical nurse specialists or social 

workers should provide this counseling. Alternatively, the 

employer may refer staff victims to an outside specialist. In 

addition, the employer may establish an employee counseling 

service, peer counseling, or support groups.

Counselors should be well trained and have a good 

understanding of the issues and consequences of assaults and 

other aggressive, violent behavior. Appropriate and promptly 

rendered post-incident debriefings and counseling reduce acute 

psychological trauma and general stress levels among victims 

and witnesses. In addition, this type of counseling educates 

staff about workplace violence and positively influences 

workplace and organizational cultural norms to reduce trauma 

associated with future incidents.

Investigation of Incidents 

Once these immediate needs are taken care of, the investigation 

should begin promptly. The basic steps in conducting incident 

investigations are:

1. Report as required. Determine who needs to be notified, 

both within the organization and outside (e.g., authorities), 

when there is an incident. Understand what types of 

10 Referenced on the Substance Abuse and Mental Health Services Administration’s website 

on February 25, 2013 (www.samhsa.gov/nctic).
Occupational Safety and Health Administration

2 4

incidents must be reported, and what information needs 

to be included. If the incident involves hazardous materials 

additional reporting requirements may apply.

2. Involve workers in the incident investigation. The employees 

who work most closely in the area where the event occurred 

may have special insight into the causes and solutions.

3. Identify Root Causes: Identify the root causes of the 

incident. Don’t stop an investigation at “worker error” or 

“unpredictable event.” Ask “why” the patient or client acted, 

“why” the worker responded in a certain way, etc. 

4. Collect and review other information. 

Depending on the nature of the 

incident, records related to training, 

maintenance, inspections, audits, 

and past incident reports may be 

relevant to review. 

5. Investigate Near Misses. In addition 

to investigating all incidents 

resulting in a fatality, injury or 

illness, any near miss (a situation 

that could potentially have resulted 

in death, injury, or illness) should 

be promptly investigated as well. Near misses are caused by 

the same conditions that produce more serious outcomes, 

and signal that some hazards are not being adequately 

controlled, or that previously unidentified hazards exist.

4. Safety and Health Training

Education and training are key elements of a workplace violence 

protection program, and help ensure that all staff members are 

aware of potential hazards and how to protect themselves and 

their coworkers through established policies and procedures. Such 

training can be part of a broader type of instruction that includes 

protecting patients and clients (such as training on de-escalation 

techniques). However, employers should ensure that worker safety 

is a separate component that is thoroughly addressed. 

Identify the root causes 

of the incident. Don’t 

stop an investigation 

at “worker error” or 

“unpredictable event.” 

Ask “why” the patient 

or client acted, “why” 

the worker responded 

in a certain way, etc.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

2 5

Training for all workers

Training can: (1) help raise the overall safety and health 

knowledge across the workforce, (2) provide employees with 

the tools needed to identify workplace safety and security 

hazards, and (3) address potential problems before they arise 

and ultimately reduce the likelihood of workers being assaulted. 

The training program should involve all workers, including 

contract workers, supervisors, and managers. Workers who 

may face safety and security hazards should receive formal 

instruction on any specific or potential hazards associated 

with the unit or job and the facility. Such training may include 

information on the types of injuries or problems identified in 

the facility and the methods to control the specific hazards. It 

may also include instructions to limit physical interventions in 

workplace altercations whenever possible. 

Every worker should understand the concept of “universal 

precautions for violence”— that is, that violence should be 

expected but can be avoided or mitigated through preparation. 

In addition, workers should understand the importance of a 

culture of respect, dignity, and active mutual engagement in 

preventing workplace violence.

New and reassigned workers should receive an initial 

orientation before being assigned their job duties. All workers 

should receive required training annually. In high-risk settings 

and institutions, refresher training may be needed more 

frequently, perhaps monthly or quarterly, to effectively reach 

and inform all workers. Visiting staff, such as physicians, 

should receive the same training as permanent staff and 

contract workers. Qualified trainers should instruct at the 

comprehension level appropriate for the staff. Effective training 

programs should involve role-playing, simulations and drills.

Training topics

Training topics may include management of assaultive 

behavior, professional/police assault-response training, or 

personal safety training on how to prevent and avoid assaults. 
Occupational Safety and Health Administration

2 6

A combination of training programs may be used, depending 

on the severity of the risk.

