I 

115TH CONGRESS 

2D SESSION H. R. 5223 

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

rule that requires covered health care employers to adopt a comprehensive 

workplace violence prevention plan and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 8, 2018 

Mr. KHANNA (for himself, Mr. BRADY of Pennsylvania, Ms. NORTON, Mr. 

KRISHNAMOORTHI, Mr. POCAN, Ms. VELA ́ZQUEZ, Mr. RASKIN, Ms. JACKSON LEE, Ms. JAYAPAL, Ms. JUDY CHU of California, Ms. GABBARD, Mr. 

MOULTON, and Ms. LEE) introduced the following bill; which was referred to the Committee on Education and the Workforce, and in addition 

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

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

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

A BILL 

To direct the Secretary of Labor to issue an occupational 

safety and health rule that requires covered health care 

employers to adopt a comprehensive workplace violence 

prevention plan and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Health Care Workplace Violence Prevention Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Workplace violence prevention standard. 

Sec. 3. Application of the workplace violence prevention standard to facilities 

receiving Medicare and Medicaid funds. 

Sec. 4. Rules of construction. 

Sec. 5. Definitions. 

3 SEC. 2. WORKPLACE VIOLENCE PREVENTION STANDARD. 

4 (a) RULEMAKING.— 

5 (1) Notwithstanding any other provisions of 

6 law, not later than one year of the enactment of the 

7 Act, the Secretary of Labor (‘‘Secretary’’) shall, pur8 suant to section 6 of the Occupational Safety and 

9 Health Act of 1970 (29 U.S.C. 655), promulgate an 

10 interim final standard on workplace violence preven11 tion (in this section such standard is referred to as 

12 the ‘‘workplace violence prevention standard’’) to re13 quire certain health care employers (hereinafter col14 lectively referred to as ‘‘covered health care employ15 ers’’), including hospitals, any outpatient settings or 

16 clinics operating within a hospital license or any set17 ting or clinic that provides outpatient hospital serv18 ices, psychiatric hospitals, rehabilitation hospitals, 

19 long-term care hospitals, and any hospital operated 

20 by any United States department or agency, to 

21 adopt a comprehensive plan to protect health care 

22 workers and other personnel from workplace vioVerDate Sep 11 2014 00:43 Mar 17, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5223.IH H5223

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1 lence. The interim final standard shall meet the 

2 specifications of this section, at a minimum, but may 

3 exceed the requirements for covered health care fa4 cilities. The Secretary shall accept and consider pub5 lic comments on any interim final standard pub6 lished under this paragraph for 60 days after the 

7 date of such publication. The interim final standard 

8 shall remain in effect until it is replaced by a final 

9 standard on workplace violence prevention referred 

10 to in paragraph (2). 

11 (2) Notwithstanding any other provisions of 

12 law, not later than two years of the enactment of the 

13 Act, the Secretary shall, pursuant to section 6 of the 

14 Occupational Safety and Health Act of 1970 (29 

15 U.S.C. 655), promulgate a final standard on work16 place violence prevention. The final standard shall be 

17 based on the interim final standard as promulgated 

18 under paragraph (1) of this subsection and shall 

19 meet the specifications of this section, at a min20 imum, but may exceed the requirements for covered 

21 health care facilities. 

22 (3) Not later than two years of the enactment 

23 of the Act, the Secretary shall also promulgate a 

24 final standard on workplace violence prevention to 

25 require home health agencies or organizations and 


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1 hospice agencies or organizations to adopt a com2 prehensive workplace violence prevention plan with 

3 comparable workplace protections at home health 

4 agencies or organizations and hospice agencies or or5 ganizations. The standard promulgated under this 

6 paragraph shall include procedures for hazard eval7 uation and control that fit the work settings unique 

8 to home health and hospice, which shall include, but 

9 not be limited to, each of the following: 

10 (A) Procedures to identify and evaluate en11 vironmental and patient-specific risk factors 

12 such as the presence of weapons, evidence of 

13 substance abuse, or the presence of uncoopera14 tive cohabitants. At minimum, such procedures 

15 must be utilized during intake procedures, at 

16 the time of the initial visit, and during any sub17 sequent visit when there has been a change in 

18 conditions. 

