II 

118TH CONGRESS 

1ST SESSION S. 1176 

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

standard that requires covered employers within the health care and 

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

IN THE SENATE OF THE UNITED STATES 

APRIL 18, 2023 

Ms. BALDWIN (for herself, Mr. CASEY, Mr. MERKLEY, Mr. BENNET, Ms. 

DUCKWORTH, Ms. STABENOW, Mr. WHITEHOUSE, Mr. SCHATZ, Mr. 

HICKENLOOPER, Ms. HASSAN, Mr. HEINRICH, Mr. PADILLA, Mr. MARKEY, Ms. WARREN, Mr. REED, Mr. VAN HOLLEN, Mr. MENENDEZ, Mr. 

BLUMENTHAL, Mr. MURPHY, Mr. CARDIN, Mrs. MURRAY, Mr. WELCH, 

and Mr. SANDERS) introduced the following bill; which was read twice 

and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To direct the Secretary of Labor to issue an occupational 

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

to develop and implement a comprehensive workplace 

violence prevention plan, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

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

3 Prevention for Health Care and Social Service Workers 

4 Act’’. 

5 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—WORKPLACE VIOLENCE PREVENTION STANDARD 

Sec. 101. Workplace violence prevention standard. 

Sec. 102. Scope and application. 

Sec. 103. Requirements for workplace violence prevention standard. 

Sec. 104. Rules of construction. 

Sec. 105. Other definitions. 

TITLE II—AMENDMENTS TO THE SOCIAL SECURITY ACT 

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

facilities receiving Medicare funds. 

7 TITLE I—WORKPLACE VIOLENCE 

8 PREVENTION STANDARD 

9 SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD. 

10 (a) INTERIM FINAL STANDARD.— 

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

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

13 Labor shall issue an interim final standard on work14 place violence prevention— 

15 (A) to require certain employers in the 

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

18 similar to the activities in the health care and 

19 social service sectors, to develop and implement 


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1 a comprehensive workplace violence prevention 

2 plan and carry out other activities or require3 ments described in section 103 to protect health 

4 care workers, social service workers, and other 

5 personnel from workplace violence; 

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

7 the Guidelines for Preventing Workplace Vio8 lence for Healthcare and Social Service Work9 ers published by the Occupational Safety and 

10 Health Administration of the Department of 

11 Labor in 2015 and adhere to the requirements 

12 of this title; and 

13 (C) that provides for a period determined 

14 appropriate by the Secretary, not to exceed 1 

15 year, during which the Secretary shall prioritize 

16 technical assistance and advice consistent with 

17 section 21(d) of the Occupational Safety and 

18 Health Act of 1970 (29 U.S.C. 670(d)) to em19 ployers subject to the standard with respect to 

20 compliance with the standard. 

21 (2) INAPPLICABLE PROVISIONS OF LAW AND

22 EXECUTIVE ORDER.—The following provisions of law 

23 and Executive orders shall not apply to the issuance 

24 of the interim final standard under this subsection: 


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1 (A) The requirements applicable to occupa2 tional safety and health standards under section 

3 6(b) of the Occupational Safety and Health Act 

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

5 (B) The requirements of chapters 5 and 6 

6 of title 5, United States Code. 

7 (C) Subchapter I of chapter 35 of title 44, 

8 United States Code (commonly referred to as 

9 the ‘‘Paperwork Reduction Act’’). 

10 (D) Executive Order No. 12866 (58 Fed. 

11 Reg. 51735; relating to regulatory planning and 

12 review), as amended. 

13 (3) NOTICE AND COMMENT.—Notwithstanding 

14 paragraph (2)(B), the Secretary shall, prior to 

15 issuing the interim final standard under this sub16 section, provide notice in the Federal Register of the 

17 interim final standard and a 30-day period for pub18 lic comment. 