In general, training should cover the policies and procedures for a 

facility as well as de-escalation and self-defense techniques. Both 

de-escalation and self-defense training should include a handson component. The following provides a list of possible topics:

■ The workplace violence prevention policy; 

■ Risk factors that cause or contribute to assaults; 

■ Policies and procedures for documenting patients’ or clients’ 

change in behavior; 

■ The location, operation, and coverage of safety devices such 

as alarm systems, along with the required maintenance 

schedules and procedures; 

■ Early recognition of escalating behavior or recognition of 

warning signs or situations that may lead to assaults; 

■ Ways to recognize, prevent or diffuse volatile situations or 

aggressive behavior, manage anger and appropriately use 

medications; 

■ Ways to deal with hostile people other than patients and 

clients, such as relatives and visitors; 

■ Proper use of safe rooms—areas where staff can find shelter 

from a violent incident;

■ A standard response action plan for violent situations, 

including the availability of assistance, response to alarm 

systems and communication procedures; 

■ Self-defense procedures where appropriate;

■ Progressive behavior control methods and when and how to 

apply restraints properly and safety when necessary; 

■ Ways to protect oneself and coworkers, including use of the 

“buddy system“;

■ Policies and procedures for reporting and recordkeeping;

■ Policies and procedures for obtaining medical care, traumainformed care, counseling, workers‘ compensation or legal 

assistance after a violent episode or injury. 
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

2 7

Training for supervisors and managers

Supervisors and managers must be trained to recognize highrisk situations, so they can ensure that workers are not placed 

in assignments that compromise their safety. Such training 

should include encouraging workers 

to report incidents and to seek the 

appropriate care after experiencing 

a violent incident.

Supervisors and managers should 

learn how to reduce safety hazards 

and ensure that workers receive 

appropriate training. Following 

training, supervisors and managers 

should be able to recognize a 

potentially hazardous situation 

and make any necessary changes in 

the physical plant, patient care treatment program and staffing 

policy, and procedures to reduce or eliminate the hazards.

Training for security personnel

Security personnel need specific training from the hospital 

or clinic, including the psychological components of handling 

aggressive and abusive clients, and ways to handle aggression 

and defuse hostile situations.

Evaluation of training

The training program should also include an evaluation. At 

least annually, the team or coordinator responsible for the 

program should review its content, methods and the frequency 

of training. Program evaluation may involve supervisor and 

employee interviews, testing, observing and reviewing reports 

of behavior of individuals in threatening situations.

5. Recordkeeping and Program Evaluation

Recordkeeping and evaluation of the violence prevention 

program are necessary to determine its overall effectiveness 

and identify any deficiencies or changes that should be made. 

Supervisors and 

managers must be 

trained to recognize 

high-risk situations, so 

they can ensure that 

workers are not placed 

in assignments that 

compromise their safety.
Occupational Safety and Health Administration

2 8

Accurate records of injuries, illnesses, incidents, assaults, 

hazards, corrective actions, patient histories and training can 

help employers determine the severity of the problem; identify 

any developing trends or patterns in particular locations, jobs or 

departments; evaluate methods of hazard control; identify training 

needs and develop solutions for an effective program. Records 

can be especially useful to large organizations and for members 

of a trade association that “pool” data. Key records include: 

■ OSHA Log of Work-Related Injuries and Illnesses (OSHA 

Form 300). Covered employers are required to prepare 

and maintain records of serious occupational injuries and 

illnesses, using the OSHA 300 Log. As of January 2015, all 

employers must report: (1) all work-related fatalities within 

8 hours and (2) all work-related inpatient hospitalizations, all 

amputations and all losses of an eye within 24 hours. Injuries 

caused by assaults must be entered on the log if they meet 

the recording criteria.11

■ Medical reports of work injury, workers’ compensation reports 

and supervisors’ reports for each recorded assault. These 

records should describe the type of assault, such as an 

unprovoked sudden attack or patient-to-patient altercation, 

who was assaulted, and all other circumstances of the incident. 

The records should include a description of the environment or 

location, lost work time that resulted and the nature of injuries 

sustained. These medical records are confidential documents 

and should be kept in a locked location under the direct 

responsibility of a healthcare professional. 

■ Records of incidents of abuse, reports conducted by security 

personnel, verbal attacks or aggressive behavior that may 

be threatening, such as pushing or shouting and acts of 

aggression toward other clients. This may be kept as part 

of an assaultive incident report. Ensure that the affected 

department evaluates these records routinely. 