19 (B) Procedures to correct workplace vio20 lence hazards in a timely manner, which shall 

21 include, at minimum, procedures to ensure em22 ployees will not work alone in households where 

23 there is a high risk for violence, provision of 

24 functional and maintained security or commu25 nication devices for all employees working in a 


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1 patient or client’s home or community, and pro2 vision of dedicated and available security per3 sonnel to respond to reports of violent incidents 

4 or threats. 

5 (C) Procedures for responding to actual or 

6 potential workplace violence emergencies that 

7 shall include, at minimum, obtaining help from 

8 security personnel required under subparagraph 

9 (B), or law enforcement agencies as appro10 priate. 

11 (4) Not later than two years of the enactment 

12 of the Act, the Secretary shall also promulgate a 

13 final standard on workplace violence prevention to 

14 require skilled nursing facilities and nursing facili15 ties to adopt a comprehensive workplace violence 

16 prevention plan with comparable workplace protec17 tions at skilled nursing facilities and nursing facili18 ties. 

19 (b) WORKPLACE VIOLENCE PROTECTION STANDARD

20 REQUIREMENTS.—The interim final standard promul21 gated pursuant to paragraph (1) of subsection (a) shall 

22 include each of the following: 

23 (1) PLAN DEVELOPMENT.—A requirement that 

24 each covered health care employer shall, within six 

25 months of the date of promulgation of the interim 


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1 final standard, develop and implement an effective 

2 written workplace violence prevention plan (in this 

3 section such a plan is referred to as a ‘‘Workplace 

4 Violence Prevention Plan’’), which shall be main5 tained and implemented at all times in every health 

6 care facility unit, service, and operation, be available 

7 to all employees at all times; and include, at min8 imum, each of the following for every health care fa9 cility unit, service, and operation: 

10 (A) The names or job titles of the individ11 uals responsible for implementing the Work12 place Violence Prevention Plan. 

13 (B) Effective procedures that meet the re14 quirements under paragraph (2) to obtain the 

15 active involvement of employees and, where 

16 such employees are represented through a col17 lective bargaining agent, the applicable recog18 nized or certified collective bargaining agent in 

19 developing, implementing, and reviewing the 

20 Workplace Violence Prevention Plan. 

21 (C) Effective procedures that meet the re22 quirements under paragraph (2) to obtain the 

23 active involvement of security personnel who 

24 provide security services to the employer and, 

25 where such security personnel are represented 


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1 through a collective bargaining agent, the appli2 cable recognized or certified collective bar3 gaining agent in developing, implementing, and 

4 reviewing the Workplace Violence Prevention 

5 Plan. 

6 (D) Methods that meet the requirements 

7 under paragraph (2) that the employer will use 

8 to coordinate the implementation of the Work9 place Violence Prevention Plan with other em10 ployers whose employees work in the health 

11 care facility. 

12 (E) Procedures that meet the requirements 

13 under paragraph (3) for identifying and evalu14 ating workplace violence risks and hazards. 

15 (F) Procedures that meet the requirements 

16 under paragraph (3) on communicating work17 place violence risks and hazards to employees. 

18 (G) Procedures that meet the requirements 

19 under paragraph (3) for employees to report 

20 concerns regarding workplace violence risks and 

21 hazards and potential workplace violence risks 

22 and hazards. 

23 (H) Procedures that meet the require24 ments under paragraph (4) for correcting work25 place violence hazards in a timely manner. 


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1 (I) Procedures that meet the requirements 

2 of paragraph (5) for post-incident response and 

3 investigation. 

4 (J) Procedures that meet the requirements 

5 of paragraph (6) for reporting, documenting, 

6 and retaining a written record of every work7 place violence incident, post-incident response, 

8 and workplace violence injury investigation. 

