I 

115TH CONGRESS 

2D SESSION H. R. 7141 

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

standard that requires covered employers within the health care and 

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

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 16, 2018 

Mr. COURTNEY (for himself, Ms. BONAMICI, Mr. BRADY of Pennsylvania, Ms. 

DELAURO, Ms. NORTON, Ms. JACKSON LEE, Mr. KHANNA, Ms. SCHAKOWSKY, Mr. SCOTT of Virginia, Mr. TAKANO, Ms. WILSON of Florida, 

Ms. SHEA-PORTER, Mr. SIRES, Mr. DESAULNIER, Mr. LARSON of Connecticut, Mr. PAYNE, Mr. HIMES, Mr. POCAN, Mr. CICILLINE, Ms. ESTY

of Connecticut, Mr. NORCROSS, and Mr. ESPAILLAT) 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 standard that requires covered employers within the health care and social service industries 

to develop and implement a comprehensive workplace 

violence prevention plan, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

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

3 Prevention for Health Care and Social Service Workers 

4 Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

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

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

12 assaults over the 5-year span from 2009 through 

13 2013, based on Bureau of Justice Statistics data. 

14 (2) The health care and social service industries 

15 experience the highest rates of injuries caused by 

16 workplace violence. Nurses and nursing, psychiatric, 

17 home health, and personal care aides all are at high 

18 risk. 

19 (3) The Bureau of Labor Statistics reports that 

20 health care and social service workers suffered 69 

21 percent of all workplace violence injuries caused by 

22 persons in 2016 and are nearly 5 times as likely to 

23 suffer a workplace violence injury than workers over24 all. 

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

26 emergency physicians conducted by the American 


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1 College of Emergency Physicians, 47 percent of 

2 emergency room doctors have been physically as3 saulted at work, and 8 in 10 report that this vio4 lence is affecting patient care. 

5 (5) Workplace violence in health care and social 

6 service sectors is increasing. Bureau of Labor Statis7 tics data show that private sector injury rates of 

8 workplace violence in health care and social service 

9 sectors increased by 63 percent between 2006 and 

10 2016. Due to under-reporting, actual injury rates 

11 from workplace violence are widely recognized to be 

12 higher than reported levels. 

13 (6) Violence against workers in health care set14 tings is most commonly due to assaults by patients 

15 or clients, or persons accompanying patients or cli16 ents. 

17 (7) The Occupational Safety and Health Ad18 ministration has issued ‘‘Guidelines for Preventing 

19 Workplace Violence for Healthcare and Social Serv20 ice Workers’’, however, this guidance is not enforce21 able. Absent an enforceable standard, employers lack 

22 mandatory requirements to implement a violence 

23 prevention program, and workers lack sufficient pro24 tection from workplace violence. 


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1 (8) Studies have demonstrated that workplace 

2 violence prevention programs tailored to the needs of 

3 specific work areas and State-based workplace vio4 lence prevention legislation are strongly associated 

5 with reductions in workplace violence. Proper staff 

6 training, appropriate staffing levels, sufficient re7 sources, and the use of evidence-based practices in 

8 the provision of services (such as effective commu9 nication with patients using de-escalation tech10 niques) can reduce risks to the safety of both pa11 tients and staff. 

12 (9) Nine States have mandated that certain 

13 types of health care facilities implement workplace 

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

15 Division of Occupational Safety and Health of the 

16 State of California issued a comprehensive standard 

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

18 that requires health care facilities to implement a 

19 workplace violence prevention plan. 

20 (10) Employer organizations have challenged 

21 the Occupational Safety and Health Administra22 tion’s authority to utilize the General Duty Clause 

23 of the Occupational Safety and Health Act of 1970 

24 to enforce against workplace violence hazards, argu25 ing that Congress did not intend to cover workplace 


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1 violence under such clause when the Act was enacted 

2 in 1970. 