■ Information on patients with a history of past violence, drug 

abuse or criminal activity recorded on the patient’s chart. 

Anyone who cares for a potentially aggressive, abusive or 

11 29 CFR Part 1904, revised 2014.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

2 9

violent client should be aware of the person’s background and 

history, including triggers and de-escalation responses. Log the 

admission of violent patients to help determine potential risks. 

Log violent events on patients’ charts and flagged charts.12

■ Documentation of minutes of safety meetings, records 

of hazard analyses and corrective actions recommended 

and taken. 

■ Records of all training programs, attendees, and 

qualifications of trainers. 

Elements of a program evaluation

As part of their overall program, employers should evaluate their 

safety and security measures. Top management should review 

the program regularly and, with each incident, to evaluate its 

success. Responsible parties (including managers, supervisors 

and employees) should reevaluate policies and procedures on a 

regular basis to identify deficiencies and take corrective action.

Management should share workplace violence prevention 

evaluation reports with all workers. Any changes in the 

program should be discussed at regular meetings of the safety 

committee, union representatives or other employee groups.

All reports should protect worker and patient confidentiality 

either by presenting only aggregate data or by removing 

personal identifiers if individual data are used.

Processes involved in an evaluation include: 

■ Establishing a uniform violence reporting system and 

regular review of reports; 

■ Reviewing reports and minutes from staff meetings on 

safety and security issues; 

■ Analyzing trends and rates in illnesses, injuries or fatalities 

caused by violence relative to initial or “baseline” rates; 

■ Measuring improvement based on lowering the frequency 

and severity of workplace violence; 

12 Proper patient confidentiality must be maintained.
Occupational Safety and Health Administration

3 0

■ Keeping up-to-date records of administrative and work 

practice changes to prevent workplace violence to evaluate 

how well they work; 

■ Surveying workers before and after making job or worksite 

changes or installing security measures or new systems to 

determine their effectiveness; 

■ Tracking recommendations through to completion;

■ Keeping abreast of new strategies available to prevent and 

respond to violence in the healthcare and social service 

fields as they develop; 

■ Surveying workers periodically to learn if they experience 

hostile situations in performing their jobs; 

■ Complying with OSHA and state requirements for recording 

and reporting injuries, illnesses, and fatalities; and 

■ Requesting periodic law enforcement or outside consultant 

review of the worksite for recommendations on improving 

worker safety. 

Workplace Violence Program Checklists

These checklists can help you or your workplace violence/crime 

prevention committee evaluate the workplace and job tasks to 

identify situations that may place workers at risk of assault. It 

is not designed for a specific industry or occupation, and may 

be used for any workplace. Adapt the checklist to fit your own 

needs. It is very comprehensive and not every question will 

apply to your workplace—if the question does not apply, either 

delete or write “N/A” in the NOTES column. Add any other 

questions that may be relevant to your worksite.

1. RISK FACTORS FOR WORKPLACE VIOLENCE

Cal/OSHA and NIOSH have identified the following risk factors 

that may contribute to violence in the workplace. If you have 

one or more of these risk factors in your workplace, there may 

be a potential for violence. 
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3 1

YES NO Notes/Follow-up Action

Do employees have contact with the public?

Do they exchange money with the public?

Do they work alone?

Do they work late at night or during early 

morning hours? 

Is the workplace often understaffed?

Is the workplace located in an area with a high 

crime rate?

Do employees enter areas with a high crime rate?

Do they have a mobile workplace (patrol 

vehicle, work van, etc.)?

Do they deliver passengers or goods?

Do employees perform jobs that might put them 

in conflict with others?

Do they ever perform duties that could upset 

people (deny benefits, confiscate property, 

terminate child custody, etc.)?

Do they deal with people known or suspected of 

having a history of violence?

Do any employees or supervisors have a history 

of assault, verbal abuse, harassment, or other 

threatening behavior? 

Other risk factors – please describe:

2. INSPECTING WORK AREAS

■ Who is responsible for building security?

■ Are workers told or can they identify who is responsible for 

security? Yes No

You or your workplace violence/crime prevention committee 

should now begin a “walkaround” inspection to identify 

potential security hazards. This inspection can tell you which 

hazards are already well controlled, and what control measures 

need to be added. Not all of the following questions may be 

answered through simple observation. You may also need to 

talk to workers or investigate in other ways. 
Occupational Safety and Health Administration

3 2

All 

Areas

Some 

Areas

Few 

Areas

No 

Areas

NOTES/FOLLOW-UP 

ACTION

Are nametags or ID cards 

required for employees (omitting 

personal information such as last 

name and home address)?

