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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5223 Introduced in House (IH)]

<DOC>

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. Velazquez, 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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care 
Workplace Violence Prevention Act''.
    (b) Table of Contents.--The table of contents of 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.

SEC. 2. WORKPLACE VIOLENCE PREVENTION STANDARD.

    (a) Rulemaking.--
            (1) Notwithstanding any other provisions of law, not later 
        than one year of the enactment of the Act, the Secretary of 
        Labor (``Secretary'') shall, pursuant to section 6 of the 
        Occupational Safety and Health Act of 1970 (29 U.S.C. 655), 
        promulgate an interim final standard on workplace violence 
        prevention (in this section such standard is referred to as the 
        ``workplace violence prevention standard'') to require certain 
        health care employers (hereinafter collectively referred to as 
        ``covered health care employers''), including hospitals, any 
        outpatient settings or clinics operating within a hospital 
        license or any setting or clinic that provides outpatient 
        hospital services, psychiatric hospitals, rehabilitation 
        hospitals, long-term care hospitals, and any hospital operated 
        by any United States department or agency, to adopt a 
        comprehensive plan to protect health care workers and other 
        personnel from workplace violence. The interim final standard 
        shall meet the specifications of this section, at a minimum, 
        but may exceed the requirements for covered health care 
        facilities. The Secretary shall accept and consider public 
        comments on any interim final standard published under this 
        paragraph for 60 days after the date of such publication. The 
        interim final standard shall remain in effect until it is 
        replaced by a final standard on workplace violence prevention 
        referred to in paragraph (2).
            (2) Notwithstanding any other provisions of law, not later 
        than two years of the enactment of the Act, the Secretary 
        shall, pursuant to section 6 of the Occupational Safety and 
        Health Act of 1970 (29 U.S.C. 655), promulgate a final standard 
        on workplace violence prevention. The final standard shall be 
        based on the interim final standard as promulgated under 
        paragraph (1) of this subsection and shall meet the 
        specifications of this section, at a minimum, but may exceed 
        the requirements for covered health care facilities.
            (3) Not later than two years of the enactment of the Act, 
        the Secretary shall also promulgate a final standard on 
        workplace violence prevention to require home health agencies 
        or organizations and hospice agencies or organizations to adopt 
        a comprehensive workplace violence prevention plan with 
        comparable workplace protections at home health agencies or 
        organizations and hospice agencies or organizations. The 
        standard promulgated under this paragraph shall include 
        procedures for hazard evaluation and control that fit the work 
        settings unique to home health and hospice, which shall 
        include, but not be limited to, each of the following:
                    (A) Procedures to identify and evaluate 
                environmental and patient-specific risk factors such as 
                the presence of weapons, evidence of substance abuse, 
                or the presence of uncooperative cohabitants. At 
                minimum, such procedures must be utilized during intake 
                procedures, at the time of the initial visit, and 
                during any subsequent visit when there has been a 
                change in conditions.
                    (B) Procedures to correct workplace violence 
                hazards in a timely manner, which shall include, at 
                minimum, procedures to ensure employees will not work 
                alone in households where there is a high risk for 
                violence, provision of functional and maintained 
                security or communication devices for all employees 
                working in a patient or client's home or community, and 
                provision of dedicated and available security personnel 
                to respond to reports of violent incidents or threats.
                    (C) Procedures for responding to actual or 
                potential workplace violence emergencies that shall 
                include, at minimum, obtaining help from security 
                personnel required under subparagraph (B), or law 
                enforcement agencies as appropriate.
            (4) Not later than two years of the enactment of the Act, 
        the Secretary shall also promulgate a final standard on 
        workplace violence prevention to require skilled nursing 
        facilities and nursing facilities to adopt a comprehensive 
        workplace violence prevention plan with comparable workplace 
        protections at skilled nursing facilities and nursing 
        facilities.