3 (11) The Occupational Safety and Health Ad4 ministration (OSHA) received two petitions for rule5 making in July of 2016, calling on OSHA to pro6 mulgate a violence prevention standard for health 

7 care and social service sectors. On December 6, 

8 2016, OSHA issued a Request for Information 

9 (RFI) soliciting information on this issue. On Janu10 ary 10, 2017, OSHA conducted a public meeting to 

11 receive stakeholder input and to supplement the on12 line comments submitted in response to the RFI. At 

13 that meeting, OSHA announced it accepted the peti14 tions and would develop a Federal standard to pre15 vent workplace violence in health care and social 

16 service settings. In the spring of 2017, the work17 place violence prevention standard was removed from 

18 active consideration and placed on the Department 

19 of Labor’s ‘‘long-term agenda’’. Subsequently, it was 

20 placed back on the regulatory agenda. OSHA’s ef21 forts to move forward with rulemaking have been 

22 halting and inconsistent. Therefore, legislation is 

23 necessary to ensure the timely development of a 

24 standard to protect workers in health care and social 

25 service settings. 


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1 SEC. 3. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Findings. 

Sec. 3. Table of contents. 

TITLE I—WORKPLACE VIOLENCE PREVENTION STANDARD 

Sec. 101. Workplace violence prevention standard. 

Sec. 102. Scope and application. 

Sec. 103. Requirements for workplace violence prevention standard. 

Sec. 104. Rules of construction. 

Sec. 105. Other definitions. 

TITLE II—AMENDMENTS TO THE SOCIAL SECURITY ACT 

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

facilities receiving Medicare funds. 

3 TITLE I—WORKPLACE VIOLENCE 

4 PREVENTION STANDARD 

5 SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD. 

6 (a) INTERIM FINAL STANDARD.— 

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

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

9 Labor shall promulgate an interim final standard on 

10 workplace violence prevention— 

11 (A) to require certain employers in the 

12 healthcare and social service sectors, and cer13 tain employers in sectors that conduct activities 

14 similar to the activities in the healthcare and 

15 social service sectors, to develop and implement 

16 a comprehensive workplace violence prevention 

17 plan to protect health care workers, social servVerDate Sep 11 2014 22:47 Nov 20, 2018 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7141.IH H7141

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

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

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

7 Health Administration of the Department of 

8 Labor in 2015 and adhere to the requirements 

9 of this title. 

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

12 promulgation of the interim final standard under 

13 this subsection: 

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

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

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

18 (B) The requirements of chapters 5 and 6 

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

20 42, United States Code. 

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

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

24 than 30 days after promulgation, except that 

25 such interim final standard may include a reaVerDate Sep 11 2014 22:47 Nov 20, 2018 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7141.IH H7141

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1 sonable phase-in period for the implementation 

2 of required engineering controls that take effect 

3 after such date; 

4 (B) be enforced in the same manner and 

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

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

8 655(b)); and 

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

11 enforceable. 

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

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

16 in effect and enforced in the same manner and to 

17 the same extent as any standard promulgated under 

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

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

23 (b) FINAL STANDARD.— 

24 (1) PROPOSED FINAL STANDARD.—Not later 

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


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1 the Secretary of Labor shall, pursuant to section 6 

2 of the Occupational Safety and Health Act (29 

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

4 on workplace violence prevention— 

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

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

8 elements contained in the interim final standard 

9 promulgated under subsection (a). 

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

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

12 Secretary shall promulgate a final standard on such 

13 proposed standard that shall— 

14 (A) provide no less protection than any 

15 workplace violence standard adopted by a State 

16 plan that has been approved by the Secretary 

17 under section 18 of the Occupational Safety 

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

19 (B) be effective and enforceable in the 

20 same manner and to the same extent as any 

21 standard promulgated under section 6(b) of the 

22 Occupational Safety and Health Act of 1970 

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

24 SEC. 102. SCOPE AND APPLICATION. 

25 In this title: 


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

2 facility’’ includes the following: 

3 (A) Any hospital, including any specialty 

4 hospital, in-patient or outpatient setting, or 

5 clinic operating within a hospital license, or any 

6 setting that provides outpatient services. 

