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 work-
place 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. SCHA-
KOWSKY, Mr. SCOTT of Virginia, Mr. TAKANO, Ms. WILSON of Florida, 
Ms. SHEA-PORTER, Mr. SIRES, Mr. DESAULNIER, Mr. LARSON of Con-
necticut, Mr. PAYNE, Mr. HIMES, Mr. POCAN, Mr. CICILLINE, Ms. ESTY 
of Connecticut, Mr. NORCROSS, and Mr. ESPAILLAT) introduced the fol-
lowing 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 employ-
ers within the health care and social service industries 
to develop and implement 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Workplace Violence 
Prevention for Health Care and Social Service Workers 
Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In a 2016 report entitled, ‘‘Workplace Safe-
ty and Health: Additional Efforts Needed to Help 
Protect Health Care Workers from Workplace Vio-
lence’’, the Government Accountability Office re-
ported over 730,000 cases of health care workplace 
assaults over the 5-year span from 2009 through 
2013, based on Bureau of Justice Statistics data. 
(2) The health care and social service industries 
experience the highest rates of injuries caused by 
workplace violence. Nurses and nursing, psychiatric, 
home health, and personal care aides all are at high 
risk. 
(3) The Bureau of Labor Statistics reports that 
health care and social service workers suffered 69 
percent of all workplace violence injuries caused by 
persons in 2016 and are nearly 5 times as likely to 
suffer a workplace violence injury than workers over-
all. 
(4) According to a survey of 3,500 American 
emergency physicians conducted by the American 
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College of Emergency Physicians, 47 percent of 
emergency room doctors have been physically as-
saulted at work, and 8 in 10 report that this vio-
lence is affecting patient care. 
(5) Workplace violence in health care and social 
service sectors is increasing. Bureau of Labor Statis-
tics data show that private sector injury rates of 
workplace violence in health care and social service 
sectors increased by 63 percent between 2006 and 
2016. Due to under-reporting, actual injury rates 
from workplace violence are widely recognized to be 
higher than reported levels. 
(6) Violence against workers in health care set-
tings is most commonly due to assaults by patients 
or clients, or persons accompanying patients or cli-
ents. 
(7) The Occupational Safety and Health Ad-
ministration has issued ‘‘Guidelines for Preventing 
Workplace Violence for Healthcare and Social Serv-
ice Workers’’, however, this guidance is not enforce-
able. Absent an enforceable standard, employers lack 
mandatory requirements to implement a violence 
prevention program, and workers lack sufficient pro-
tection from workplace violence. 
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(8) Studies have demonstrated that workplace 
violence prevention programs tailored to the needs of 
specific work areas and State-based workplace vio-
lence prevention legislation are strongly associated 
with reductions in workplace violence. Proper staff 
training, appropriate staffing levels, sufficient re-
sources, and the use of evidence-based practices in 
the provision of services (such as effective commu-
nication with patients using de-escalation tech-
niques) can reduce risks to the safety of both pa-
tients and staff. 
(9) Nine States have mandated that certain 
types of health care facilities implement workplace 
violence prevention programs. On April 1, 2018, the 
Division of Occupational Safety and Health of the 
State of California issued a comprehensive standard 
(‘‘Workplace Violence Prevention in Health Care’’) 
that requires health care facilities to implement a 
workplace violence prevention plan. 
(10) Employer organizations have challenged 
the Occupational Safety and Health Administra-
tion’s authority to utilize the General Duty Clause 
of the Occupational Safety and Health Act of 1970 
to enforce against workplace violence hazards, argu-
ing that Congress did not intend to cover workplace 
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violence under such clause when the Act was enacted 
in 1970. 
(11) The Occupational Safety and Health Ad-
ministration (OSHA) received two petitions for rule-
making in July of 2016, calling on OSHA to pro-
mulgate a violence prevention standard for health 
care and social service sectors. On December 6, 
2016, OSHA issued a Request for Information 
(RFI) soliciting information on this issue. On Janu-
ary 10, 2017, OSHA conducted a public meeting to 
receive stakeholder input and to supplement the on-
line comments submitted in response to the RFI. At 
that meeting, OSHA announced it accepted the peti-
tions and would develop a Federal standard to pre-
vent workplace violence in health care and social 
service settings. In the spring of 2017, the work-
place violence prevention standard was removed from 
active consideration and placed on the Department 
of Labor’s ‘‘long-term agenda’’. Subsequently, it was 
placed back on the regulatory agenda. OSHA’s ef-
forts to move forward with rulemaking have been 
halting and inconsistent. Therefore, legislation is 
necessary to ensure the timely development of a 
standard to protect workers in health care and social 
service settings. 