    (b) Workplace Violence Protection Standard Requirements.--The 
interim final standard promulgated pursuant to paragraph (1) of 
subsection (a) shall include each of the following:
            (1) Plan development.--A requirement that each covered 
        health care employer shall, within six months of the date of 
        promulgation of the interim final standard, develop and 
        implement an effective written workplace violence prevention 
        plan (in this section such a plan is referred to as a 
        ``Workplace Violence Prevention Plan''), which shall be 
        maintained and implemented at all times in every health care 
        facility unit, service, and operation, be available to all 
        employees at all times; and include, at minimum, each of the 
        following for every health care facility unit, service, and 
        operation:
                    (A) The names or job titles of the individuals 
                responsible for implementing the Workplace Violence 
                Prevention Plan.
                    (B) Effective procedures that meet the requirements 
                under paragraph (2) to obtain the active involvement of 
                employees and, where such employees are represented 
                through a collective bargaining agent, the applicable 
                recognized or certified collective bargaining agent in 
                developing, implementing, and reviewing the Workplace 
                Violence Prevention Plan.
                    (C) Effective procedures that meet the requirements 
                under paragraph (2) to obtain the active involvement of 
                security personnel who provide security services to the 
                employer and, where such security personnel are 
                represented through a collective bargaining agent, the 
                applicable recognized or certified collective 
                bargaining agent in developing, implementing, and 
                reviewing the Workplace Violence Prevention Plan.
                    (D) Methods that meet the requirements under 
                paragraph (2) that the employer will use to coordinate 
                the implementation of the Workplace Violence Prevention 
                Plan with other employers whose employees work in the 
                health care facility.
                    (E) Procedures that meet the requirements under 
                paragraph (3) for identifying and evaluating workplace 
                violence risks and hazards.
                    (F) Procedures that meet the requirements under 
                paragraph (3) on communicating workplace violence risks 
                and hazards to employees.
                    (G) Procedures that meet the requirements under 
                paragraph (3) for employees to report concerns 
                regarding workplace violence risks and hazards and 
                potential workplace violence risks and hazards.
                    (H) Procedures that meet the requirements under 
                paragraph (4) for correcting workplace violence hazards 
                in a timely manner.
                    (I) Procedures that meet the requirements of 
                paragraph (5) for post-incident response and 
                investigation.
                    (J) Procedures that meet the requirements of 
                paragraph (6) for reporting, documenting, and retaining 
                a written record of every workplace violence incident, 
                post-incident response, and workplace violence injury 
                investigation.
                    (K) Procedures that meet the requirements of 
                paragraph (6) for reviewing the effectiveness of the 
                Workplace Violence Prevention Plan at least annually.
                    (L) The nonretaliation policy that the covered 
                health care employer is required to establish under 
                paragraph (7).
                    (M) Procedures that meet the requirements of 
                paragraph (8) for providing effective education and in-
                person training to all employees, including temporary 
                employees and personnel working in the facility but not 
                directly employed by the employer.
                    (N) A copy of the most recent annual written 
                evaluation of the Workplace Violence Prevention Plan as 
                conducted under the requirements of paragraph (9).
                    (O) A copy of the current notice to employees that 
                is required under paragraph (10).
            (2) Employee and security personnel participation.--
                    (A) A requirement that each covered health care 
                employer shall obtain active involvement from employees 
                and, where such employees are represented through a 
                collective bargaining agent, the applicable recognized 
                or certified collective bargaining agent, in 
                developing, implementing, and reviewing the Workplace 
                Violence Prevention Plan. Active involvement shall 
                include the participation of employees or their 
                applicable representatives in--
                            (i) identifying, evaluating, and correcting 
                        workplace violence hazards;
                            (ii) designing and implementing training; 
                        and
                            (iii) reporting and investigating workplace 
                        violence incidents.