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

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

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

15 (E) Any community care setting, including 

16 a community-based residential facility, group 

17 home, and mental health clinic. 

18 (F) Any psychiatric treatment facility. 

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

21 (H) Any independent freestanding emer22 gency centers. 

23 (I) Any facility described in subparagraphs 

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1 pational safety and health standards pursuant 

2 to section 1960 of title 29, Code of Federal 

3 Regulations. 

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

6 promulgated under section 101. 

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

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

10 (A) Any services and operations provided 

11 in any field work setting, including home health 

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

14 (B) Any emergency services and transport, 

15 including such services provided by firefighters 

16 and emergency responders. 

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

19 Government agency and required to comply 

20 with occupational safety and health standards 

21 pursuant to section 1960 of title 29, Code of 

22 Federal Regulations. 

23 (D) Any other services and operations the 

24 Secretary determines should be covered under 

25 the standards promulgated under section 101. 


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1 (3) COVERED EMPLOYER.— 

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

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

7 or to perform covered services. 

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

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

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

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

17 SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 

18 PREVENTION STANDARD. 

19 Each standard described in section 101 shall include, 

20 at a minimum, the following requirements: 

21 (1) WORKPLACE VIOLENCE PREVENTION

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

23 promulgation of the interim final standard under 

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


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1 violence prevention plan for covered employees at 

2 each covered facility controlled by the employer and 

3 for covered employees performing a covered service 

4 on behalf of such employer, which meet the fol5 lowing: 

6 (A) PLAN DEVELOPMENT.—Each Plan 

7 shall— 

8 (i) be developed and implemented with 

9 the meaningful participation of direct care 

10 employees and, where applicable, employee 

11 representatives and collective bargaining 

12 representatives, for all aspects of the Plan; 

13 (ii) be tailored and specific to condi14 tions and hazards for the covered facility 

15 or the covered service, including patient16 specific risk factors and risk factors spe17 cific to each work area or unit; and 

18 (iii) be suitable for the size and com19 plexity of operations at the covered facility 

20 or for the covered service, and remain in 

21 effect at all times. 

22 (B) PLAN CONTENT.—Each Plan shall in23 clude procedures and methods for the following: 

24 (i) Identification of the individual re25 sponsible for implementation of the Plan. 


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1 (ii) With respect to each work area 

2 and unit at the covered facility or while 

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

6 hazards to employees exposed to such risks 

7 and hazards (including environmental risk 

8 factors and patient-specific risk factors), 

9 which shall be— 

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

12 or such covered service; and 

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

15 (aa) direct care employees; 

16 (bb) where applicable, the 

17 representatives of such employ18 ees; and 

19 (cc) the employer. 

20 (iii) Hazard prevention, engineering 

21 controls, and work practice controls to cor22 rect hazards in a timely manner applying 

23 industrial hygiene principles of the hier24 archy of controls, which— 


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1 (I) may include security and 

2 alarm systems, adequate exit routes, 

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

5 and clients, lighting, entry procedures, 

6 staffing and working in teams, and 

7 systems to identify and flag clients 

8 with a history of violence; and 

9 (II) shall ensure that employers 

10 correct, in a timely manner, hazards 

11 identified in the annual report de12 scribed in paragraph (5). 

13 (iv) Reporting, incident response, and 

14 post-incident investigation procedures, in15 cluding procedures— 

16 (I) for employees to report work17 place violence risks, hazards, and inci18 dents; 

19 (II) for employers to respond to 

20 reports of workplace violence; 

21 (III) for employers to perform a 

22 post-incident investigation and de23 briefing of all reports of workplace vi24 olence with the participation of em25 ployees and their representatives; and 


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1 (IV) to provide medical care or 

2 first aid to affected employees. 