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SEC. 3. TABLE OF CONTENTS. 
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. 
TITLE I—WORKPLACE VIOLENCE 
PREVENTION STANDARD 
SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD. 
(a) INTERIM FINAL STANDARD.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary of 
Labor shall promulgate an interim final standard on 
workplace violence prevention— 
(A) to require certain employers in the 
healthcare and social service sectors, and cer-
tain employers in sectors that conduct activities 
similar to the activities in the healthcare and 
social service sectors, to develop and implement 
a comprehensive workplace violence prevention 
plan to protect health care workers, social serv-
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ice workers, and other personnel from work-
place violence; and 
(B) that shall, at a minimum, be based on 
the Guidelines for Preventing Workplace Vio-
lence for Healthcare and Social Service Work-
ers published by the Occupational Safety and 
Health Administration of the Department of 
Labor in 2015 and adhere to the requirements 
of this title. 
(2) APPLICABILITY OF OTHER STATUTORY RE-
QUIREMENTS.—The following shall not apply to the 
promulgation of the interim final standard under 
this subsection: 
(A) The requirements applicable to occupa-
tional safety and health standards under section 
6(b) of the Occupational Safety and Health Act 
of 1970 (29 U.S.C. 655(b)). 
(B) The requirements of chapters 5 and 6 
of title 5, United States Code, and titles 2 and 
42, United States Code. 
(3) EFFECTIVE
DATE
OF
INTERIM
STAND-
ARD.—The interim final standard shall— 
(A) take effect on a date that is not later 
than 30 days after promulgation, except that 
such interim final standard may include a rea-
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sonable phase-in period for the implementation 
of required engineering controls that take effect 
after such date; 
(B) be enforced in the same manner and 
to the same extent as any standard promul-
gated under section 6(b) of the Occupational 
Safety and Health Act of 1970 (29 U.S.C. 
655(b)); and 
(C) be in effect until the final standard de-
scribed in subsection (b) becomes effective and 
enforceable. 
(4) FAILURE TO PROMULGATE.—If an interim 
final standard described in paragraph (1) is not pro-
mulgated not later than 1 year of the date of enact-
ment of this Act, the provisions of this title shall be 
in effect and enforced in the same manner and to 
the same extent as any standard promulgated under 
section 6(b) of the Occupational Safety and Health 
Act (29 U.S.C. 655(b)) until such provisions are su-
perseded in whole by an interim final standard pro-
mulgated by the Secretary that meets the require-
ments of paragraph (1). 
(b) FINAL STANDARD.— 
(1) PROPOSED
FINAL
STANDARD.—Not later 
than 2 years after the date of enactment of this Act, 
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the Secretary of Labor shall, pursuant to section 6 
of the Occupational Safety and Health Act (29 
U.S.C. 655), promulgate a proposed final standard 
on workplace violence prevention— 
(A) for the purposes described in sub-
section (a)(1)(A); and 
(B) that shall include, at a minimum, the 
elements contained in the interim final standard 
promulgated under subsection (a). 
(2) FINAL
STANDARD.—Not later than 42 
months after the date of enactment of this Act, the 
Secretary shall promulgate a final standard on such 
proposed standard that shall— 
(A) provide no less protection than any 
workplace violence standard adopted by a State 
plan that has been approved by the Secretary 
under section 18 of the Occupational Safety 
and Health Act of 1970 (29 U.S.C. 667); and 
(B) be effective and enforceable in the 
same manner and to the same extent as any 
standard promulgated under section 6(b) of the 
Occupational Safety and Health Act of 1970 
(29 U.S.C. 655(b)). 
SEC. 102. SCOPE AND APPLICATION. 
In this title: 
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(1) COVERED
FACILITY.—The term ‘‘covered 
facility’’ includes the following: 
(A) Any hospital, including any specialty 
hospital, in-patient or outpatient setting, or 
clinic operating within a hospital license, or any 
setting that provides outpatient services. 
(B) Any residential treatment facility, in-
cluding any nursing home, skilled nursing facil-
ity, hospice facility, and long-term care facility. 
(C) Any non-residential treatment or serv-
ice setting. 
(D) Any medical treatment or social serv-
ice setting or clinic at a correctional or deten-
tion facility. 
(E) Any community care setting, including 
a community-based residential facility, group 
home, and mental health clinic. 
(F) Any psychiatric treatment facility. 