                    (B) Where security personnel are not employees of 
                the health care facility, the covered health care 
                employer shall be required to obtain active involvement 
                with security personnel and, where such security 
                personnel are represented through a collective 
                bargaining agent, the applicable recognized or 
                certified collective bargaining agent. Active 
                involvement shall include the participation of security 
                personnel or their applicable representatives in--
                            (i) identifying, evaluating, and correcting 
                        workplace violence hazards;
                            (ii) designing and implementing training; 
                        and
                            (iii) reporting and investigating workplace 
                        violence incidents.
                    (C) A requirement that each covered health care 
                employer shall establish methods to coordinate the 
                implementation of the Workplace Violence Prevention 
                Plan with other employers whose employees work in the 
                health care facility.
            (3) Workplace violence hazard identification and 
        evaluation.--
                    (A) A requirement that each covered health care 
                employer shall assess factors in each unit, area of the 
                establishment, and areas surrounding the facility that 
                may contribute to or help prevent workplace violence 
                incidents. Factors assessed shall include, at minimum, 
                each of the following:
                            (i) Staffing, including staffing patterns 
                        that contribute to or are insufficient to 
                        address the risk of violence.
                            (ii) Sufficiency of security systems, 
                        including alarms, emergency response systems, 
                        and availability of security personnel.
                            (iii) Job design, equipment, and 
                        facilities.
                            (iv) Environmental risk factors, as defined 
                        in subparagraph (a)(6) of section 5.
                            (v) Patient-specific risk factors, as 
                        defined in subparagraph (a)(10) of section 5.
                    (B) A requirement that each covered health care 
                employer shall establish procedures for employees to 
                report concerns regarding workplace violence risks and 
                hazards or potential workplace violence risks or 
                hazards, including but not limited to, concerns 
                regarding--
                            (i) the availability, condition, and 
                        maintenance of any engineering controls 
                        identified in the Workplace Violence Prevention 
                        Plan as corrective measures;
                            (ii) the implementation or enforcement of 
                        any work practice controls identified in the 
                        Workplace Violence Prevention Plan as 
                        corrective measures;
                            (iii) the sufficiency, availability, 
                        condition, and maintenance of security systems, 
                        including alarms, and emergency response 
                        systems;
                            (iv) potential or unaddressed hazards and 
                        risks related to job design, equipment, or 
                        facilities with regard to workplace violence;
                            (v) potential or unaddressed hazards and 
                        risks related to environmental and patient-
                        specific risk factors with regard to workplace 
                        violence; and
                            (vi) the availability of sufficient staff 
                        or security personnel to implement the 
                        Workplace Violence Prevention Plan.
                    (C) A requirement that each covered health care 
                employer establish procedures for how employee concerns 
                will be investigated, and how employees will be 
                informed of the results of the investigation and any 
                correct actions to be taken.
                    (D) A requirement that each covered health care 
                employer establish communication procedures regarding 
                the Workplace Violence Prevention Plan, including how 
                employees can document and communicate information 
                regarding conditions that may increase the potential 
                for workplace violence incidents to other employees and 
                between shifts and units.
            (4) Workplace violence hazard correction.--
                    (A) A requirement that each covered health care 
                employer shall correct workplace violence hazards in a 
                timely manner. Each covered health care employer shall 
                be required to use engineering controls and work 
                practice controls to eliminate or minimize employee 
                exposure to the identified hazards. Corrective measures 
                taken under this paragraph shall include, at minimum, 
                each of the following as appropriate:
                            (i) Assigning or placing sufficient numbers 
                        of staff to reduce patient-specific Type 2 
                        workplace violence hazards.
                            (ii) Maintenance of sufficient numbers of 
                        trained staff, including security personnel, 
                        who are available to prevent and immediately 
                        respond to workplace violence incidents during 
                        each shift. A staff person is not considered to 
                        be available if other assignments prevent him 
                        or her from immediately responding to an alarm 
                        or other notification of a violent incident.
                            (iii) Reconfiguration of facility spaces so 
                        that--
                                    (I) employee access to doors and 
                                alarm systems cannot be impeded;
                                    (II) employees can maintain line of 
                                sight and other immediate means of 
                                communication in all areas where 
                                patients or members of the public may 
                                be present; and
                                    (III) furnishings and other objects 
                                cannot be used as improvised weapons.
