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. JACK-
SON LEE, Ms. JAYAPAL, Ms. JUDY CHU of California, Ms. GABBARD, Mr. 
MOULTON, and Ms. LEE) introduced the following bill; which was re-
ferred 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 com-
mittee 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 Representa-
tives 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’’. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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, pur-
suant 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 preven-
tion (in this section such standard is referred to as 
the ‘‘workplace violence prevention standard’’) to re-
quire certain health care employers (hereinafter col-
lectively referred to as ‘‘covered health care employ-
ers’’), including hospitals, any outpatient settings or 
clinics operating within a hospital license or any set-
ting or clinic that provides outpatient hospital serv-
ices, 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 vio-
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
lence. The interim final standard shall meet the 
specifications of this section, at a minimum, but may 
exceed the requirements for covered health care fa-
cilities. The Secretary shall accept and consider pub-
lic comments on any interim final standard pub-
lished 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 work-
place 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 min-
imum, 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 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
hospice agencies or organizations to adopt a com-
prehensive workplace violence prevention plan with 
comparable workplace protections at home health 
agencies or organizations and hospice agencies or or-
ganizations. The standard promulgated under this 
paragraph shall include procedures for hazard eval-
uation 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 en-
vironmental and patient-specific risk factors 
such as the presence of weapons, evidence of 
substance abuse, or the presence of uncoopera-
tive cohabitants. At minimum, such procedures 
must be utilized during intake procedures, at 
the time of the initial visit, and during any sub-
sequent visit when there has been a change in 
conditions. 
(B) Procedures to correct workplace vio-
lence hazards in a timely manner, which shall 
include, at minimum, procedures to ensure em-
ployees will not work alone in households where 
there is a high risk for violence, provision of 
functional and maintained security or commu-
nication devices for all employees working in a 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
patient or client’s home or community, and pro-
vision of dedicated and available security per-
sonnel 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 appro-
priate. 
(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 facili-
ties to adopt a comprehensive workplace violence 
prevention plan with comparable workplace protec-
tions at skilled nursing facilities and nursing facili-
ties. 
(b) WORKPLACE VIOLENCE PROTECTION STANDARD 
REQUIREMENTS.—The interim final standard promul-
gated 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 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
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 main-
tained 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 min-
imum, each of the following for every health care fa-
cility unit, service, and operation: 
(A) The names or job titles of the individ-
uals responsible for implementing the Work-
place Violence Prevention Plan. 
(B) Effective procedures that meet the re-
quirements under paragraph (2) to obtain the 
active involvement of employees and, where 
such employees are represented through a col-
lective bargaining agent, the applicable recog-
nized or certified collective bargaining agent in 
developing, implementing, and reviewing the 
Workplace Violence Prevention Plan. 
(C) Effective procedures that meet the re-
quirements 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 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
through a collective bargaining agent, the appli-
cable recognized or certified collective bar-
gaining 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 Work-
place Violence Prevention Plan with other em-
ployers whose employees work in the health 
care facility. 
(E) Procedures that meet the requirements 
under paragraph (3) for identifying and evalu-
ating workplace violence risks and hazards. 
(F) Procedures that meet the requirements 
under paragraph (3) on communicating work-
place 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 require-
ments under paragraph (4) for correcting work-
place violence hazards in a timely manner. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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 work-
place 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 cov-
ered health care employer is required to estab-
lish under paragraph (7). 
(M) Procedures that meet the require-
ments of paragraph (8) for providing effective 
education and in-person training to all employ-
ees, including temporary employees and per-
sonnel working in the facility but not directly 
employed by the employer. 
(N) A copy of the most recent annual writ-
ten evaluation of the Workplace Violence Pre-
vention Plan as conducted under the require-
ments of paragraph (9). 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(O) A copy of the current notice to employ-
ees that is required under paragraph (10). 
(2) EMPLOYEE
AND
SECURITY
PERSONNEL 
PARTICIPATION.— 
(A) A requirement that each covered 
health care employer shall obtain active involve-
ment from employees and, where such employ-
ees are represented through a collective bar-
gaining agent, the applicable recognized or cer-
tified collective bargaining agent, in developing, 
implementing, and reviewing the Workplace Vi-
olence Prevention Plan. Active involvement shall 
include the participation of employees or their 
applicable representatives in— 
(i) identifying, evaluating, and cor-
recting workplace violence hazards; 
(ii) designing and implementing train-
ing; and 
(iii) reporting and investigating work-
place violence incidents. 
(B) Where security personnel are not em-
ployees 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 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
through a collective bargaining agent, the appli-
cable recognized or certified collective bar-
gaining agent. Active involvement shall include 
the participation of security personnel or their 
applicable representatives in— 
(i) identifying, evaluating, and cor-
recting workplace violence hazards; 
(ii) designing and implementing train-
ing; and 
(iii) reporting and investigating work-
place 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 facil-
ity. 