Are workers notified of past 

violent acts in the workplace?

Are trained security and 

counseling personnel 

accessible to workers in a 

timely manner?

Do security and counseling 

personnel have sufficient 

authority to take all necessary 

action to ensure worker safety?

Is there an established liaison 

with state police and/or local 

police and counseling agencies?

Are bullet-resistant windows or 

similar barriers used when money 

is exchanged with the public?

Are areas where money 

is exchanged visible to 

others who could help in an 

emergency? (For example, can 

you see cash register areas 

from outside?)

Is a limited amount of cash 

kept on hand, with appropriate 

signs posted?

Could someone hear a worker 

who calls for help?

Can employees observe patients 

or clients in waiting areas?

Do areas used for patient 

or client interviews allow 

co-workers to observe any 

problems?

Are waiting areas and work 

areas free of objects that could 

be used as weapons?

Are chairs and furniture secured 

to prevent their use as weapons?

Is furniture in waiting areas and 

work areas arranged to prevent 

entrapment of workers?

Are patient or client waiting 

areas designed to maximize 

comfort and minimize stress?
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3 3

All 

Areas

Some 

Areas

Few 

Areas

No 

Areas

NOTES/FOLLOW-UP 

ACTION

Are patients or clients in 

waiting areas clearly informed 

how to use the department’s 

services so they will not 

become frustrated?

Are waiting times for patient 

or client services kept short to 

prevent frustration?

Are private, locked restrooms 

available for employees?

Is there a secure place for 

workers to store personal 

belongings?

3. INSPECTING EXTERIOR BUILDING AREAS

Yes No NOTES/FOLLOW-UP ACTION

Do workers feel safe walking to and from 

the workplace?

Are the entrances to the building clearly visible 

from the street?

Is the area surrounding the building free of 

bushes or other hiding places?

Is lighting bright and effective in outside areas?

Are security personnel provided outside 

the building?

Is video surveillance provided outside 

the building?

Are remote areas secured during off shifts?

Is a buddy escort system required to remote 

areas during off shifts?

Are all exterior walkways visible to 

security personnel?
Occupational Safety and Health Administration

3 4

4. INSPECTING PARKING AREAS

Yes No NOTES/FOLLOW-UP ACTION

Is there a nearby parking lot reserved for 

employees only?

Is the parking lot attended or 

otherwise secured?

Is the parking lot free of blind spots and is 

landscaping trimmed back to prevent hiding places?

Is there enough lighting to see clearly in the 

parking lot and when walking to the building?

Are security escorts available to employees 

walking to and from the parking lot?

5. SECURITY MEASURES 

Does the workplace have: 

In 

Place

Should 

Add

Doesn’t 

Apply NOTES/FOLLOW-UP ACTION

Physical barriers (plexiglass 

partitions, bullet-resistant customer 

window, etc.)?

Security cameras or closed-circuit 

TV in high-risk areas?

Panic buttons?

Alarm systems?

Metal detectors?

Security screening device?

Door locks?

Internal telephone system to contact 

emergency assistance?

Telephones with an outside line 

programmed for 911?

Two-way radios, pagers, or cellular 

telephones?

Security mirrors (e.g., convex mirrors)?

Secured entry (e.g., “buzzers”)?

Personal alarm devices?

“Drop safes” to limit the amount of 

cash on hand?

Broken windows repaired promptly?

Security systems, locks, etc. tested 

on a regular basis and repaired 

promptly when necessary?
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3 5

6. COMMENTS

Checklist completed by: Date: 

Department/Location: 

Phone Number: 

Workplace Violence Prevention Program Assessment Checklist

Use this checklist as part of a regular safety and health 

inspection or audit to be conducted by the Health and Safety, 

Crime/Workplace Violence Prevention Coordinator, or joint 

labor/management committee. If a question does not apply to 

the workplace, then write “N/A” (not applicable) in the notes 

column. Add any other questions that may be appropriate. 

Yes No NOTES

STAFFING

Is there someone responsible for building security?

Who is it?

Are workers told who is responsible for security? 

Is adequate and trained staffing available 

to protect workers who are in potentially 

dangerous situations?