                            (iv) Procedures to prevent the transport of 
                        unauthorized firearms and other weapons into 
                        the facility.
                            (v) Procedures by which employees can 
                        summon security and other aid and be alerted to 
                        the presence, location, and nature of a 
                        security threat.
                            (vi) Establishment of an effective response 
                        plan for actual or potential workplace violence 
                        emergencies that shall include, at minimum--
                                    (I) procedures for warning 
                                employees of the situation;
                                    (II) procedures for obtaining help 
                                from security or law enforcement 
                                agencies as appropriate; and
                                    (III) procedures to respond to mass 
                                casualty threats, such as active 
                                shooters, by developing evacuation or 
                                sheltering plans that are appropriate 
                                and feasible for the facility.
            (5) Incident response and post-incident investigation.--A 
        requirement that each covered health care employer shall 
        establish procedures to accept and respond to reports of 
        workplace violence, and to perform a post-incident 
        investigation of each workplace violence incident based on 
        information solicited from the employees who experienced the 
        violence that shall include, at minimum, each of the following:
                    (A) Procedures for how an employee can report a 
                violent incident, threat, or other workplace violence 
                concern.
                    (B) Procedures for response to reports of violent 
                incidents, threats, or other workplace violence 
                concerns.
                    (C) Procedures for providing immediate medical care 
                or first aid to employees who have been injured in the 
                incident.
                    (D) Procedures for making individual trauma 
                counseling available to all employees affected by the 
                incident.
                    (E) Conducting a post-incident debriefing as soon 
                as possible after the incident with all employees, 
                supervisors, security personnel, and other personnel 
                involved in the incident.
                    (F) A review of whether the Workplace Violence 
                Prevention Plan and any corrective measures developed 
                under the plan were effectively implemented and the 
                circumstances surrounding the workplace violence 
                incident.
                    (G) Procedures for investigating the circumstances 
                of each employee injury, if any, related to the 
                workplace violence incident.
                    (H) Solicitation of opinions from all employees or 
                personnel involved in the incident, including any 
                injured employee, regarding the cause of the incident 
                and whether any corrective measures could have 
                prevented the incident from occurring.
                    (I) A policy prohibiting the employer from holding 
                any employee or personnel who participates in an 
                incident investigation at fault for workplace violence.
            (6) Violent incident log maintenance and review.--
                    (A) A requirement that each covered health care 
                employer establish procedures for reporting and 
                maintaining a written log of--
                            (i) each violent incident against health 
                        care facility employees or personnel regardless 
                        of whether the employee or personnel sustains 
                        an injury, and regardless of whether the report 
                        is made by the personnel who is the subject of 
                        the violent incident or any other personnel;
                            (ii) each post-incident response; and
                            (iii) each workplace violence injury 
                        investigation.
                    (B) Written records of violent incidents maintained 
                under this paragraph shall be based on reports made by 
                employees and personnel and shall include, each of the 
                following:
                            (i) A detailed description of the incident.
                            (ii) A classification of the perpetrator, 
                        circumstances surrounding the incident, and 
                        location of the incident.
                            (iii) The type of incident and consequences 
                        of the incident, including any injuries.
                    (C) As part of the procedures required under 
                subparagraph (A), each covered health care employer 
                shall be required to provide all employees or personnel 
                the opportunity to provide input pertaining to their 
                own experience of the incident.
                    (D) A requirement that each covered health care 
                employer shall establish a review program to analyze 
                data relevant to the implementation of the covered 
                health care employer's Workplace Violence Prevention 
                Plan.
                    (E) Each covered health care employer shall, upon 
                request, make available their findings and data used in 
                such review to employees, any designated 
                representatives or collective bargaining agents, and 
                the Secretary or other Federal agency. Each covered 
                health care employer shall maintain the data and 
                findings from their review for at least five years.