(3) WORKPLACE
VIOLENCE
HAZARD
IDENTI-
FICATION 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. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
Factors assessed shall include, at minimum, 
each of the following: 
(i) Staffing, including staffing pat-
terns that contribute to or are insufficient 
to address the risk of violence. 
(ii) Sufficiency of security systems, in-
cluding alarms, emergency response sys-
tems, and availability of security personnel. 
(iii) Job design, equipment, and facili-
ties. 
(iv) Environmental risk factors, as de-
fined in subparagraph (a)(6) of section 5. 
(v) Patient-specific risk factors, as de-
fined 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 poten-
tial workplace violence risks or hazards, includ-
ing but not limited to, concerns regarding— 
(i) the availability, condition, and 
maintenance of any engineering controls 
identified in the Workplace Violence Pre-
vention Plan as corrective measures; 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(ii) the implementation or enforce-
ment of any work practice controls identi-
fied in the Workplace Violence Prevention 
Plan as corrective measures; 
(iii) the sufficiency, availability, condi-
tion, 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 vio-
lence; 
(v) potential or unaddressed hazards 
and risks related to environmental and pa-
tient-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. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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 regard-
ing conditions that may increase the potential 
for workplace violence incidents to other em-
ployees and between shifts and units. 
(4) WORKPLACE
VIOLENCE
HAZARD
CORREC-
TION.— 
(A) A requirement that each covered 
health care employer shall correct workplace vi-
olence hazards in a timely manner. Each cov-
ered health care employer shall be required to 
use engineering controls and work practice con-
trols to eliminate or minimize employee expo-
sure to the identified hazards. Corrective meas-
ures taken under this paragraph shall include, 
at minimum, each of the following as appro-
priate: 
(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 per-
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
sonnel, 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 im-
mediately 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 ob-
jects cannot be used as improvised 
weapons. 
(iv) Procedures to prevent the trans-
port of unauthorized firearms and other 
weapons into the facility. 
(v) Procedures by which employees 
can summon security and other aid and be 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
alerted to the presence, location, and na-
ture of a security threat. 
(vi) Establishment of an effective re-
sponse plan for actual or potential work-
place violence emergencies that shall in-
clude, at minimum— 
(I) procedures for warning em-
ployees 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 so-
licited from the employees who experienced the vio-
lence that shall include, at minimum, each of the fol-
lowing: 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(A) Procedures for how an employee can 
report a violent incident, threat, or other work-
place violence concern. 
(B) Procedures for response to reports of 
violent incidents, threats, or other workplace vi-
olence 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 trau-
ma counseling available to all employees af-
fected 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 Vi-
olence Prevention Plan and any corrective 
measures developed under the plan were effec-
tively implemented and the circumstances sur-
rounding the workplace violence incident. 
(G) Procedures for investigating the cir-
cumstances of each employee injury, if any, re-
lated to the workplace violence incident. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(H) Solicitation of opinions from all em-
ployees or personnel involved in the incident, in-
cluding any injured employee, regarding the 
cause of the incident and whether any correc-
tive measures could have prevented the incident 
from occurring. 
(I) A policy prohibiting the employer from 
holding any employee or personnel who partici-
pates 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 regard-
less of whether the employee or personnel 
sustains an injury, and regardless of 
whether the report is made by the per-
sonnel who is the subject of the violent in-
cident or any other personnel; 
(ii) each post-incident response; and 
(iii) each workplace violence injury in-
vestigation. 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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 inci-
dent. 
(ii) A classification of the perpetrator, 
circumstances surrounding the incident, 
and location of the incident. 
(iii) The type of incident and con-
sequences of the incident, including any in-
juries. 
(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 pro-
vide 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 imple-
mentation of the covered health care employer’s 
Workplace Violence Prevention Plan. 
(E) Each covered health care employer 
shall, upon request, make available their find-
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
ings and data used in such review to employees, 
any designated representatives or collective bar-
gaining agents, and the Secretary or other Fed-
eral 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 prohib-
iting 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 prohib-
iting the employer from disallowing an employee 
from, or taking punitive or retaliatory action 
against an employee for, reporting violent inci-
dents, threats, or other workplace violence con-
cerns. 
(8) EDUCATION
AND
TRAINING.—A require-
ment that each covered health care employer shall 
provide in-person training to all employees, including 
temporary employees and personnel working in the 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
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 op-
eration; 
(B) address the corrective measures the 
employer has implemented with regard to work-
place violence hazards identified; 
(C) address the activities that each em-
ployee 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 trans-
ferred to a new patient care unit; 
(iv) when conditions change or pre-
viously unrecognized hazards are identi-
fied; 
(v) when requested by an employee; 
and 
(vi) as otherwise necessary; 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(E) provide an opportunity for in-person 
interactive questions and answers; 
(F) be conducted in-person by an indi-
vidual with knowledge of workplace violence 
prevention and the covered health care employ-
er’s Workplace Violence Prevention Plan and 
procedures; 
(G) include training on emergency re-
sponse plans and procedures related to work-
place violence and practice drills on emergency 
response plans and procedures, including any 
procedures adopted for responding to mass cas-
ualty 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 re-
garding their respective work areas, services, 
and operations of the implementation and effec-
tiveness of the Workplace Violence Prevention 
Plan, including hazard assessment and evalua-
tion procedures and findings, hazard correction 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
procedures, selection of engineering and work 
practice controls, and post-incident response 
and investigation. 