19 (4) EFFECTIVE DATE OF INTERIM STAND20 ARD.—The interim final standard shall— 

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

22 than 30 days after issuance, except that such 

23 interim final standard may include a reasonable 

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1 quired engineering controls that take effect 

2 after such date; 

3 (B) be enforced in the same manner and 

4 to the same extent as any standard promul5 gated under section 6(b) of the Occupational 

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

7 655(b)); and 

8 (C) be in effect until the final standard de9 scribed in subsection (b) becomes effective and 

10 enforceable. 

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

12 final standard described in paragraph (1) is not 

13 issued not later than 1 year of the date of enactment 

14 of this Act, the provisions of this title shall be in ef15 fect and enforced in the same manner and to the 

16 same extent as any standard promulgated under sec17 tion 6(b) of the Occupational Safety and Health Act 

18 of 1970 (29 U.S.C. 655(b)) until such provisions are 

19 superseded in whole by an interim final standard 

20 issued by the Secretary that meets the requirements 

21 of paragraph (1). 

22 (b) FINAL STANDARD.— 

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

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

25 Secretary of Labor shall, pursuant to section 6 of 


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1 the Occupational Safety and Health Act of 1970 (29 

2 U.S.C. 655), promulgate a proposed standard on 

3 workplace violence prevention— 

4 (A) for the purposes described in sub5 section (a)(1)(A); and 

6 (B) that shall include, at a minimum, re7 quirements contained in the interim final stand8 ard required under subsection (a). 

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

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

11 Secretary shall issue a final standard on such pro12 posed standard that shall— 

13 (A) provide no less protection than any 

14 workplace violence standard adopted by a State 

15 plan that has been approved by the Secretary 

16 under section 18 of the Occupational Safety 

17 and Health Act of 1970 (29 U.S.C. 667), pro18 vided the Secretary finds that the final stand19 ard is feasible on the basis of the best available 

20 evidence; and 

21 (B) be effective and enforceable in the 

22 same manner and to the same extent as any 

23 standard promulgated under section 6(b) of the 

24 Occupational Safety and Health Act of 1970 

25 (29 U.S.C. 655(b)). 


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1 SEC. 102. SCOPE AND APPLICATION. 

2 In this title: 

3 (1) COVERED FACILITY.— 

4 (A) IN GENERAL.—The term ‘‘covered fa5 cility’’ includes the following: 

6 (i) Any hospital, including any spe7 cialty hospital, in-patient or outpatient set8 ting, or clinic operating within a hospital 

9 license, or any setting that provides out10 patient services. 

11 (ii) Any residential treatment facility, 

12 including any nursing home, skilled nurs13 ing facility, hospice facility, Alzheimer’s 

14 and memory care facility, and long-term 

15 care facility. 

16 (iii) Any nonresidential treatment or 

17 service setting. 

18 (iv) Any medical treatment or social 

19 service setting or clinic at a correctional or 

20 detention facility. 

21 (v) Any community care setting, in22 cluding a community-based residential fa23 cility, group home, and mental health clin24 ic. 

25 (vi) Any psychiatric treatment facility. 


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1 (vii) Any drug abuse or substance use 

2 disorder treatment center. 

3 (viii) Any independent freestanding 

4 emergency center. 

5 (ix) Any facility described in clauses 

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

7 Government agency and required to comply 

8 with occupational safety and health stand9 ards pursuant to part 1960 of title 29, 

10 Code of Federal Regulations (as such part 

11 is in effect on the date of enactment of this 

12 Act). 

13 (x) Any other facility the Secretary 

14 determines should be covered under the 

15 standards promulgated under section 101. 

16 (B) EXCLUSION.—The term ‘‘covered facil17 ity’’ does not include an office of a physician, 

18 dentist, podiatrist, or any other health practi19 tioner that is not physically located within a 

20 covered facility described in clauses (i) through 

21 (x) of subparagraph (A). 

22 (2) COVERED SERVICES.— 

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

24 service’’ includes the following services and op25 erations: 


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1 (i) Any services and operations pro2 vided in any field work setting, including 

3 home health care, home-based hospice, and 

4 home-based social work. 

5 (ii) Any emergency services and trans6 port, including such services provided by 

7 firefighters and emergency responders. 