9 (K) Procedures that meet the requirements 

10 of paragraph (6) for reviewing the effectiveness 

11 of the Workplace Violence Prevention Plan at 

12 least annually. 

13 (L) The nonretaliation policy that the cov14 ered health care employer is required to estab15 lish under paragraph (7). 

16 (M) Procedures that meet the require17 ments of paragraph (8) for providing effective 

18 education and in-person training to all employ19 ees, including temporary employees and per20 sonnel working in the facility but not directly 

21 employed by the employer. 

22 (N) A copy of the most recent annual writ23 ten evaluation of the Workplace Violence Pre24 vention Plan as conducted under the require25 ments of paragraph (9). 


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1 (O) A copy of the current notice to employ2 ees that is required under paragraph (10). 

3 (2) EMPLOYEE AND SECURITY PERSONNEL

4 PARTICIPATION.— 

5 (A) A requirement that each covered 

6 health care employer shall obtain active involve7 ment from employees and, where such employ8 ees are represented through a collective bar9 gaining agent, the applicable recognized or cer10 tified collective bargaining agent, in developing, 

11 implementing, and reviewing the Workplace Vi12 olence Prevention Plan. Active involvement shall 

13 include the participation of employees or their 

14 applicable representatives in— 

15 (i) identifying, evaluating, and cor16 recting workplace violence hazards; 

17 (ii) designing and implementing train18 ing; and 

19 (iii) reporting and investigating work20 place violence incidents. 

21 (B) Where security personnel are not em22 ployees of the health care facility, the covered 

23 health care employer shall be required to obtain 

24 active involvement with security personnel and, 

25 where such security personnel are represented 


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1 through a collective bargaining agent, the appli2 cable recognized or certified collective bar3 gaining agent. Active involvement shall include 

4 the participation of security personnel or their 

5 applicable representatives in— 

6 (i) identifying, evaluating, and cor7 recting workplace violence hazards; 

8 (ii) designing and implementing train9 ing; and 

10 (iii) reporting and investigating work11 place violence incidents. 

12 (C) A requirement that each covered 

13 health care employer shall establish methods to 

14 coordinate the implementation of the Workplace 

15 Violence Prevention Plan with other employers 

16 whose employees work in the health care facil17 ity. 

18 (3) WORKPLACE VIOLENCE HAZARD IDENTI19 FICATION AND EVALUATION.— 

20 (A) A requirement that each covered 

21 health care employer shall assess factors in 

22 each unit, area of the establishment, and areas 

23 surrounding the facility that may contribute to 

24 or help prevent workplace violence incidents. 


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1 Factors assessed shall include, at minimum, 

2 each of the following: 

3 (i) Staffing, including staffing pat4 terns that contribute to or are insufficient 

5 to address the risk of violence. 

6 (ii) Sufficiency of security systems, in7 cluding alarms, emergency response sys8 tems, and availability of security personnel. 

9 (iii) Job design, equipment, and facili10 ties. 

11 (iv) Environmental risk factors, as de12 fined in subparagraph (a)(6) of section 5. 

13 (v) Patient-specific risk factors, as de14 fined in subparagraph (a)(10) of section 5. 

15 (B) A requirement that each covered 

16 health care employer shall establish procedures 

17 for employees to report concerns regarding 

18 workplace violence risks and hazards or poten19 tial workplace violence risks or hazards, includ20 ing but not limited to, concerns regarding— 

21 (i) the availability, condition, and 

22 maintenance of any engineering controls 

23 identified in the Workplace Violence Pre24 vention Plan as corrective measures; 


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1 (ii) the implementation or enforce2 ment of any work practice controls identi3 fied in the Workplace Violence Prevention 

4 Plan as corrective measures; 

5 (iii) the sufficiency, availability, condi6 tion, and maintenance of security systems, 

7 including alarms, and emergency response 

8 systems; 

9 (iv) potential or unaddressed hazards 

10 and risks related to job design, equipment, 

11 or facilities with regard to workplace vio12 lence; 

13 (v) potential or unaddressed hazards 

14 and risks related to environmental and pa15 tient-specific risk factors with regard to 

16 workplace violence; and 

17 (vi) the availability of sufficient staff 

18 or security personnel to implement the 

19 Workplace Violence Prevention Plan. 

20 (C) A requirement that each covered 

21 health care employer establish procedures for 

22 how employee concerns will be investigated, and 

23 how employees will be informed of the results of 

24 the investigation and any correct actions to be 

25 taken. 