3 (v) Procedures for emergency re4 sponse, including procedures for threats of 

5 mass casualties and procedures for inci6 dents involving a firearm or a dangerous 

7 weapon. 

8 (vi) Procedures for communicating 

9 with and training of covered employees on 

10 workplace violence hazards, threats, and 

11 work practice controls, the employer’s plan, 

12 and procedures for confronting, responding 

13 to, and reporting workplace violence 

14 threats, incidents, and concerns, and em15 ployee rights. 

16 (vii) Procedures for coordination of 

17 risk assessment efforts, Plan development, 

18 and implementation of the Plan with other 

19 employers who have employees who work 

20 at the covered facility or who are per21 forming the covered service. 

22 (viii) Procedures for conducting the 

23 annual evaluation under paragraph (6). 

24 (C) AVAILABILITY OF PLAN.—Each Plan 

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1 ered employees who are covered under such 

2 Plan. 

3 (2) VIOLENT INCIDENT INVESTIGATION.— 

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

5 after a workplace violence incident, risk, or haz6 ard of which a covered employer has knowledge, 

7 the employer shall conduct an investigation of 

8 such incident, risk, or hazard under which the 

9 employer shall— 

10 (i) review the circumstances of the in11 cident, risk, or hazard, and whether any 

12 controls or measures implemented pursu13 ant to the Plan of the employer were effec14 tive; and 

15 (ii) solicit input from involved employ16 ees, their representatives, and supervisors, 

17 about the cause of the incident, risk, or 

18 hazard, and whether further corrective 

19 measures (including system-level factors) 

20 could have prevented the incident, risk, or 

21 hazard. 

22 (B) DOCUMENTATION.—A covered em23 ployer shall document the findings, rec24 ommendations, and corrective measures taken 


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1 for each investigation conducted under this 

2 paragraph. 

3 (3) TRAINING AND EDUCATION.—With respect 

4 to the covered employees covered under a Plan of a 

5 covered employer, the employer shall provide train6 ing and education to such employees who may be ex7 posed to workplace violence hazards and risks, which 

8 meet the following requirements: 

9 (A) Annual training and education includes 

10 information on the Plan, including identified 

11 workplace violence hazards, work practice con12 trol measures, reporting procedures, record 

13 keeping requirements, response procedures, and 

14 employee rights. 

15 (B) Additional hazard recognition training 

16 for supervisors and managers to ensure they 

17 can recognize high-risk situations and do not 

18 assign employees to situations that predictably 

19 compromise their safety. 

20 (C) Additional training for each such cov21 ered employee whose job circumstances has 

22 changed, within a reasonable timeframe after 

23 such change. 

24 (D) New employee training prior to assign25 ment. 


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1 (E) All training provides such employees 

2 opportunities to ask questions, give feedback on 

3 such training, and request additional instruc4 tion, clarification, or other follow up. 

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

6 by an individual with knowledge of workplace 

7 violence prevention and of the Plan. 

8 (G) All training is appropriate in content 

9 and vocabulary to the language, educational 

10 level, and literacy of such covered employees. 

11 (4) RECORDKEEPING AND ACCESS TO PLAN

12 RECORDS.— 

13 (A) IN GENERAL.—Each covered employer 

14 shall— 

15 (i) maintain at all times— 

16 (I) records related to each Plan 

17 of the employer, including workplace 

18 violence risk and hazard assessments, 

19 and identification, evaluation, correc20 tion, and training procedures; 

21 (II) a violent incident log de22 scribed in subparagraph (B) for re23 cording all workplace violence inci24 dents; and 


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1 (III) records of all incident inves2 tigations as required under paragraph 

3 (2)(B); and 

4 (ii) make such records and logs avail5 able, upon request, to covered employees 

6 and their representatives for examination 

7 and copying in accordance with section 

8 1910.1020 of title 29, Code of Federal 

9 Regulations, and in a manner consistent 

10 with HIPAA privacy regulations (defined 

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

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

13 2 of title 42, Code of Federal Regulations. 