8 (iii) Any services described in clauses 

9 (i) and (ii) performed by a Federal Gov10 ernment agency and required to comply 

11 with occupational safety and health stand12 ards pursuant to part 1960 of title 29, 

13 Code of Federal Regulations (as such part 

14 is in effect on the date of enactment of this 

15 Act). 

16 (iv) Any other services and operations 

17 the Secretary determines should be covered 

18 under the standards promulgated under 

19 section 101. 

20 (B) EXCLUSION.—The term ‘‘covered serv21 ice’’ does not include child day care services. 

22 (3) COVERED EMPLOYER.— 

23 (A) IN GENERAL.—The term ‘‘covered em24 ployer’’ includes a person (including a con25 tractor, a subcontractor, a temporary service 


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1 firm, or an employee leasing entity) that em2 ploys an individual to work at a covered facility 

3 or to perform covered services. 

4 (B) EXCLUSION.—The term ‘‘covered em5 ployer’’ does not include an individual who pri6 vately employs, in the individual’s residence, a 

7 person to perform covered services for the indi8 vidual or a family member of the individual. 

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

10 employee’’ includes an individual employed by a cov11 ered employer to work at a covered facility or to per12 form covered services. 

13 SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 

14 PREVENTION STANDARD. 

15 Each standard described in section 101 shall include, 

16 at a minimum, the following requirements: 

17 (1) WORKPLACE VIOLENCE PREVENTION

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

19 promulgation of the interim final standard under 

20 section 101(a), or 18 months after the date of enact21 ment of this Act in a case described in section 

22 101(a)(5), a covered employer shall develop, imple23 ment, and maintain an effective written workplace 

24 violence prevention plan (in this section referred to 

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1 ered facility and for covered employees performing a 

2 covered service on behalf of such employer, which 

3 meets the following: 

4 (A) PLAN DEVELOPMENT.—Each Plan— 

5 (i) shall be developed and imple6 mented with the meaningful participation 

7 of direct care employees, other employees, 

8 and employee representatives, for all as9 pects of the Plan; 

10 (ii) shall be tailored and specific to 

11 conditions and hazards for the covered fa12 cility or the covered service, including pa13 tient-specific risk factors and risk factors 

14 specific to each work area or unit; 

15 (iii) shall be suitable for the size, com16 plexity, and type of operations at the cov17 ered facility or for the covered service, and 

18 remain in effect at all times; and 

19 (iv) may be in consultation with stake20 holders or experts who specialize in work21 place violence prevention, emergency re22 sponse, or other related areas of expertise 

23 for all relevant aspects of the Plan. 

24 (B) PLAN CONTENT.—Each Plan shall in25 clude procedures and methods for the following: 


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1 (i) Identification of the individual and 

2 the individual’s position responsible for im3 plementation of the Plan. 

4 (ii) With respect to each work area 

5 and unit at the covered facility or while 

6 covered employees are performing the cov7 ered service, risk assessment and identi8 fication of workplace violence risks and 

9 hazards to employees exposed to such risks 

10 and hazards (including environmental risk 

11 factors and patient-specific risk factors), 

12 which shall be— 

13 (I) informed by past violent inci14 dents specific to such covered facility 

15 or such covered service; and 

16 (II) conducted with, at a min17 imum— 

18 (aa) direct care employees; 

19 (bb) where applicable, the 

20 representatives of such employ21 ees; and 

22 (cc) the employer. 

23 (iii) Hazard prevention, engineering 

24 controls, or work practice controls to cor25 rect hazards, in a timely manner, applying 


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1 industrial hygiene principles of the hier2 archy of controls, which— 

3 (I) may include security and 

4 alarm systems, adequate exit routes, 

5 monitoring systems, barrier protec6 tion, established areas for patients 

7 and clients, lighting, entry procedures, 

8 staffing and working in teams, and 

9 systems to identify and flag clients 

10 with a history of violence; and 

11 (II) shall ensure that employers 

12 correct, in a timely manner, hazards 

13 identified in any violent incident in14 vestigation described in paragraph (2) 

15 and any annual report described in 

16 paragraph (5). 