(B) ACTIVE INVOLVEMENT.—The evalua-
tion shall— 
(i) be conducted with the active in-
volvement of employees, and if applicable, 
the representatives and collective bar-
gaining agents of such employees; and 
(ii) document the input of the individ-
uals described in clause (i) regarding em-
ployees’ respective work areas, services, 
and operations. 
(C) CORRECTIVE
ACTION.—Each covered 
health care employer shall correct unsafe condi-
tions, work practices, and work procedures 
identified in the annual written evaluation in a 
timely manner. 
(10) NOTICE OF WORKPLACE VIOLENCE PRE-
VENTION 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 preven-
tion standard; 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(B) includes information regarding work-
place violence prevention policies and training; 
(C) explains procedures to report and 
record information on workplace violence inci-
dents and workplace violence-related injuries; 
and 
(D) explains employees’ rights under this 
Act, including rights to report concerns regard-
ing potential workplace violence risks or haz-
ards without punitive or retaliatory action taken 
by the employer. 
(c) EMERGENCIES.—The Secretary shall establish 
procedures to be followed in cases where emergency situa-
tions affect the operation of a workplace violence preven-
tion plan. 
(d) INSPECTIONS.—The Secretary shall conduct un-
scheduled 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 vio-
lence prevention standard. 
SEC. 3. APPLICATION OF THE WORKPLACE VIOLENCE PRE-
VENTION STANDARD TO FACILITIES RECEIV-
ING MEDICARE AND MEDICAID FUNDS. 
(a) IN GENERAL.—Section 1866 of the Social Secu-
rity Act (42 U.S.C. 1395cc) is amended— 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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 begin-
ning on the date that is 1 year after the date of issuance 
of the interim final standard on workplace violence preven-
tion 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 fa-
cilities, services, and operations not covered by this 
Act; 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(2) preempt the application of any other statute 
or regulation of any State or local government re-
lated to workplace violence in health care facilities 
except to the extent that such provisions are incon-
sistent 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 provi-
sion of law of a State or local government is not in-
consistent 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 em-
ployee 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 me-
chanical, 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— 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
(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 set-
ting or clinic that provides outpatient hospital 
services; 
(B) psychiatric hospitals (as defined in sec-
tion 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 De-
fense, the Indian Health Service under the De-
partment of Health and Human Services, or 
any other department or agency of the United 
States. 
(3) DANGEROUS
WEAPON.—The term ‘‘dan-
gerous weapon’’ means an instrument capable of in-
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
flicting 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 ‘‘en-
gineering 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 em-
ployee occupied areas, weapon detectors (installed or 
handheld), enclosed workstations with shatter-resist-
ant glass, deep service counters; separate rooms or 
areas for high risk patients, locks on doors; fur-
niture 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 de-
vices. 
(6) ENVIRONMENTAL
RISK
FACTORS.—The 
term ‘‘environmental risk factors’’ means factors in 
the facility or area in which health care services or 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
operations are conducted that may contribute to the 
likelihood or severity of a workplace violence inci-
dent. Environmental risk factors may be associated 
with the specific task being performed or the work 
area, such as working in an isolated area, poor illu-
mination or blocked visibility, lack of physical bar-
riers between employees and persons at risk of com-
mitting 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, includ-
ing a patient’s mental status, treatment and medica-
tion status, history of violence as known to the 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
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-re-
sponsive 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 pur-
pose. 
(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 work-
place 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, psycho-
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
logical 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, includ-
ing the use of common objects as weapons, re-
gardless of whether the employee sustains an 
injury. 
(C) Four workplace violence types: 
(i) ‘‘Type 1 violence’’ means work-
place 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 work-
place violence directed at an employee by 
customers, clients, patients, students, in-
mates, or any others for whom an organi-
zation provides services. 
(iii) ‘‘Type 3 violence’’ means work-
place violence directed at an employee by a 
present or former employee, supervisor, or 
manager. 
(iv) ‘‘Type 4 violence’’ means work-
place violence directed at an employee by 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS
someone who does not work there, but has 
or is known to have had a personal rela-
tionship 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 inci-
dent and for post-incident response. 
Æ 
VerDate Sep 11 2014 
00:43 Mar 17, 2018
Jkt 079200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6301
E:\BILLS\H5223.IH
H5223
SSpencer on DSKBBXCHB2PROD with BILLS