            (7) Nonretaliation.--
                    (A) A requirement that each covered health care 
                employer establish a policy prohibiting the employer 
                from disallowing an employee from, or taking punitive 
                or retaliatory action against an employee for, seeking 
                assistance and intervention from local emergency 
                services or law enforcement when a violent incident 
                occurs.
                    (B) A requirement that each covered health care 
                employer establish a policy prohibiting the employer 
                from disallowing an employee from, or taking punitive 
                or retaliatory action against an employee for, 
                reporting violent incidents, threats, or other 
                workplace violence concerns.
            (8) Education and training.--A requirement that each 
        covered health care employer shall provide in-person training 
        to all employees, including temporary employees and personnel 
        working in the facility but not directly employed by the 
        employer. Such training shall be on the Workplace Violence 
        Prevention Plan as established under paragraph (1) and shall--
                    (A) address the workplace violence hazards 
                identified in the facility, unit, work area, or 
                operation;
                    (B) address the corrective measures the employer 
                has implemented with regard to workplace violence 
                hazards identified;
                    (C) address the activities that each employee is 
                reasonably anticipated to perform under the Workplace 
                Violence Prevention Plan;
                    (D) be provided--
                            (i) upon entering employment;
                            (ii) on an annual basis;
                            (iii) when such employee is transferred to 
                        a new patient care unit;
                            (iv) when conditions change or previously 
                        unrecognized hazards are identified;
                            (v) when requested by an employee; and
                            (vi) as otherwise necessary;
                    (E) provide an opportunity for in-person 
                interactive questions and answers;
                    (F) be conducted in-person by an individual with 
                knowledge of workplace violence prevention and the 
                covered health care employer's Workplace Violence 
                Prevention Plan and procedures;
                    (G) include training on emergency response plans 
                and procedures related to workplace violence and 
                practice drills on emergency response plans and 
                procedures, including any procedures adopted for 
                responding to mass casualty threats; and
                    (H) utilize material appropriate in content and 
                vocabulary to the educational level, literacy, and 
                language of employees.
            (9) Annual evaluation.--
                    (A) In general.--A requirement that each covered 
                health care employer shall conduct an annual written 
                evaluation with employees regarding their respective 
                work areas, services, and operations of the 
                implementation and effectiveness of the Workplace 
                Violence Prevention Plan, including hazard assessment 
                and evaluation procedures and findings, hazard 
                correction procedures, selection of engineering and 
                work practice controls, and post-incident response and 
                investigation.
                    (B) Active involvement.--The evaluation shall--
                            (i) be conducted with the active 
                        involvement of employees, and if applicable, 
                        the representatives and collective bargaining 
                        agents of such employees; and
                            (ii) document the input of the individuals 
                        described in clause (i) regarding employees' 
                        respective work areas, services, and 
                        operations.
                    (C) Corrective action.--Each covered health care 
                employer shall correct unsafe conditions, work 
                practices, and work procedures identified in the annual 
                written evaluation in a timely manner.
            (10) Notice of workplace violence prevention plan and 
        rights under this act.--A requirement that each covered health 
        care employer shall post a uniform notice in a form specified 
        by the Secretary that--
                    (A) explains the workplace violence prevention 
                standard;
                    (B) includes information regarding workplace 
                violence prevention policies and training;
                    (C) explains procedures to report and record 
                information on workplace violence incidents and 
                workplace violence-related injuries; and
                    (D) explains employees' rights under this Act, 
                including rights to report concerns regarding potential 
                workplace violence risks or hazards without punitive or 
                retaliatory action taken by the employer.
    (c) Emergencies.--The Secretary shall establish procedures to be 
followed in cases where emergency situations affect the operation of a 
workplace violence prevention plan.
    (d) Inspections.--The Secretary shall conduct unscheduled 
inspections under section 8 of the Occupational Safety and Health Act 
of 1970 (29 U.S.C. 657) to ensure implementation of and compliance with 
the workplace violence prevention standard.