17 (iv) Reporting, incident response, and 

18 post-incident investigation procedures, in19 cluding procedures— 

20 (I) for employees to report work21 place violence risks, hazards, and inci22 dents; 

23 (II) for employers to respond to 

24 reports of workplace violence; 


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1 (III) for employers to perform a 

2 post-incident investigation and de3 briefing of all reports of workplace vi4 olence with the participation of em5 ployees and their representatives; 

6 (IV) to provide medical care or 

7 first aid to affected employees; and 

8 (V) to provide employees with in9 formation about available trauma and 

10 related counseling. 

11 (v) Procedures for emergency re12 sponse, including procedures for threats of 

13 mass casualties and procedures for inci14 dents involving a firearm or a dangerous 

15 weapon. 

16 (vi) Procedures for communicating 

17 with and training the covered employees on 

18 workplace violence hazards, threats, and 

19 work practice controls, the employer’s plan, 

20 and procedures for confronting, responding 

21 to, and reporting workplace violence 

22 threats, incidents, and concerns, and em23 ployee rights. 

24 (vii) Procedures for— 


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1 (I) ensuring the coordination of 

2 risk assessment efforts, Plan develop3 ment, and implementation of the Plan 

4 with other employers who have em5 ployees who work at the covered facil6 ity or who are performing the covered 

7 service; and 

8 (II) determining which covered 

9 employer or covered employers shall 

10 be responsible for implementing and 

11 complying with the provisions of the 

12 standard applicable to the working 

13 conditions over which such employers 

14 have control. 

15 (viii) Procedures for conducting the 

16 annual evaluation under paragraph (6). 

17 (C) AVAILABILITY OF PLAN.—Each Plan 

18 shall be made available at all times to the cov19 ered employees who are covered under such 

20 Plan. 

21 (2) VIOLENT INCIDENT INVESTIGATION.— 

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

23 after a workplace violence incident, risk, or haz24 ard of which a covered employer has knowledge, 

25 the employer shall conduct an investigation of 


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1 such incident, risk, or hazard under which the 

2 employer shall— 

3 (i) review the circumstances of the in4 cident, risk, or hazard, and whether any 

5 controls or measures implemented pursu6 ant to the Plan of the employer were effec7 tive; and 

8 (ii) solicit input from involved employ9 ees, their representatives, and supervisors 

10 about the cause of the incident, risk, or 

11 hazard, and whether further corrective 

12 measures (including system-level factors) 

13 could have prevented the incident, risk, or 

14 hazard. 

15 (B) DOCUMENTATION.—A covered em16 ployer shall document the findings, rec17 ommendations, and corrective measures taken 

18 for each investigation conducted under this 

19 paragraph. 

20 (3) TRAINING AND EDUCATION.—With respect 

21 to the covered employees covered under a Plan of a 

22 covered employer, the employer shall provide train23 ing and education to such employees who may be ex24 posed to workplace violence hazards and risks, which 

25 meet the following requirements: 


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1 (A) Annual training and education shall 

2 include information on the Plan, including iden3 tified workplace violence hazards, work practice 

4 control measures, reporting procedures, record 

5 keeping requirements, response procedures, 

6 anti-retaliation policies, and employee rights. 

7 (B) Additional hazard recognition training 

8 shall be provided for supervisors and managers 

9 to ensure they— 

10 (i) can recognize high-risk situations; 

11 and 

12 (ii) do not assign employees to situa13 tions that predictably compromise the safe14 ty of such employees. 

15 (C) Additional training shall be provided 

16 for each such covered employee whose job cir17 cumstances have changed, within a reasonable 

18 timeframe after such change. 

19 (D) Additional training shall be provided 

20 for each such covered employee whose job cir21 cumstances require working with victims of tor22 ture, trafficking, or domestic violence. 

23 (E) Applicable training shall be provided 

24 under this paragraph for each new covered em25 ployee prior to the employee’s job assignment. 


