The California Division of Occupational Safety & Health Standards Board recently passed a new safety order intended to protect healthcare workers from workplace violence. The new safety order, which the California Office of Administrative Law approved on December 8, 2016, will require healthcare providers to develop workplace violence prevention plans, institute training programs, and keep records on certain incidents of workplace violence. The new General Industry Safety Order, entitled “Workplace Violence Prevention in Health care” and codified at the California Code of Regulations, Title 8, Section 3342, will become effective on April 1, 2017.

Covered Employers

The new safety order applies to the following types of healthcare facilities:

  • “Health facilities” defined as “any facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, or treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which the persons are admitted for a 24-hour stay or longer”
  • Outpatient medical offices and clinics
  • Home health care and home-based hospice
  • Paramedic and emergency medical services, including paramedic and emergency services provided by firefighters and other emergency responders
  • Field operations such as mobile clinics and dispensing operations, medical outreach services, and other off-site operations
  • Drug treatment programs
  • Ancillary healthcare operations

According to the new safety order, different facilities must comply with different provisions of the new law. For example, general acute care hospitals, acute psychiatric hospitals, and special hospitals must comply with all the provisions with which health facilities must comply—and, in addition, must report incidents to the California Division of Occupational Safety and Health (Cal/OSHA) of the Department of Industrial Relations.

Workplace Violence Prevention Plan

The new safety order requires every covered employer—as part of its Injury and Illness Prevention Program (IIPP)—to “implement and maintain an effective workplace violence prevention plan.” The new safety order specifies the following requirements:

  • The plan must be in writing.
  • It must be in effect at all times.
  • The plan must be in effect in every unit, service, and operation.
  • Plans must be “specific to the hazards and corrective measures for the unit, service, or operation.”
  • The plan must be available to employees at all times.

Employers have the option to incorporate the plan into their written IIPPs or maintain a separate violence prevention plan.

To comply with the safety order, the workplace violence protection plan must include the following elements, among others:

  1. The names or job titles of the persons responsible for implementing the plan
  2. Procedures to involve employees and their representatives, in addition to security personnel, in developing, implementing, and reviewing a workplace violence plan
  3. Procedures for coordinating implementation of a workplace violence plan with other employers whose employees work in the healthcare facility, service, or operation
  4. “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”
  5. Procedures to accept and respond to reports of workplace violence, including a prohibition against retaliating against employees who make such reports
  6. “Assessment procedures to identify and evaluate environmental risk factors, including community-based risk factors, for each facility, unit, service, or operation”

Violent Incident Log

The new safety order requires employers to record information about “every incident, post-incident response, and workplace violence injury investigation” in a violent incident log. Employers must record at least the following information in the log:

  1. “The date, time, specific location, and department of the incident”
  2. Information provided by each employee who experienced workplace violence, including:
    1. a description of the incident,
    2. a classification of the perpetrator, i.e., a patient, client, customer, family member of friend of the patient, a friend of family member of a client or customer, a stranger with criminal intent, a coworker, a supervisor, a partner or spouse, a parent or relative, etc.
    3. the “circumstances at the time of the incident, including whether the employee was completing usual job duties, working in poorly lit areas, rushed, working during a low staffing level, in a high crime area, isolated or alone, unable to get help or assistance, working in a community setting, working in an unfamiliar or new location, or other circumstances”
  3. A description of the incident, including where the incident occurred and the type of incident, i.e., a physical attack, an attack with a weapon or object, a threat of physical force, a sexual assault or threat, etc.
  4. The consequences of the incident, including whether the employee received medical treatment and whether security or law enforcement was contacted
  5. The name, title, phone number, and email address of the person completing the log and the date the log was completed

Communication With Employees

The new safety order requires an employer’s workplace prevention plan to include procedures to communicate with employees regarding workplace violence matters, including procedures for:

  1. how to communicate information regarding conditions that may increase the potential for workplace violence incidents among employees and between shifts and units;
  2. how to report a violent incident, threat, or other workplace violence concern;
  3. how employees can communicate their concerns about workplace violence without fear of reprisal; and
  4. how the employer will investigate employee concerns, inform employees of the results of such investigations, and take any corrective actions.


The new safety order requires employers to train all employees, including temporary employees, working in their facilities. The training must address the identified workplace violence hazards for each facility, any corrective measures that the employer has implemented, and any activities employees are “reasonably anticipated to perform” under the workplace prevention plan. Employers must conduct an initial training when they first implement a workplace violence protection plan.

In addition, employers must train newly hired employees and employees that it newly assigns “to perform duties for which the training required in this subsection was not previously provided.” Employers must also train employees when they introduce new equipment or work practices and when an employer identifies “a new or previously unrecognized workplace violence hazard.”

Key Takeaways

Given the safety order’s extensive requirements, potentially covered healthcare employers will want to begin the process of preparing to comply as soon as possible. Workplace violence plans required under the new rule are complex in that they address workplace security, violence, and safety issues. Thus, employers will want to formulate a compliant plan and consider consultation with a security expert, workplace violence expert, and/or workplace safety consultant.

One more consideration for non-medical employers is that Cal/OSHA is currently underway on a rulemaking on a similar workplace violence regulation that is expected to apply to all workplaces in California.


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