Are there trained security personnel accessible 

to workers in a timely manner?

Do security personnel have sufficient authority to 

take all necessary action to ensure worker safety?

Are security personnel provided outside 

the building?

Is the parking lot attended or otherwise secure?

Are security escorts available to walk 

employees to and from the parking lot?
Occupational Safety and Health Administration

3 6

Yes No NOTES

TRAINING

Are workers trained in the emergency response 

plan (for example, escape routes, notifying the 

proper authorities)?

Are workers trained to report violent incidents 

or threats?

Are workers trained in how to handle difficult 

clients or patients?

Are workers trained in ways to prevent or 

defuse potentially violent situations?

Are workers trained in personal safety and 

self-defense?

FACILITY DESIGN

Are there enough exits and adequate routes 

of escape?

Can exit doors be opened only from the inside to 

prevent unauthorized entry?

Is the lighting adequate to see clearly in 

indoor areas?

Are there employee-only work areas that are 

separate from public areas?

Is access to work areas only through a 

reception area?

Are reception and work areas designed to 

prevent unauthorized entry?

Could someone hear a worker call for help?

Can workers observe patients or clients in 

waiting areas?

Do areas used for patient or client interviews 

allow co-workers to observe any problems?

Are waiting and work areas free of objects that 

could be used as weapons?

Are chairs and furniture secured to prevent 

their use as weapons?

Is furniture in waiting and work areas arranged 

to prevent workers from becoming trapped?

Are patient or client areas designed to maximize 

comfort and minimize stress?

Is a secure place available for workers to store 

their personal belongings?

Are private, locked restrooms available for staff?
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3 7

Yes No NOTES

SECURITY MEASURES – 

Does the workplace have?

Physical barriers (Plexiglas partitions, elevated 

counters to prevent people from jumping over 

them, bullet-resistant customer windows, etc.)?

Security cameras or closed-circuit TV in highrisk areas?

Panic buttons – (portable or fixed)

Alarm systems?

Metal detectors?

X-ray machines?

Door locks?

Internal phone system to activate emergency 

assistance?

Phones with an outside line programmed to 

call 911?

Security mirrors (convex mirrors)?

Secured entry (buzzers)?

Personal alarm devices?

OUTSIDE THE FACILITY

Do workers feel safe walking to and from 

the workplace?

Are the entrances to the building clearly visible 

from the street?

Is the area surrounding the building free of 

bushes or other hiding places?

Is video surveillance provided outside the building?

Is there enough lighting to see clearly outside 

the building?

Are all exterior walkways visible to 

security personnel?

Is there a nearby parking lot reserved for 

employees only?

Is the parking lot free of bushes or other 

hiding places?

Is there enough lighting to see clearly in the 

parking lot and when walking to the building?

Have neighboring facilities and businesses 

experienced violence or crime?
Occupational Safety and Health Administration

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Yes No NOTES

WORKPLACE PROCEDURES

Are employees given maps and clear directions 

in order to navigate the areas where they will 

be working?

Is public access to the building controlled?

Are floor plans posted showing building 

entrances, exits, and location of security 

personnel?

Are these floor plans visible only to staff and not 

to outsiders?

Is other emergency information posted, such as 

the telephone numbers?

Are special security measures taken to protect 

people who work late at night (escorts, locked 

entrances, etc.)?

Are visitors or clients escorted to offices for 

appointments?

Are authorized visitors to the building required 

to wear ID badges?

Are identification tags required for staff 

(omitting personal information such as the 

person’s last name and social security number)?

Are workers notified of past violent acts by 

particular clients, patients, etc.?

Is there an established liaison with local police 

and counseling agencies?

Are patients or clients in waiting areas clearly 

informed how to use the department’s services 

so they will not become frustrated? 

Are waiting times for patient or client services 

kept short to prevent frustration?

Are broken windows and locks repaired promptly?

Are security devices (locks, cameras, alarms, 

etc.) tested on a regular basis and repaired 

promptly when necessary?

FIELD WORK – Staffing:

Are escorts or “buddies” provided for people 

who work in potentially dangerous situations?

Is assistance provided to workers in the field in 

a timely manner when requested?

FIELD WORK – Training:

Are workers briefed about the area in which 

they will be working (gang colors, neighborhood 

culture, language, drug activity, etc.)?
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

3 9

Yes No NOTES

Can workers effectively communicate with people 

they meet in the field (same language, etc.)?