(G) Any drug abuse or substance use dis-
order treatment center. 
(H) Any independent freestanding emer-
gency centers. 
(I) Any facility described in subparagraphs 
(A) through (H) operated by a Federal Govern-
ment agency and required to comply with occu-
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pational safety and health standards pursuant 
to section 1960 of title 29, Code of Federal 
Regulations. 
(J) Any other facility the Secretary deter-
mines should be covered under the standards 
promulgated under section 101. 
(2) COVERED
SERVICES.—The term ‘‘covered 
service’’ includes the following services and oper-
ations: 
(A) Any services and operations provided 
in any field work setting, including home health 
care, home-based hospice, and home-based so-
cial work. 
(B) Any emergency services and transport, 
including such services provided by firefighters 
and emergency responders. 
(C) Any services described in subpara-
graphs (A) and (B) performed by a Federal 
Government agency and required to comply 
with occupational safety and health standards 
pursuant to section 1960 of title 29, Code of 
Federal Regulations. 
(D) Any other services and operations the 
Secretary determines should be covered under 
the standards promulgated under section 101. 
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(3) COVERED EMPLOYER.— 
(A) IN GENERAL.—The term ‘‘covered em-
ployer’’ includes a person (including a con-
tractor, subcontractor, a temporary service 
firm, or an employee leasing entity) that em-
ploys an individual to work at a covered facility 
or to perform covered services. 
(B) EXCLUSION.—The term ‘‘covered em-
ployer’’ does not include an individual who pri-
vately employs, in the individual’s residence, a 
person to perform covered services for the indi-
vidual or a family member of the individual. 
(4) COVERED EMPLOYEE.—The term ‘‘covered 
employee’’ includes an individual employed by a cov-
ered employer to work at a covered facility or to per-
form covered services. 
SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE 
PREVENTION STANDARD. 
Each standard described in section 101 shall include, 
at a minimum, the following requirements: 
(1) 
WORKPLACE
VIOLENCE
PREVENTION 
PLAN.—Not later than 6 months after the date of 
promulgation of the interim final standard under 
section 101(a), a covered employer shall develop, im-
plement, and maintain an effective written workplace 
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violence prevention plan for covered employees at 
each covered facility controlled by the employer and 
for covered employees performing a covered service 
on behalf of such employer, which meet the fol-
lowing: 
(A) PLAN
DEVELOPMENT.—Each Plan 
shall— 
(i) be developed and implemented with 
the meaningful participation of direct care 
employees and, where applicable, employee 
representatives and collective bargaining 
representatives, for all aspects of the Plan; 
(ii) be tailored and specific to condi-
tions and hazards for the covered facility 
or the covered service, including patient- 
specific risk factors and risk factors spe-
cific to each work area or unit; and 
(iii) be suitable for the size and com-
plexity of operations at the covered facility 
or for the covered service, and remain in 
effect at all times. 
(B) PLAN CONTENT.—Each Plan shall in-
clude procedures and methods for the following: 
(i) Identification of the individual re-
sponsible for implementation of the Plan. 
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(ii) With respect to each work area 
and unit at the covered facility or while 
covered employees are performing the cov-
ered service, risk assessment and identi-
fication of workplace violence risks and 
hazards to employees exposed to such risks 
and hazards (including environmental risk 
factors and patient-specific risk factors), 
which shall be— 
(I) informed by past violent inci-
dents specific to such covered facility 
or such covered service; and 
(II) conducted with, at a min-
imum— 
(aa) direct care employees; 
(bb) where applicable, the 
representatives of such employ-
ees; and 
(cc) the employer. 
(iii) Hazard prevention, engineering 
controls, and work practice controls to cor-
rect hazards in a timely manner applying 
industrial hygiene principles of the hier-
archy of controls, which— 
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(I) may include security and 
alarm systems, adequate exit routes, 
monitoring systems, barrier protec-
tion, established areas for patients 
and clients, lighting, entry procedures, 
staffing and working in teams, and 
systems to identify and flag clients 
with a history of violence; and 
(II) shall ensure that employers 
correct, in a timely manner, hazards 
identified in the annual report de-
scribed in paragraph (5). 
(iv) Reporting, incident response, and 
post-incident investigation procedures, in-
cluding procedures— 
(I) for employees to report work-
place violence risks, hazards, and inci-
dents; 
(II) for employers to respond to 
reports of workplace violence; 
(III) for employers to perform a 
post-incident investigation and de-
briefing of all reports of workplace vi-
olence with the participation of em-
ployees and their representatives; and 
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