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, names and job titles 

6 of involved employees; 

7 (III) identification of the alleged 

8 individual who committed the violence, 

9 in a manner consistent with HIPAA 

10 privacy regulations (defined in section 

11 1180(b)(3) of the Social Security Act 

12 (42 U.S.C. 1320d–9(b)(3))) and part 

13 2 of title 42, Code of Federal Regula14 tions; 

15 (IV) the nature and extent of in16 juries to covered employees; 

17 (V) the type of violent incident 

18 (such as type 1 violence, type 2 vio19 lence, type 3 violence, or type 4 vio20 lence); and 

21 (VI) how the incident was 

22 abated; 

23 (iv) not later than 7 days after the 

24 employer learns of such incident, contain a 

25 record of each violent incident, which is 


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1 updated to ensure completeness of such 

2 record; 

3 (v) be maintained for not less than 5 

4 years; and 

5 (vi) in the case of a violent incident 

6 involving a privacy concern case, protect 

7 the identity of employees in a manner con8 sistent with section 1904.29(b) of title 29, 

9 Code of Federal Regulations. 

10 (C) ANNUAL SUMMARY.— 

11 (i) COVERED EMPLOYERS.—Each cov12 ered employer shall prepare an annual 

13 summary of each violent incident log for 

14 the preceding calendar year that shall— 

15 (I) with respect to each covered 

16 facility, and each covered service, for 

17 which such a log has been maintained, 

18 include the total number of violent in19 cidents, the number of recordable in20 juries related to such incidents, and 

21 the total number of hours worked by 

22 the covered employees for such pre23 ceding year; 

24 (II) be completed on a form pro25 vided by the Secretary; 


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1 (III) be posted for three months 

2 beginning February 1 of each year in 

3 a manner consistent with the require4 ments of section 1904 of title 29, 

5 Code of Federal Regulations, relating 

6 to the posting of summaries of injury 

7 and illness logs; 

8 (IV) be located in a conspicuous 

9 place or places where notices to em10 ployees are customarily posted; and 

11 (V) not be altered, defaced, or 

12 covered by other material. 

13 (ii) SECRETARY.—Not later than 1 

14 year after the promulgation of the interim 

15 final standard under section 101(a), the 

16 Secretary shall make available a platform 

17 for the electronic submission of annual 

18 summaries required under this paragraph. 

19 (5) ANNUAL REPORT.—Not later than Feb20 ruary 15 of each year, each covered employer shall 

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

22 severity of workplace violence, and any incident re23 sponse and post-incident investigation (including 

24 abatement measures for the incidents) set forth in 


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1 the annual summary of the violent incident log de2 scribed in paragraph (4)(C). 

3 (6) ANNUAL EVALUATION.—Each covered em4 ployer shall conduct an annual written evaluation, 

5 conducted with the full, active participation of cov6 ered employees and employee representatives, of— 

7 (A) the implementation and effectiveness 

8 of the Plan, including a review of the violent in9 cident log; and 

10 (B) compliance with training required by 

11 each standard described in section 101, and 

12 specified in the Plan. 

13 (7) ANTI-RETALIATION.— 

14 (A) POLICY.—Each covered employer shall 

15 adopt a policy prohibiting any person (including 

16 an agent of the employer) from discriminating 

17 or retaliating against any employee for report18 ing, or seeking assistance or intervention from, 

19 a workplace violence incident, threat, or concern 

20 to the employer, law enforcement, local emer21 gency services, or a government agency, or par22 ticipating in an incident investigation. 

23 (B) PROHIBITION.—No covered employer 

24 shall discriminate or retaliate against any em25 ployee for reporting, or seeking assistance or 


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1 intervention from, a workplace violence incident, 

2 threat, or concern to the employer, law enforce3 ment, local emergency services, or a government 

4 agency, or for exercising any other rights under 

5 this paragraph. 