Are people who work in the field late at night 

or early mornings advised about special 

precautions to take?

FIELD WORK – Work Environment:

Is there enough lighting to see clearly in all 

areas where workers must go?

Are there safe places for workers to eat, use 

the restroom, store valuables, etc.?

Are there places where workers can go for 

protection in an emergency?

Is safe parking readily available for employees 

in the field?

FIELD WORK – Security Measures:

Are workers provided two-way radios, pagers, 

or cellular phones?

Are workers provided with personal alarm 

devices or portable panic buttons?

Are vehicle door and window locks controlled 

by the driver?

Are vehicles equipped with physical barriers 

(Plexiglas partitions, etc.)?

FIELD WORK – Work Procedures:

Are employees given maps and clear directions 

for covering the areas where they will be working?

Are employees given alternative routes to use 

in neighborhoods with a high crime rate?

Does a policy exist to allow employees to refuse 

service to clients or customers (in the home, 

etc.) in a hazardous situation?

Has a liaison with the police been established?

Do workers avoid carrying unnecessary items 

that someone could use as weapon against them?

Does the employer provide a safe vehicle or 

other transportation for use in the field?

Are vehicles used in the field routinely 

inspected and kept in good working order?

Is there always someone who knows where 

each employee is?

Are nametags required for workers in the field 

(omitting personal information such as last 

name and social security number)?

Are workers notified of past violent acts by 

particular clients, patients, etc.?
Occupational Safety and Health Administration

4 0

Yes No NOTES

FIELD WORK – Are special precautions taken 

when workers:

Have to take something away from people 

(remove children from the home)?

Have contact with people who behave violently?

Use vehicles or wear clothing marked with the 

name of an organization that the public may 

strongly dislike?

Perform duties inside people’s homes?

Have contact with dangerous animals (dogs, etc.)?

Adapted from the workplace violence prevention program 

checklist, California Department of Human Resources, see www.

calhr.ca.gov/Documents/model-workplace-violence-and-bullyingprevention-program.pdf (last accessed November 25, 2014). 

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Preventing violence in the health care setting. (45). The Joint 

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and strategies: United Kingdom, Australia, Sweden, USA (OSHA 

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Occupational Safety and Health Administration

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Workers’ Rights

Workers have the right to:

■ Working conditions that do not pose a risk of serious harm. 

■ Receive information and training (in a language and 

vocabulary the worker understands) about workplace 

hazards, methods to prevent them, and the OSHA standards 

that apply to their workplace. 

■ Review records of work-related injuries and illnesses. 

■ File a complaint asking OSHA to inspect their workplace if 

they believe there is a serious hazard or that their employer 

is not following OSHA’s rules. OSHA will keep all identities 

confidential.

■ Exercise their rights under the law without retaliation, 

including reporting an injury or raising health and safety 

concerns with their employer or OSHA. If a worker has been 

retaliated against for using their rights, they must file a 

complaint with OSHA as soon as possible, but no later than 

30 days. 

For more information, see OSHA’s Workers page.

OSHA Assistance, Services and Programs 

OSHA has a great deal of information to assist employers in 

complying with their responsibilities under OSHA law. Several 

OSHA programs and services can help employers identify and 

correct job hazards, as well as improve their injury and illness 

prevention program.

Establishing an Injury and Illness 

Prevention Program

The key to a safe and healthful work environment is a 

comprehensive injury and illness prevention program.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

4 7

Injury and illness prevention programs are systems that can 

substantially reduce the number and severity of workplace 

injuries and illnesses, while reducing costs to employers. 

Thousands of employers across the United States already 

manage safety using injury and illness prevention programs, and 

OSHA believes that all employers can and should do the same. 

Thirty-four states have requirements or voluntary guidelines 

for workplace injury and illness prevention programs. Most 

successful injury and illness prevention programs are based 

on a common set of key elements. These include management 

leadership, worker participation, hazard identification, hazard 

prevention and control, education and training, and program 

evaluation and improvement. Visit OSHA’s Injury and Illness 

Prevention Programs web page at www.osha.gov/dsg/topics/

safetyhealth for more information.

Compliance Assistance Specialists

OSHA has compliance assistance specialists throughout the 

nation located in most OSHA offices. Compliance assistance 

specialists can provide information to employers and workers 

about OSHA standards, short educational programs on specific 

hazards or OSHA rights and responsibilities, and information on 

additional compliance assistance resources. For more details, 

visit www.osha.gov/dcsp/compliance_assistance/cas.html or 

call 1-800-321-OSHA (6742) to contact your local OSHA office.