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1 (D) A requirement that each covered 

2 health care employer establish communication 

3 procedures regarding the Workplace Violence 

4 Prevention Plan, including how employees can 

5 document and communicate information regard6 ing conditions that may increase the potential 

7 for workplace violence incidents to other em8 ployees and between shifts and units. 

9 (4) WORKPLACE VIOLENCE HAZARD CORREC10 TION.— 

11 (A) A requirement that each covered 

12 health care employer shall correct workplace vi13 olence hazards in a timely manner. Each cov14 ered health care employer shall be required to 

15 use engineering controls and work practice con16 trols to eliminate or minimize employee expo17 sure to the identified hazards. Corrective meas18 ures taken under this paragraph shall include, 

19 at minimum, each of the following as appro20 priate: 

21 (i) Assigning or placing sufficient 

22 numbers of staff to reduce patient-specific 

23 Type 2 workplace violence hazards. 

24 (ii) Maintenance of sufficient numbers 

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1 sonnel, who are available to prevent and 

2 immediately respond to workplace violence 

3 incidents during each shift. A staff person 

4 is not considered to be available if other 

5 assignments prevent him or her from im6 mediately responding to an alarm or other 

7 notification of a violent incident. 

8 (iii) Reconfiguration of facility spaces 

9 so that— 

10 (I) employee access to doors and 

11 alarm systems cannot be impeded; 

12 (II) employees can maintain line 

13 of sight and other immediate means 

14 of communication in all areas where 

15 patients or members of the public may 

16 be present; and 

17 (III) furnishings and other ob18 jects cannot be used as improvised 

19 weapons. 

20 (iv) Procedures to prevent the trans21 port of unauthorized firearms and other 

22 weapons into the facility. 

23 (v) Procedures by which employees 

24 can summon security and other aid and be 


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1 alerted to the presence, location, and na2 ture of a security threat. 

3 (vi) Establishment of an effective re4 sponse plan for actual or potential work5 place violence emergencies that shall in6 clude, at minimum— 

7 (I) procedures for warning em8 ployees of the situation; 

9 (II) procedures for obtaining help 

10 from security or law enforcement 

11 agencies as appropriate; and 

12 (III) procedures to respond to 

13 mass casualty threats, such as active 

14 shooters, by developing evacuation or 

15 sheltering plans that are appropriate 

16 and feasible for the facility. 

17 (5) INCIDENT RESPONSE AND POST-INCIDENT

18 INVESTIGATION.—A requirement that each covered 

19 health care employer shall establish procedures to 

20 accept and respond to reports of workplace violence, 

21 and to perform a post-incident investigation of each 

22 workplace violence incident based on information so23 licited from the employees who experienced the vio24 lence that shall include, at minimum, each of the fol25 lowing: 


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1 (A) Procedures for how an employee can 

2 report a violent incident, threat, or other work3 place violence concern. 

4 (B) Procedures for response to reports of 

5 violent incidents, threats, or other workplace vi6 olence concerns. 

7 (C) Procedures for providing immediate 

8 medical care or first aid to employees who have 

9 been injured in the incident. 

10 (D) Procedures for making individual trau11 ma counseling available to all employees af12 fected by the incident. 

13 (E) Conducting a post-incident debriefing 

14 as soon as possible after the incident with all 

15 employees, supervisors, security personnel, and 

16 other personnel involved in the incident. 

17 (F) A review of whether the Workplace Vi18 olence Prevention Plan and any corrective 

19 measures developed under the plan were effec20 tively implemented and the circumstances sur21 rounding the workplace violence incident. 