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1 (F) All training shall provide such employ2 ees opportunities to ask questions, give feed3 back on training, and request additional in4 struction, clarification, or other followup. 

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

6 and by an individual with knowledge of work7 place violence prevention and of the Plan, ex8 cept that any annual training described in sub9 paragraph (A) provided to an employee after 

10 the first year such training is provided to such 

11 employee may be conducted by live video if in12 person training is impracticable. 

13 (H) All training shall be appropriate in 

14 content and vocabulary to the language, edu15 cational level, and literacy of such covered em16 ployees. 

17 (4) RECORDKEEPING AND ACCESS TO PLAN

18 RECORDS.— 

19 (A) IN GENERAL.—Each covered employer 

20 shall— 

21 (i) maintain for not less than 5 

22 years— 

23 (I) records related to each Plan 

24 of the employer, including workplace 

25 violence risk and hazard assessments, 


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1 and identification, evaluation, correc2 tion, and training procedures; 

3 (II) a violent incident log de4 scribed in subparagraph (B) for re5 cording all workplace violence inci6 dents; and 

7 (III) records of all incident inves8 tigations as required under paragraph 

9 (2)(B); and 

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

11 available, upon request, to covered employ12 ees and their representatives for examina13 tion and copying in accordance with sec14 tion 1910.1020 of title 29, Code of Federal 

15 Regulations (as such section is in effect on 

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

17 a manner consistent with HIPAA privacy 

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

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

20 1320d–9(b)(3))) and part 2 of title 42, 

21 Code of Federal Regulations (as such part 

22 is in effect on the date of enactment of this 

23 Act); and 

24 (II) ensure that any such records and 

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1 tronically, or otherwise removed from the 

2 employer’s control for purposes of this 

3 clause omit any element of personal identi4 fying information sufficient to allow identi5 fication of any patient, resident, client, or 

6 other individual alleged to have committed 

7 a violent incident (including the individ8 ual’s name, address, electronic mail ad9 dress, telephone number, or social security 

10 number, or other information that, alone 

11 or in combination with other publicly avail12 able information, reveals such individual’s 

13 identity). 

14 (B) VIOLENT INCIDENT LOG DESCRIP15 TION.—Each violent incident log shall— 

16 (i) be maintained by a covered em17 ployer for each covered facility controlled 

18 by the employer and for each covered serv19 ice being performed by a covered employee 

20 on behalf of such employer; 

21 (ii) be based on a template developed 

22 by the Secretary not later than 1 year 

23 after the date of enactment of this Act; 

24 (iii) include, at a minimum, a descrip25 tion of— 


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1 (I) the violent incident (including 

2 environmental risk factors present at 

3 the time of the incident); 

4 (II) the date, time, and location 

5 of the incident, and the names and 

6 job titles of involved employees; 

7 (III) the nature and extent of in8 juries to covered employees; 

9 (IV) a classification of the perpe10 trator who committed the violence, in11 cluding whether the perpetrator was— 

12 (aa) a patient, client, resi13 dent, or customer of a covered 

14 employer; 

15 (bb) a family or friend of a 

16 patient, client, resident, or cus17 tomer of a covered employer; 

18 (cc) a stranger; 

19 (dd) a coworker, supervisor, 

20 or manager of a covered em21 ployee; 

22 (ee) a partner, spouse, par23 ent, or relative of a covered em24 ployee; or 


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1 (ff) any other appropriate 

2 classification; 

3 (V) the type of violent incident 

4 (such as type 1 violence, type 2 vio5 lence, type 3 violence, or type 4 vio6 lence); and 

7 (VI) how the incident was 

8 abated; 

9 (iv) not later than 7 days after the 

10 employer learns of such incident, contain a 

11 record of each violent incident, which is 

12 updated to ensure completeness of such 

13 record; 

14 (v) be maintained for not less than 5 

15 years; and 

16 (vi) in the case of a violent incident 

17 involving a privacy concern case, protect 

18 the identity of employees in a manner con19 sistent with section 1904.29(b) of title 29, 

20 Code of Federal Regulations (as such sec21 tion is in effect on the date of enactment 

22 of this Act). 