Free On-site Safety and Health Consultation 

Services for Small Business

OSHA’s On-site Consultation Program offers free and 

confidential advice to small and medium-sized businesses 

in all states across the country, with priority given to highhazard worksites. Each year, responding to requests from small 

employers looking to create or improve their safety and health 

management programs, OSHA’s On-site Consultation Program 

conducts over 29,000 visits to small business worksites 

covering over 1.5 million workers across the nation.
Occupational Safety and Health Administration

4 8

On-site consultation services are separate from enforcement 

and do not result in penalties or citations. Consultants from state 

agencies or universities work with employers to identify workplace 

hazards, provide advice on compliance with OSHA standards, and 

assist in establishing safety and health management programs.

For more information, to find the local On-site Consultation office 

in your state, or to request a brochure on Consultation Services, 

visit www.osha.gov/consultation, or call 1-800-321-OSHA (6742).

Under the consultation program, certain exemplary employers 

may request participation in OSHA’s Safety and Health 

Achievement Recognition Program (SHARP). Eligibility for 

participation includes, but is not limited to, receiving a fullservice, comprehensive consultation visit, correcting all 

identified hazards and developing an effective safety and 

health management program. Worksites that receive SHARP 

recognition are exempt from programmed inspections during 

the period that the SHARP certification is valid.

Cooperative Programs

OSHA offers cooperative programs under which businesses, 

labor groups and other organizations can work cooperatively 

with OSHA. To find out more about any of the following 

programs, visit www.osha.gov/cooperativeprograms.

Strategic Partnerships and Alliances

The OSHA Strategic Partnerships (OSP) provide the opportunity 

for OSHA to partner with employers, workers, professional or 

trade associations, labor organizations, and/or other interested 

stakeholders. OSHA Partnerships are formalized through unique 

agreements designed to encourage, assist, and recognize 

partner efforts to eliminate serious hazards and achieve model 

workplace safety and health practices. Through the Alliance 

Program, OSHA works with groups committed to worker safety 

and health to prevent workplace fatalities, injuries and illnesses 

by developing compliance assistance tools and resources to 

share with workers and employers, and educate workers and 

employers about their rights and responsibilities.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

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Voluntary Protection Programs (VPP)

The VPP recognize employers and workers in private industry 

and federal agencies who have implemented effective safety and 

health management programs and maintain injury and illness rates 

below the national average for their respective industries. In VPP, 

management, labor, and OSHA work cooperatively and proactively 

to prevent fatalities, injuries, and illnesses through a system 

focused on: hazard prevention and control, worksite analysis, 

training, and management commitment and worker involvement.

Occupational Safety and Health Training

The OSHA Training Institute partners with 27 OSHA Training 

Institute Education Centers at 42 locations throughout the United 

States to deliver courses on OSHA standards and occupational 

safety and health topics to thousands of students a year. For more 

information on training courses, visit www.osha.gov/otiec.

OSHA Educational Materials

OSHA has many types of educational materials in English, 

Spanish, Vietnamese and other languages available in print or 

online. These include:

■ Brochures/booklets;

■ Fact Sheets;

■ Guidance documents that provide detailed examinations of 

specific safety and health issues;

■ Online Safety and Health Topics pages;

■ Posters;

■ Small, laminated QuickCardsTM that provide brief safety and 

health information; and

■ QuickTakes, OSHA’s free, twice-monthly online 

newsletter with the latest news about OSHA initiatives 

and products to assist employers and workers in finding 

and preventing workplace hazards. To sign up for 

QuickTakes visit www.osha.gov/quicktakes.
To view materials available online or for a listing of free

publications, visit www.osha.gov/publications. You can also call

1-800-321-OSHA (6742) to order publications.

Select OSHA publications are available in e-Book format.

OSHA e-Books are designed to increase readability on

smartphones, tablets and other mobile devices. For access,

go to www.osha.gov/ebooks.

OSHA’s web site also has information on job hazards and

injury and illness prevention for employers and workers. To

learn more about OSHA’s safety and health resources online,

visit www.osha.gov or www.osha.gov/html/a-z-index.html.