22 (G) Procedures for investigating the cir23 cumstances of each employee injury, if any, re24 lated to the workplace violence incident. 


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1 (H) Solicitation of opinions from all em2 ployees or personnel involved in the incident, in3 cluding any injured employee, regarding the 

4 cause of the incident and whether any correc5 tive measures could have prevented the incident 

6 from occurring. 

7 (I) A policy prohibiting the employer from 

8 holding any employee or personnel who partici9 pates in an incident investigation at fault for 

10 workplace violence. 

11 (6) VIOLENT INCIDENT LOG MAINTENANCE AND

12 REVIEW.— 

13 (A) A requirement that each covered 

14 health care employer establish procedures for 

15 reporting and maintaining a written log of— 

16 (i) each violent incident against health 

17 care facility employees or personnel regard18 less of whether the employee or personnel 

19 sustains an injury, and regardless of 

20 whether the report is made by the per21 sonnel who is the subject of the violent in22 cident or any other personnel; 

23 (ii) each post-incident response; and 

24 (iii) each workplace violence injury in25 vestigation. 


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1 (B) Written records of violent incidents 

2 maintained under this paragraph shall be based 

3 on reports made by employees and personnel 

4 and shall include, each of the following: 

5 (i) A detailed description of the inci6 dent. 

7 (ii) A classification of the perpetrator, 

8 circumstances surrounding the incident, 

9 and location of the incident. 

10 (iii) The type of incident and con11 sequences of the incident, including any in12 juries. 

13 (C) As part of the procedures required 

14 under subparagraph (A), each covered health 

15 care employer shall be required to provide all 

16 employees or personnel the opportunity to pro17 vide input pertaining to their own experience of 

18 the incident. 

19 (D) A requirement that each covered 

20 health care employer shall establish a review 

21 program to analyze data relevant to the imple22 mentation of the covered health care employer’s 

23 Workplace Violence Prevention Plan. 

24 (E) Each covered health care employer 

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1 ings and data used in such review to employees, 

2 any designated representatives or collective bar3 gaining agents, and the Secretary or other Fed4 eral agency. Each covered health care employer 

5 shall maintain the data and findings from their 

6 review for at least five years. 

7 (7) NONRETALIATION.— 

8 (A) A requirement that each covered 

9 health care employer establish a policy prohib10 iting the employer from disallowing an employee 

11 from, or taking punitive or retaliatory action 

12 against an employee for, seeking assistance and 

13 intervention from local emergency services or 

14 law enforcement when a violent incident occurs. 

15 (B) A requirement that each covered 

16 health care employer establish a policy prohib17 iting the employer from disallowing an employee 

18 from, or taking punitive or retaliatory action 

19 against an employee for, reporting violent inci20 dents, threats, or other workplace violence con21 cerns. 

22 (8) EDUCATION AND TRAINING.—A require23 ment that each covered health care employer shall 

24 provide in-person training to all employees, including 

25 temporary employees and personnel working in the 


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1 facility but not directly employed by the employer. 

2 Such training shall be on the Workplace Violence 

3 Prevention Plan as established under paragraph (1) 

4 and shall— 

5 (A) address the workplace violence hazards 

6 identified in the facility, unit, work area, or op7 eration; 

8 (B) address the corrective measures the 

9 employer has implemented with regard to work10 place violence hazards identified; 

11 (C) address the activities that each em12 ployee is reasonably anticipated to perform 

13 under the Workplace Violence Prevention Plan; 

14 (D) be provided— 

15 (i) upon entering employment; 

16 (ii) on an annual basis; 

17 (iii) when such employee is trans18 ferred to a new patient care unit; 

19 (iv) when conditions change or pre20 viously unrecognized hazards are identi21 fied; 

22 (v) when requested by an employee; 

23 and 

24 (vi) as otherwise necessary; 


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1 (E) provide an opportunity for in-person 

2 interactive questions and answers; 

3 (F) be conducted in-person by an indi4 vidual with knowledge of workplace violence 

5 prevention and the covered health care employ6 er’s Workplace Violence Prevention Plan and 

7 procedures; 

8 (G) include training on emergency re9 sponse plans and procedures related to work10 place violence and practice drills on emergency 

11 response plans and procedures, including any 

12 procedures adopted for responding to mass cas13 ualty threats; and 

14 (H) utilize material appropriate in content 

15 and vocabulary to the educational level, literacy, 

16 and language of employees. 