23 (C) ANNUAL SUMMARY.— 

24 (i) COVERED EMPLOYERS.—Each cov25 ered employer shall prepare and submit to 


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1 the Secretary an annual summary of each 

2 violent incident log for the preceding cal3 endar year that shall— 

4 (I) with respect to each covered 

5 facility, and each covered service, for 

6 which such a log has been maintained, 

7 include— 

8 (aa) the total number of vio9 lent incidents; 

10 (bb) the number of record11 able injuries related to such inci12 dents; and 

13 (cc) the total number of 

14 hours worked by the covered em15 ployees for such preceding year; 

16 (II) be completed on a form pro17 vided by the Secretary; 

18 (III) be posted for 3 months be19 ginning February 1 of each year in a 

20 manner consistent with the require21 ments of part 1904 of title 29, Code 

22 of Federal Regulations (as such part 

23 is in effect on the date of enactment 

24 of this Act), relating to the posting of 

25 summaries of injury and illness logs; 


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1 (IV) be located in a conspicuous 

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

4 (V) not be altered, defaced, or 

5 covered by other material. 

6 (ii) SECRETARY.—Not later than 1 

7 year after the promulgation of the interim 

8 final standard under section 101(a), or 2 

9 years after the date of enactment of this 

10 Act in a case described in section 

11 101(a)(5), the Secretary shall make avail12 able a platform for the electronic submis13 sion of annual summaries required under 

14 this subparagraph. 

15 (5) ANNUAL REPORT.— 

16 (A) REPORT TO SECRETARY.—Not later 

17 than February 15 of each year, each covered 

18 employer shall report to the Secretary, on a 

19 form provided by the Secretary, the frequency, 

20 quantity, and severity of workplace violence, 

21 and any incident response and post-incident in22 vestigation (including abatement measures) for 

23 the incidents set forth in the annual summary 

24 of the violent incident log described in para25 graph (4)(C). 


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1 (B) REPORT TO CONGRESS.—Not later 

2 than 6 months after February 15 of each year, 

3 the Secretary shall submit to Congress a sum4 mary of the reports received under subpara5 graph (A). The contents of the summary of the 

6 Secretary to Congress shall not disclose any 

7 confidential information. 

8 (6) ANNUAL EVALUATION.—Each covered em9 ployer shall conduct an annual written evaluation, 

10 conducted with the full, active participation of cov11 ered employees and employee representatives, of— 

12 (A) the implementation and effectiveness 

13 of the Plan, including a review of the violent in14 cident log; and 

15 (B) compliance with training required by 

16 each standard described in section 101, and 

17 specified in the Plan. 

18 (7) PLAN UPDATES.—Each covered employer 

19 shall incorporate changes to the Plan, in a manner 

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

21 findings from the most recent annual evaluation con22 ducted under paragraph (6), as appropriate. 

23 (8) ANTI-RETALIATION.— 

24 (A) POLICY.—Each covered employer shall 

25 adopt a policy prohibiting any person (including 


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1 an agent of the employer) from the discrimina2 tion or retaliation described in subparagraph 

3 (B). 

4 (B) PROHIBITION.—No covered employer 

5 shall discriminate or retaliate against any em6 ployee for— 

7 (i) reporting a workplace violence inci8 dent, threat, or concern to, or seeking as9 sistance or intervention with respect to 

10 such incident, threat, or concern from, the 

11 employer, law enforcement, local emer12 gency services, or a local, State, or Federal 

13 government agency; or 

14 (ii) exercising any other rights under 

15 this section. 