SEC. 3. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION STANDARD TO 
              FACILITIES RECEIVING MEDICARE AND MEDICAID FUNDS.

    (a) In General.--Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended--
            (1) in subsection (a)(1)(V), by inserting ``and Workplace 
        Violence Prevention Standard (as initially promulgated under 
        section 2 of the Health Care Workplace Violence Prevention Act 
        of 2018)'' before the period at the end; and
            (2) in subsection (b)(4)--
                    (A) in subparagraph (A), by inserting ``and 
                Workplace Violence Prevention Standard after Bloodborne 
                Pathogens standard''; and
                    (B) in subparagraph (B), by inserting ``or 
                Workplace Violence Prevention Standard'' after 
                ``Bloodborne Pathogens standard''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to health care facilities beginning on the date that is 1 year 
after the date of issuance of the interim final standard on workplace 
violence prevention required under section 2.

SEC. 4. RULES OF CONSTRUCTION.

    (a) Effect on Other Laws.--Nothing in this Act shall be construed 
to--
            (1) curtail or limit authority of the Secretary under any 
        other provision of the law, including the application of other 
        safety orders in health care facilities, services, and 
        operations not covered by this Act;
            (2) preempt the application of any other statute or 
        regulation of any State or local government related to 
        workplace violence in health care facilities except to the 
        extent that such provisions are inconsistent with this Act, an 
        interim final standard, or a final standard promulgated under 
        this Act, and then only to the extent of the inconsistency. A 
        provision of law of a State or local government is not 
        inconsistent with this Act, an interim final standard, or a 
        final standard promulgated under this Act if such provision 
        provides equal or greater protection to workers than the 
        protection provided under this Act or such regulation;
            (3) impair or diminish the rights, privileges, or remedies 
        of any health care worker or other employee under any Federal 
        or State law, or under any collective bargaining agreement.

SEC. 5. DEFINITIONS.

    (a) Definitions.--For the purposes of this Act.
            (1) Alarm.--The term ``alarm'' means a mechanical, 
        electrical, or electronic device that does not rely upon an 
        employee's vocalization in order to alert others.
            (2) Covered health care employer.--The term ``covered 
        health care employer'' includes--
                    (A) hospitals (as defined in section 1861(e) of the 
                Social Security Act (42 U.S.C. 1395x(e)), and any 
                outpatient settings or clinics operating within a 
                hospital license or any setting or clinic that provides 
                outpatient hospital services;
                    (B) psychiatric hospitals (as defined in section 
                1861(e) of the Social Security Act (42 U.S.C. 
                1395x(f));
                    (C) rehabilitation hospitals (as defined by the 
                Secretary of Health and Human Services under section 
                1886(d)(1)(B)(ii) of the Social Security Act (42 U.S.C. 
                1395ww(d)(1)(B)(ii));
                    (D) long-term care hospitals as defined in section 
                1861 of the Social Security Act (42 U.S.C. 1395x(ccc)); 
                and
                    (E) hospitals operated by the Department of 
                Veterans Affairs, the Department of Defense, the Indian 
                Health Service under the Department of Health and Human 
                Services, or any other department or agency of the 
                United States.
            (3) Dangerous weapon.--The term ``dangerous weapon'' means 
        an instrument capable of inflicting death or serious bodily 
        injury, regardless of whether it was designed for that purpose.
            (4) Employee.--The term ``employee'' includes any 
        individual employed by a covered health care employer, 
        including independent contractors.
            (5) Engineering controls.--The term ``engineering 
        controls'' means an aspect of the built space or a device that 
        removes a hazard from the workplace or creates a barrier 
        between the worker and the hazard. For purposes of reducing 
        workplace violence hazards, engineering controls include, but 
        are not limited to, electronic access controls to employee 
        occupied areas, weapon detectors (installed or handheld), 
        enclosed workstations with shatter-resistant glass, deep 
        service counters; separate rooms or areas for high risk 
        patients, locks on doors; furniture affixed to the floor, 
        opaque glass in patient rooms (protects privacy, but allows the 
        health care provider to see where the patient is before 
        entering the room), closed-circuit television monitoring and 
        video recording, sight-aids, and personal alarm devices.