17 (9) ANNUAL EVALUATION.— 

18 (A) IN GENERAL.—A requirement that 

19 each covered health care employer shall conduct 

20 an annual written evaluation with employees re21 garding their respective work areas, services, 

22 and operations of the implementation and effec23 tiveness of the Workplace Violence Prevention 

24 Plan, including hazard assessment and evalua25 tion procedures and findings, hazard correction 


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1 procedures, selection of engineering and work 

2 practice controls, and post-incident response 

3 and investigation. 

4 (B) ACTIVE INVOLVEMENT.—The evalua5 tion shall— 

6 (i) be conducted with the active in7 volvement of employees, and if applicable, 

8 the representatives and collective bar9 gaining agents of such employees; and 

10 (ii) document the input of the individ11 uals described in clause (i) regarding em12 ployees’ respective work areas, services, 

13 and operations. 

14 (C) CORRECTIVE ACTION.—Each covered 

15 health care employer shall correct unsafe condi16 tions, work practices, and work procedures 

17 identified in the annual written evaluation in a 

18 timely manner. 

19 (10) NOTICE OF WORKPLACE VIOLENCE PRE20 VENTION PLAN AND RIGHTS UNDER THIS ACT.—A 

21 requirement that each covered health care employer 

22 shall post a uniform notice in a form specified by the 

23 Secretary that— 

24 (A) explains the workplace violence preven25 tion standard; 


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1 (B) includes information regarding work2 place violence prevention policies and training; 

3 (C) explains procedures to report and 

4 record information on workplace violence inci5 dents and workplace violence-related injuries; 

6 and 

7 (D) explains employees’ rights under this 

8 Act, including rights to report concerns regard9 ing potential workplace violence risks or haz10 ards without punitive or retaliatory action taken 

11 by the employer. 

12 (c) EMERGENCIES.—The Secretary shall establish 

13 procedures to be followed in cases where emergency situa14 tions affect the operation of a workplace violence preven15 tion plan. 

16 (d) INSPECTIONS.—The Secretary shall conduct un17 scheduled inspections under section 8 of the Occupational 

18 Safety and Health Act of 1970 (29 U.S.C. 657) to ensure 

19 implementation of and compliance with the workplace vio20 lence prevention standard. 

21 SEC. 3. APPLICATION OF THE WORKPLACE VIOLENCE PRE22 VENTION STANDARD TO FACILITIES RECEIV23 ING MEDICARE AND MEDICAID FUNDS. 

24 (a) IN GENERAL.—Section 1866 of the Social Secu25 rity Act (42 U.S.C. 1395cc) is amended— 


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1 (1) in subsection (a)(1)(V), by inserting ‘‘and 

2 Workplace Violence Prevention Standard (as initially 

3 promulgated under section 2 of the Health Care 

4 Workplace Violence Prevention Act of 2018)’’ before 

5 the period at the end; and 

6 (2) in subsection (b)(4)— 

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

8 ‘‘and Workplace Violence Prevention Standard 

9 after Bloodborne Pathogens standard’’; and 

10 (B) in subparagraph (B), by inserting ‘‘or 

11 Workplace Violence Prevention Standard’’ after 

12 ‘‘Bloodborne Pathogens standard’’. 

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

14 subsection (a) shall apply to health care facilities begin15 ning on the date that is 1 year after the date of issuance 

16 of the interim final standard on workplace violence preven17 tion required under section 2. 