NIOSH Health Hazard Evaluation Program

Getting Help with Health Hazards

The National Institute for Occupational Safety and Health

(NIOSH) is a federal agency that conducts scientific and medical

research on workers’ safety and health. At no cost to employers

or workers, NIOSH can help identify health hazards and

recommend ways to reduce or eliminate those hazards in the

workplace through its Health Hazard Evaluation (HHE) Program.

Workers, union representatives and employers can request a

NIOSH HHE. An HHE is often requested when there is a higher

than expected rate of a disease or injury in a group of workers.

These situations may be the result of an unknown cause, a new

hazard, or a mixture of sources. To request a NIOSH Health 

Hazard Evaluation go to www.cdc.gov/niosh/hhe/request.html. 

To find out more, in English or Spanish, about the Health Hazard

Evaluation Program: 

E-mail HHERequestHelp@cdc.gov or call 800-CDC-INFO

(800-232-4636).

Occupational Safety and Health Administration

5 0
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

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OSHA Regional Offices

Region I

Boston Regional Office

(CT*, ME*, MA, NH, RI, VT*) 

JFK Federal Building, Room E340

Boston, MA 02203

(617) 565-9860 (617) 565-9827 Fax 

Region II

New York Regional Office

(NJ*, NY*, PR*, VI*)

201 Varick Street, Room 670

New York, NY 10014

(212) 337-2378 (212) 337-2371 Fax

Region III

Philadelphia Regional Office

(DE, DC, MD*, PA, VA*, WV)

The Curtis Center

170 S. Independence Mall West

Suite 740 West

Philadelphia, PA 19106-3309

(215) 861-4900 (215) 861-4904 Fax

Region IV 

Atlanta Regional Office

(AL, FL, GA, KY*, MS, NC*, SC*, TN*)

61 Forsyth Street, SW, Room 6T50

Atlanta, GA 30303

(678) 237-0400 (678) 237-0447 Fax

Region V

Chicago Regional Office

(IL*, IN*, MI*, MN*, OH, WI)

230 South Dearborn Street 

Room 3244

Chicago, IL 60604

(312) 353-2220 (312) 353-7774 Fax
Occupational Safety and Health Administration

5 2

Region VI

Dallas Regional Office

(AR, LA, NM*, OK, TX)

525 Griffin Street, Room 602

Dallas, TX 75202

(972) 850-4145 (972) 850-4149 Fax

(972) 850-4150 FSO Fax

Region VII

Kansas City Regional Office

(IA*, KS, MO, NE)

Two Pershing Square Building

2300 Main Street, Suite 1010

Kansas City, MO 64108-2416

(816) 283-8745 (816) 283-0547 Fax

Region VIII

Denver Regional Office

(CO, MT, ND, SD, UT*, WY*)

Cesar Chavez Memorial Building

1244 Speer Boulevard, Suite 551

Denver, CO 80204

(720) 264-6550 (720) 264-6585 Fax

Region IX 

San Francisco Regional Office

(AZ*, CA*, HI*, NV*, and American Samoa, 

Guam and the Northern Mariana Islands)

90 7th Street, Suite 18100

San Francisco, CA 94103

(415) 625-2547 (415) 625-2534 Fax

Region X

Seattle Regional Office

(AK*, ID, OR*, WA*)

300 Fifth Avenue, Suite 1280

Seattle, WA 98104

(206) 757-6700 (206) 757-6705 Fax
* These states and territories operate their own OSHA-approved 

job safety and health plans and cover state and local government 

employees as well as private sector employees. The Connecticut, 

Illinois, Maine, New Jersey, New York and Virgin Islands 

programs cover public employees only. (Private sector workers 

in these states are covered by Federal OSHA). States with 

approved programs must have standards that are identical to, 

or at least as effective as, the Federal OSHA standards.

Note: To get contact information for OSHA area offices, OSHAapproved state plans and OSHA consultation projects, please visit 

us online at www.osha.gov or call us at 1-800-321-OSHA (6742).

How to Contact OSHA

For questions or to get information or advice, to report an 

emergency, fatality, inpatient hospitalization, amputation, 

or loss of an eye, or to file a confidential complaint, contact 

your nearest OSHA office, visit www.osha.gov or call OSHA 

at 1-800-321-OSHA (6742), TTY 1-877-889-5627.

For assistance, contact us.

We are OSHA. We can help.
U.S. Department of Labor

For more information:

Occupational

Safety and Health

Administration

www.osha.gov (800) 321-OSHA (6742)