6 (C) ENFORCEMENT.—This paragraph shall 

7 be enforced in the same manner and to the 

8 same extent as any standard promulgated 

9 under section 6(b) of the Occupational Safety 

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

11 SEC. 104. RULES OF CONSTRUCTION. 

12 Notwithstanding section 18 of the Occupational Safe13 ty and Health Act of 1970 (29 U.S.C. 667)— 

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

15 curtail or limit authority of the Secretary under any 

16 other provision of the law; and 

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

18 employees shall be in addition to the rights, privi19 leges, or remedies provided under any Federal or 

20 State law, or any collective bargaining agreement. 

21 SEC. 105. OTHER DEFINITIONS. 

22 In this title: 

23 (1) WORKPLACE VIOLENCE.— 

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

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


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1 violence, without regard to intent, that occurs 

2 at a covered facility or while a covered employee 

3 performs a covered service. 

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

5 violence’’ does not include lawful acts of self-de6 fense or defense of others. 

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

8 violence’’ includes— 

9 (i) the threat or use of physical force 

10 against a covered employee that results in 

11 or has a high likelihood of resulting in in12 jury, psychological trauma, or stress, with13 out regard to whether the covered em14 ployee sustains an injury, psychological 

15 trauma, or stress; and 

16 (ii) an incident involving the threat or 

17 use of a firearm or a dangerous weapon, 

18 including the use of common objects as 

19 weapons, without regard to whether the 

20 employee sustains an injury, psychological 

21 trauma, or stress. 

22 (2) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio23 lence’’— 

24 (A) means workplace violence directed at a 

25 covered employee at a covered facility or while 


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1 performing a covered service by an individual 

2 who has no legitimate business at the covered 

3 facility or with respect to such covered service; 

4 and 

5 (B) includes violent acts by any individual 

6 who enters the covered facility or worksite 

7 where a covered service is being performed with 

8 the intent to commit a crime. 

9 (3) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio10 lence’’ means workplace violence directed at a cov11 ered employee by customers, clients, patients, stu12 dents, inmates, or any individual for whom a covered 

13 facility provides services or for whom the employee 

14 performs covered services. 

15 (4) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio16 lence’’ means workplace violence directed at a cov17 ered employee by a present or former employee, su18 pervisor, or manager. 

19 (5) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio20 lence’’ means workplace violence directed at a cov21 ered employee by an individual who is not an em22 ployee, but has or is known to have had a personal 

23 relationship with such employee. 

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

25 of violence’’ means a statement or conduct that 


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

2 there is a reasonable possibility the person might be 

3 physically injured, and that serves no legitimate pur4 pose. 

5 (7) ALARM.—The term ‘‘alarm’’ means a me6 chanical, electrical, or electronic device that does not 

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

8 others. 

9 (8) DANGEROUS WEAPON.—The term ‘‘dan10 gerous weapon’’ means an instrument capable of in11 flicting death or serious bodily injury, regardless of 

12 whether such instrument was designed for that pur13 pose. 

14 (9) ENGINEERING CONTROLS.— 

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

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

17 a device that removes a hazard from the work18 place or creates a barrier between a covered 

19 employee and the hazard. 

20 (B) INCLUSIONS.—For purposes of reduc21 ing workplace violence hazards, the term ‘‘engi22 neering controls’’ includes electronic access con23 trols to employee occupied areas, weapon detec24 tors (installed or handheld), enclosed worksta25 tions with shatter-resistant glass, deep service 


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1 counters, separate rooms or areas for high-risk 

2 patients, locks on doors, removing access to or 

3 securing items that could be used as weapons, 

4 furniture affixed to the floor, opaque glass in 

5 patient rooms (which protects privacy, but al6 lows the health care provider to see where the 

7 patient is before entering the room), closed-cir8 cuit television monitoring and video recording, 

9 sight-aids, and personal alarm devices. 