18 SEC. 4. RULES OF CONSTRUCTION. 

19 (a) EFFECT ON OTHER LAWS.—Nothing in this Act 

20 shall be construed to— 

21 (1) curtail or limit authority of the Secretary 

22 under any other provision of the law, including the 

23 application of other safety orders in health care fa24 cilities, services, and operations not covered by this 

25 Act; 


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1 (2) preempt the application of any other statute 

2 or regulation of any State or local government re3 lated to workplace violence in health care facilities 

4 except to the extent that such provisions are incon5 sistent with this Act, an interim final standard, or 

6 a final standard promulgated under this Act, and 

7 then only to the extent of the inconsistency. A provi8 sion of law of a State or local government is not in9 consistent with this Act, an interim final standard, 

10 or a final standard promulgated under this Act if 

11 such provision provides equal or greater protection 

12 to workers than the protection provided under this 

13 Act or such regulation; 

14 (3) impair or diminish the rights, privileges, or 

15 remedies of any health care worker or other em16 ployee under any Federal or State law, or under any 

17 collective bargaining agreement. 

18 SEC. 5. DEFINITIONS. 

19 (a) DEFINITIONS.—For the purposes of this Act. 

20 (1) ALARM.—The term ‘‘alarm’’ means a me21 chanical, electrical, or electronic device that does not 

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

23 others. 

24 (2) COVERED HEALTH CARE EMPLOYER.—The 

25 term ‘‘covered health care employer’’ includes— 


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1 (A) hospitals (as defined in section 1861(e) 

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

3 1395x(e)), and any outpatient settings or clinics 

4 operating within a hospital license or any set5 ting or clinic that provides outpatient hospital 

6 services; 

7 (B) psychiatric hospitals (as defined in sec8 tion 1861(e) of the Social Security Act (42 

9 U.S.C. 1395x(f)); 

10 (C) rehabilitation hospitals (as defined by 

11 the Secretary of Health and Human Services 

12 under section 1886(d)(1)(B)(ii) of the Social 

13 Security Act (42 U.S.C. 1395ww(d)(1)(B)(ii)); 

14 (D) long-term care hospitals as defined in 

15 section 1861 of the Social Security Act (42 

16 U.S.C. 1395x(ccc)); and 

17 (E) hospitals operated by the Department 

18 of Veterans Affairs, the Department of De19 fense, the Indian Health Service under the De20 partment of Health and Human Services, or 

21 any other department or agency of the United 

22 States. 

23 (3) DANGEROUS WEAPON.—The term ‘‘dan24 gerous weapon’’ means an instrument capable of inVerDate Sep 11 2014 00:43 Mar 17, 2018 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H5223.IH H5223

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1 flicting death or serious bodily injury, regardless of 

2 whether it was designed for that purpose. 

3 (4) EMPLOYEE.—The term ‘‘employee’’ includes 

4 any individual employed by a covered health care 

5 employer, including independent contractors. 

6 (5) ENGINEERING CONTROLS.—The term ‘‘en7 gineering controls’’ means an aspect of the built 

8 space or a device that removes a hazard from the 

9 workplace or creates a barrier between the worker 

10 and the hazard. For purposes of reducing workplace 

11 violence hazards, engineering controls include, but 

12 are not limited to, electronic access controls to em13 ployee occupied areas, weapon detectors (installed or 

14 handheld), enclosed workstations with shatter-resist15 ant glass, deep service counters; separate rooms or 

16 areas for high risk patients, locks on doors; fur17 niture affixed to the floor, opaque glass in patient 

18 rooms (protects privacy, but allows the health care 

19 provider to see where the patient is before entering 

20 the room), closed-circuit television monitoring and 

21 video recording, sight-aids, and personal alarm de22 vices. 

23 (6) ENVIRONMENTAL RISK FACTORS.—The 

24 term ‘‘environmental risk factors’’ means factors in 

25 the facility or area in which health care services or 


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1 operations are conducted that may contribute to the 

2 likelihood or severity of a workplace violence inci3 dent. Environmental risk factors may be associated 

4 with the specific task being performed or the work 

5 area, such as working in an isolated area, poor illu6 mination or blocked visibility, lack of physical bar7 riers between employees and persons at risk of com8 mitting workplace violence. 