16 (C) ENFORCEMENT.—This paragraph shall 

17 be enforced in the same manner and to the 

18 same extent as any standard promulgated 

19 under section 6(b) of the Occupational Safety 

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

21 SEC. 104. RULES OF CONSTRUCTION. 

22 Notwithstanding section 18 of the Occupational Safe23 ty and Health Act of 1970 (29 U.S.C. 667)— 


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

2 curtail or limit authority of the Secretary under any 

3 other provision of the law; 

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

5 employees shall be in addition to the rights, privi6 leges, or remedies provided under any Federal or 

7 State law, or any collective bargaining agreement; 

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

9 limit or prevent health care workers, social service 

10 workers, and other personnel from reporting violent 

11 incidents to appropriate law enforcement; and 

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

13 limit or diminish any protections in relevant Federal, 

14 State, or local law related to— 

15 (A) domestic violence; 

16 (B) stalking; 

17 (C) dating violence; and 

18 (D) sexual assault. 

19 SEC. 105. OTHER DEFINITIONS. 

20 In this title: 

21 (1) WORKPLACE VIOLENCE.— 

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

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

24 violence, without regard to intent, that occurs 


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1 at a covered facility or while a covered employee 

2 performs a covered service. 

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

4 violence’’ does not include lawful acts of self-de5 fense or lawful acts of defense of others. 

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

7 violence’’ includes— 

8 (i) the threat or use of physical force 

9 against a covered employee that results in 

10 or has a high likelihood of resulting in in11 jury, psychological trauma, or stress, with12 out regard to whether the covered em13 ployee sustains an injury, psychological 

14 trauma, or stress; and 

15 (ii) an incident involving the threat or 

16 use of a firearm or a dangerous weapon, 

17 including the use of common objects as 

18 weapons, without regard to whether the 

19 employee sustains an injury, psychological 

20 trauma, or stress. 

21 (2) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio22 lence’’— 

23 (A) means workplace violence directed at a 

24 covered employee at a covered facility or while 

25 performing a covered service by an individual 


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1 who has no legitimate business at the covered 

2 facility or with respect to such covered service; 

3 and 

4 (B) includes violent acts by any individual 

5 who enters the covered facility or worksite 

6 where a covered service is being performed with 

7 the intent to commit a crime. 

8 (3) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio9 lence’’ means workplace violence directed at a cov10 ered employee by customers, clients, patients, stu11 dents, inmates, or any individual for whom a covered 

12 facility provides services or for whom the employee 

13 performs covered services. 

14 (4) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio15 lence’’ means workplace violence directed at a cov16 ered employee by a present or former employee, su17 pervisor, or manager. 

18 (5) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio19 lence’’ means workplace violence directed at a cov20 ered employee by an individual who is not an em21 ployee, but has or is known to have had a personal 

22 relationship with such employee, or with a customer, 

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

24 whom a covered facility provides services or for 

25 whom the employee performs covered services. 


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

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

3 (A) causes an individual to fear for such 

4 individual’s safety because there is a reasonable 

5 possibility the individual might be physically in6 jured; and 

7 (B) serves no legitimate purpose. 

8 (7) ALARM.—The term ‘‘alarm’’ means a me9 chanical, electrical, or electronic device that does not 

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

11 others. 

12 (8) DANGEROUS WEAPON.—The term ‘‘dan13 gerous weapon’’ means an instrument capable of in14 flicting death or serious bodily injury, without re15 gard to whether such instrument was designed for 

16 that purpose. 

17 (9) ENGINEERING CONTROLS.— 

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

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

20 a device that removes a hazard from the work21 place or creates a barrier between a covered 

22 employee and the hazard. 

23 (B) INCLUSIONS.—For purposes of reduc24 ing workplace violence hazards, the term ‘‘engi25 neering controls’’ includes electronic access conVerDate Sep 11 2014 20:20 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1176.IS S1176

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1 trols to employee occupied areas, weapon detec2 tors (installed or handheld), enclosed work3 stations with shatter-resistant glass, deep serv4 ice counters, separate rooms or areas for high5 risk patients, locks on doors, removing access to 

6 or securing items that could be used as weap7 ons, furniture affixed to the floor, opaque glass 

8 in patient rooms (which protects privacy, but 

9 allows the health care provider to see where the 

10 patient is before entering the room), closed-cir11 cuit television monitoring and video recording, 

12 sight-aids, and personal alarm devices. 