10 (10) ENVIRONMENTAL RISK FACTORS.— 

11 (A) IN GENERAL.—The term ‘‘environ12 mental risk factors’’ means factors in the cov13 ered facility or area in which a covered service 

14 is performed that may contribute to the likeli15 hood or severity of a workplace violence inci16 dent. 

17 (B) CLARIFICATION.—Environmental risk 

18 factors may be associated with the specific task 

19 being performed or the work area, such as 

20 working in an isolated area, poor illumination 

21 or blocked visibility, and lack of physical bar22 riers between employees and persons at risk of 

23 committing workplace violence. 

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

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


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1 specific to a patient that may increase the likelihood 

2 or severity of a workplace violence incident, includ3 ing a patient’s mental status, treatment and medica4 tion status, history of violence as known to a covered 

5 employee at a covered facility or while performing a 

6 covered service, use of drugs or alcohol as known to 

7 a covered employee at a covered facility or while per8 forming a covered service, and any other conditions 

9 or disease processes that may cause the patient to 

10 experience confusion or disorientation, to be non-re11 sponsive to instruction, or to behave unpredictably. 

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

13 means the Secretary of Labor. 

14 (13) WORK PRACTICE CONTROLS.— 

15 (A) IN GENERAL.—The term ‘‘work prac16 tice controls’’ means procedures and rules that 

17 are used to effectively reduce workplace violence 

18 hazards. 

19 (B) INCLUSIONS.—The term ‘‘work prac20 tice controls’’ includes assigning and placing 

21 sufficient numbers of staff to reduce patient22 specific Type 2 workplace violence hazards, pro23 vision of dedicated and available safety per24 sonnel such as security guards, employee train25 ing on workplace violence prevention method 


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1 and techniques to de-escalate and minimize vio2 lent behavior, and employee training on proce3 dures for response in the event of a workplace 

4 violence incident and for post-incident response. 

5 TITLE II—AMENDMENTS TO THE 

6 SOCIAL SECURITY ACT 

7 SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE 

8 PREVENTION STANDARD TO CERTAIN FACILI9 TIES RECEIVING MEDICARE FUNDS. 

10 (a) IN GENERAL.—Section 1866 of the Social Secu11 rity Act (42 U.S.C. 1395cc) is amended— 

12 (1) in subsection (a)(1)— 

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

14 ‘‘and’’ at the end; 

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

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

17 (C) by inserting after subparagraph (Y) 

18 the following new subparagraph: 

19 ‘‘(Z) in the case of hospitals that are not other20 wise subject to the Occupational Safety and Health 

21 Act of 1970 (or a State occupational safety and 

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

23 Act) and skilled nursing facilities that are not other24 wise subject to such Act (or such a State occupa25 tional safety and health plan), to comply with the 


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1 Workplace Violence Prevention Standard (as pro2 mulgated under section 101 of the Health Care 

3 Workplace Violence Prevention Act of 2018).’’; and 

4 (2) in subsection (b)(4)— 

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

6 ‘‘and a hospital or skilled nursing facility that 

7 fails to comply with the requirement of sub8 section (a)(1)(Z) (relating to the Workplace Vi9 olence Prevention Standard)’’ after ‘‘Blood10 borne Pathogens Standard)’’; and 

11 (B) in subparagraph (B)— 

12 (i) by striking ‘‘(a)(1)(U)’’ and insert13 ing ‘‘(a)(1)(V)’’; and 

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

15 failure to comply with the requirement of 

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

17 Workplace Violence Prevention standard 

18 referred to in such subsection by a hospital 

19 or skilled nursing facility, as applicable, 

20 that is subject to the provisions of such 

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

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

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

24 1 year after the date of issuance of the interim final standVerDate Sep 11 2014 22:47 Nov 20, 2018 Jkt 089200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H7141.IH H7141

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1 ard on workplace violence prevention required under sec2 tion 101. 

Æ 


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