9 (7) HOME HEALTH AGENCY.—The term ‘‘home 

10 health agency’’ has the meaning given such term in 

11 section 1861(o) of the Social Security Act (42 

12 U.S.C. 1395x(o)). 

13 (8) HOSPICE.—The term ‘‘hospice’’ has the 

14 meaning given such term in section 1861(d) of the 

15 Social Security Act (42 U.S.C. 1395x(dd)(1)). 

16 (9) NURSING FACILITY.—The term ‘‘nursing 

17 facility’’ has the meaning given such term in section 

18 1919 of the Social Security Act (42 U.S.C. 

19 1396r(a)). 

20 (10) PATIENT-SPECIFIC RISK FACTORS.—The 

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

22 specific to a patient that may increase the likelihood 

23 or severity of a workplace violence incident, includ24 ing a patient’s mental status, treatment and medica25 tion status, history of violence as known to the 


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1 health care facility, use of drugs or alcohol as known 

2 to the health care facility, and any other conditions 

3 or disease processes that may cause the patient to 

4 experience confusion or disorientation, to be non-re5 sponsive to instruction, or to behave unpredictably. 

6 (11) SKILLED NURSING FACILITY.—The term 

7 ‘‘skilled nursing facility’’ has the meaning given such 

8 term in section 1819(a) of the Social Security Act 

9 (42 U.S.C. 1395i–3(a)). 

10 (12) THREAT OF VIOLENCE.—The term ‘‘threat 

11 of violence’’ means a statement or conduct that 

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

13 there is a reasonable possibility the person might be 

14 physically injured, and that serves no legitimate pur15 pose. 

16 (13) WORKPLACE VIOLENCE.—The term 

17 ‘‘workplace violence’’ means any act of violence or 

18 threat of violence that occurs at the work site. The 

19 term workplace violence shall not include lawful acts 

20 of self-defense or defense of others. The term work21 place violence includes the following: 

22 (A) The threat or use of physical force 

23 against an employee that results in or has a 

24 high likelihood of resulting in injury, psychoVerDate Sep 11 2014 00:43 Mar 17, 2018 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5223.IH H5223

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1 logical trauma, or stress, regardless of whether 

2 the employee sustains an injury. 

3 (B) An incident involving the threat or use 

4 of a firearm or other dangerous weapon, includ5 ing the use of common objects as weapons, re6 gardless of whether the employee sustains an 

7 injury. 

8 (C) Four workplace violence types: 

9 (i) ‘‘Type 1 violence’’ means work10 place violence directed at an employee by a 

11 person who has no legitimate business at 

12 the work site, and includes violent acts by 

13 anyone who enters the workplace with the 

14 intent to commit a crime. 

15 (ii) ‘‘Type 2 violence’’ means work16 place violence directed at an employee by 

17 customers, clients, patients, students, in18 mates, or any others for whom an organi19 zation provides services. 

20 (iii) ‘‘Type 3 violence’’ means work21 place violence directed at an employee by a 

22 present or former employee, supervisor, or 

23 manager. 

24 (iv) ‘‘Type 4 violence’’ means work25 place violence directed at an employee by 


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1 someone who does not work there, but has 

2 or is known to have had a personal rela3 tionship with an employee. 

4 (14) WORK PRACTICE CONTROLS.—The term 

5 ‘‘work practice controls’’ means procedures, and 

6 rules which are used to effectively reduce workplace 

7 violence hazards. Work practice controls include, but 

8 are not limited to, assigning and placing sufficient 

9 numbers of staff to reduce patient-specific Type 2 

10 workplace violence hazards, provision of dedicated 

11 and available safety personnel (i.e., security guards), 

12 employee training on workplace violence prevention 

13 methods, and employee training on procedures for 

14 response in the event of a workplace violence inci15 dent and for post-incident response. 

Æ 


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