13 (10) ENVIRONMENTAL RISK FACTORS.— 

14 (A) IN GENERAL.—The term ‘‘environ15 mental risk factors’’ means factors in the cov16 ered facility or area in which a covered service 

17 is performed that may contribute to the likeli18 hood or severity of a workplace violence inci19 dent. 

20 (B) CLARIFICATION.—Environmental risk 

21 factors may be associated with the specific task 

22 being performed or the work area, such as 

23 working in an isolated area, poor illumination 

24 or blocked visibility, and lack of physical barVerDate Sep 11 2014 20:20 Apr 20, 2023 Jkt 039200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S1176.IS S1176

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1 riers between individuals and persons at risk of 

2 committing workplace violence. 

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

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

5 specific to a patient that may increase the likelihood 

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

8 (A) a patient’s treatment and medication 

9 status, and history of violence and use of drugs 

10 or alcohol; and 

11 (B) any conditions or disease processes of 

12 the patient that may cause the patient to expe13 rience confusion or disorientation, be non14 responsive to instruction, behave unpredictably, 

15 or engage in disruptive, threatening, or violent 

16 behavior. 

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

18 means the Secretary of Labor. 

19 (13) WORK PRACTICE CONTROLS.— 

20 (A) IN GENERAL.—The term ‘‘work prac21 tice controls’’ means procedures and rules that 

22 are used to effectively reduce workplace violence 

23 hazards. 

24 (B) INCLUSIONS.—The term ‘‘work prac25 tice controls’’ includes— 


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1 (i) assigning and placing sufficient 

2 numbers of staff to reduce patient-specific 

3 type 2 violence hazards; 

4 (ii) provision of dedicated and avail5 able safety personnel such as security 

6 guards; 

7 (iii) employee training on workplace 

8 violence prevention methods and tech9 niques to de-escalate and minimize violent 

10 behavior; and 

11 (iv) employee training on procedures 

12 for response in the event of a workplace vi13 olence incident and for post-incident re14 sponse. 

15 TITLE II—AMENDMENTS TO THE 

16 SOCIAL SECURITY ACT 

17 SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE 

18 PREVENTION STANDARD TO CERTAIN FACILI19 TIES RECEIVING MEDICARE FUNDS. 

20 (a) IN GENERAL.—Section 1866 of the Social Secu21 rity Act (42 U.S.C. 1395cc) is amended— 

22 (1) in subsection (a)(1)— 

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

24 ‘‘and’’ at the end; 


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1 (B) in subparagraph (Y), by striking the 

2 period at the end and inserting ‘‘, and’’; and 

3 (C) by inserting after subparagraph (Y) 

4 the following new subparagraph: 

5 ‘‘(Z) in the case of hospitals that are not other6 wise subject to the Occupational Safety and Health 

7 Act of 1970 (or a State occupational safety and 

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

9 Act) and skilled nursing facilities that are not other10 wise subject to such Act (or such a State occupa11 tional safety and health plan), to comply with the 

12 Workplace Violence Prevention Standard (as pro13 mulgated under section 101 of the Workplace Vio14 lence Prevention for Health Care and Social Service 

15 Workers Act).’’; and 

16 (2) in subsection (b)(4)— 

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

18 ‘‘and a hospital or skilled nursing facility that 

19 fails to comply with the requirement of sub20 section (a)(1)(Z) (relating to the Workplace Vi21 olence Prevention Standard)’’ after 

22 ‘‘Bloodborne Pathogens standard)’’; and 

23 (B) in subparagraph (B)— 

24 (i) by striking ‘‘(a)(1)(U)’’ and insert25 ing ‘‘(a)(1)(V)’’; and 


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

2 failure to comply with the requirement of 

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

4 Workplace Violence Prevention standard 

5 referred to in such subsection by a hospital 

6 or skilled nursing facility, as applicable, 

7 that is subject to the provisions of such 

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

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

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

11 1 year after the date of issuance of the interim final stand12 ard on workplace violence prevention required under sec13 tion 101. 

Æ 


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