Hospitals must annually review and update the security and safety assessment and plan. This law permits the plan to include security considerations relating to efforts to cooperate with local law enforcement about violent acts in the facility and would require the hospital to consult with affected employees, including the recognized collective bargaining agent or agents, if any, and members of the medical staff.

Furthermore, the California Division of Occupational Safety and Health (Cal/OSHA) requires specified covered health care facilities to establish workplace violence prevention plans to protect health care workers and other facility personnel from aggressive and violent behavior. This requirement is contained in Labor Code section 6401.8.

Specifically, Cal/OSHA requires covered health care facilities to:1

• Adopt workplace violence prevention plans as part of their injury and illness prevention programs in coordination with affected employees.
• Train personnel on how to recognize and respond to violence, and resources available to employees who are victims of violence.
• Develop a plan for how to respond to, and investigate violence incidents.
• Assess factors that contribute to violence in the hospital, including sufficiency staffing, security, access, and lighting.
• Document and report incidents of violence to Cal/OSHA.

Cal/OSHA has also enacted workplace violence regulations to provide additional details on this standard. The regulations apply to all healthcare facilities, including home healthcare operators, hospices/home hospices, emergency medical service providers/medical transport providers, outpatient medical service providers in correctional and detention setting and drug treatment programs.2 The rule contains recordkeeping and reporting requirements and prevention and training requirements.

Under this rule, employers can neither prohibit employees from contacting law enforcement nor retaliate against employees who contact law enforcement or report acts and threats of violence.

• Employers in these industries should seek advice on creating compliant plans. Covered employers will also want to review the full text of the regulation.

Recordkeeping and Reporting

Covered employers must keep a “violent incident log” listing all incidents, post-incident responses and investigations of workplace violence injuries, based on information from the employees who experienced workplace violence. You must eliminate any personal identifying information from the report.

A covered employer must keep records, including:

• Workplace hazard identification, evaluation and correction.
• Training records.
• Records of violent incidents.

There are specific reporting requirements for general acute care hospitals, acute psychiatric hospitals and special hospitals. These entities must report any incident involving use of physical force against an employee by a patient or person accompanying a patient (regardless of whether an injury was sustained) and any incident involving firearms or dangerous weapons. Depending on the type of incident, the report must be made within 24 or 72 hours, and reports must be made using Cal/OSHA's Workplace Violent Incident Online Reporting in Healthcare.

Prevention Plan

A covered employer must establish a workplace violence prevention plan. California Code of Regulations Title 8 section 3342(c) is a step-by-step directive of how the plan is to be established, implemented and maintained to ensure it is effective. The workplace violence prevention plan is to be part of the employer’s Injury and Illness Prevention Program (IIPP).

The violence prevention and response plan must be in writing and must include:

• The name and title of the person heading the program;
• The manner in which the plan will be communicated to employees;
• How to notify law enforcement about concerns; and
• The method for employees to document and report their concerns about violence.

The rule additionally requires that the prevention plan be in effect at all times and within all units and work settings.

The regulation requires employers to include employees and their representatives in developing, implementing and reviewing the plan. The involvement includes their participation in identifying, evaluating and correcting workplace violence hazards, designing and implementing training, and reporting and investigating workplace violence incidents.

The regulation contains nearly 50 separate instructions the employer is to consider, from specific risk factors such as employees working in isolated locations, to how to contact and obtain assistance from an appropriate law enforcement agency.

• Because of the number and specificity of the requirements in section 3342(c), employers affected by this regulation should review them extensively and initiate them where required to ensure compliance for all work sites and operations.

Training

Employers must provide all necessary personal protective equipment and training on workplace violence.3 This training is to be done when the plan is first established and for new hires, or when an employee is assigned to another position that did not require initial training.

Training must be included as part of the employer’s Injury and Illness Prevention Program (IIPP). The training must include prevention and response protocols, must occur during employee paid time and must take place at no cost to the employee.

The regulation specifies eight components the training must cover, such as how to recognize the potential for violence and strategies to avoid physical harm.

Under the rule, employers must allow employees and their representatives to participate in the development and implementation of the required training.

For more information on IIPPs, see Injury and Illness Prevention Program.

1. Lab. Code sec. 6401.8

2. 8 CCR sec. 3342

3. 8 CCR sec. 3342(f)