            (6) Environmental risk factors.--The term ``environmental 
        risk factors'' means factors in the facility or area in which 
        health care services or operations are conducted that may 
        contribute to the likelihood or severity of a workplace 
        violence incident. Environmental risk factors may be associated 
        with the specific task being performed or the work area, such 
        as working in an isolated area, poor illumination or blocked 
        visibility, lack of physical barriers between employees and 
        persons at risk of committing workplace violence.
            (7) Home health agency.--The term ``home health agency'' 
        has the meaning given such term in section 1861(o) of the 
        Social Security Act (42 U.S.C. 1395x(o)).
            (8) Hospice.--The term ``hospice'' has the meaning given 
        such term in section 1861(d) of the Social Security Act (42 
        U.S.C. 1395x(dd)(1)).
            (9) Nursing facility.--The term ``nursing facility'' has 
        the meaning given such term in section 1919 of the Social 
        Security Act (42 U.S.C. 1396r(a)).
            (10) Patient-specific risk factors.--The term ``patient-
        specific risk factors'' means factors specific to a patient 
        that may increase the likelihood or severity of a workplace 
        violence incident, including a patient's mental status, 
        treatment and medication status, history of violence as known 
        to the health care facility, use of drugs or alcohol as known 
        to the health care facility, and any other conditions or 
        disease processes that may cause the patient to experience 
        confusion or disorientation, to be non-responsive to 
        instruction, or to behave unpredictably.
            (11) Skilled nursing facility.--The term ``skilled nursing 
        facility'' has the meaning given such term in section 1819(a) 
        of the Social Security Act (42 U.S.C. 1395i-3(a)).
            (12) Threat of violence.--The term ``threat of violence'' 
        means a statement or conduct that causes a person to fear for 
        his or her safety because there is a reasonable possibility the 
        person might be physically injured, and that serves no 
        legitimate purpose.
            (13) Workplace violence.--The term ``workplace violence'' 
        means any act of violence or threat of violence that occurs at 
        the work site. The term workplace violence shall not include 
        lawful acts of self-defense or defense of others. The term 
        workplace violence includes the following:
                    (A) The threat or use of physical force against an 
                employee that results in or has a high likelihood of 
                resulting in injury, psychological trauma, or stress, 
                regardless of whether the employee sustains an injury.
                    (B) An incident involving the threat or use of a 
                firearm or other dangerous weapon, including the use of 
                common objects as weapons, regardless of whether the 
                employee sustains an injury.
                    (C) Four workplace violence types:
                            (i) ``Type 1 violence'' means workplace 
                        violence directed at an employee by a person 
                        who has no legitimate business at the work 
                        site, and includes violent acts by anyone who 
                        enters the workplace with the intent to commit 
                        a crime.
                            (ii) ``Type 2 violence'' means workplace 
                        violence directed at an employee by customers, 
                        clients, patients, students, inmates, or any 
                        others for whom an organization provides 
                        services.
                            (iii) ``Type 3 violence'' means workplace 
                        violence directed at an employee by a present 
                        or former employee, supervisor, or manager.
                            (iv) ``Type 4 violence'' means workplace 
                        violence directed at an employee by someone who 
                        does not work there, but has or is known to 
                        have had a personal relationship with an 
                        employee.
            (14) Work practice controls.--The term ``work practice 
        controls'' means procedures, and rules which are used to 
        effectively reduce workplace violence hazards. Work practice 
        controls include, but are not limited to, assigning and placing 
        sufficient numbers of staff to reduce patient-specific Type 2 
        workplace violence hazards, provision of dedicated and 
        available safety personnel (i.e., security guards), employee 
        training on workplace violence prevention methods, and employee 
        training on procedures for response in the event of a workplace 
        violence incident and for post-incident response.
                                 <all>
```