California hospitals take very seriously the duty to provide a safe and healthy environment for patients, staff and visitors. As a result of SB 1299 (Chapter 842, Statutes of 2014), Cal/OSHA has adopted comprehensive health care workplace violence prevention regulations. Those regulations require hospitals and other specified health care employers to adopt a workplace violence prevention plan that includes risk assessments, reporting and recording obligations, training and other components. This is in addition to other statutory obligations such as Health and Safety Code 1257.7, which requires hospitals to have a safety and security plan. As the issue of health care workplace violence is complex, it is recommended that hospitals have a multi-disciplinary team working to reduce violent incidents.
California hospitals take very seriously the duty to provide a
safe and healthy environment for patients, staff and
visitors. As a result of SB 1299 (Chapter 842, Statutes of
2014), Cal/OSHA has adopted comprehensive health care workplace
violence prevention regulations. Those
regulations require hospitals and other specified health
care employers to adopt a workplace violence prevention plan that
includes risk assessments, reporting and recording obligations,
training and other components. This is in addition to other
statutory obligations such as Health and Safety Code 1257.7,
which requires hospitals to have a safety and security
plan. As the issue of health care workplace violence is
complex, it is recommended that hospitals have a
multi-disciplinary team working to reduce violent incidents.
The materials posted on this web page are intended to provide helpful information. CHA has not reviewed the materials for accuracy and does not endorse them. These materials are not meant to be used, nor should they be used, as a substitute for legal advice. CHA advises that you consult your attorney prior to adopting or implementing any policy or procedure.
The materials posted on this web page are intended to provide
helpful information. CHA has not reviewed the materials for
accuracy and does not endorse them. These materials are not meant
to be used, nor should they be used, as a substitute for legal
advice. CHA advises that you consult your attorney prior to
adopting or implementing any policy or procedure.
CHA continues to add valuable tools to its recently updated
Violence Prevention Resources page. The latest additions
include two documents from the Health Research and Educational
Trust: 1) a checklist with the top 10 interventions for
fostering a culture of safety and 2) a change package that
summarizes strategies, change concepts and action items from high
These newly added tools were developed through clinical practice
sharing, organizational site visits and in collaboration with
subject matter experts. The tools outline effective practices and
provide strategies, concepts and action items that hospitals can
These newest additions complement existing resources on the
Workplace Violence Prevention Resource page, which was developed
to assist hospitals and health systems in reducing violent
incidents through workplace violence prevention planning. For a
complete list of resources, visit www.calhospital.org/workplace-violence-prevention.
CHA’s Workplace Violence
Prevention Resources web page has been revised to include
many new tools in a more user-friendly layout. One addition
is a comprehensive toolkit, developed by the Oregon Hospital
Association and other stakeholders, that includes gap analyses
templates, hazard evaluation assessments and a program
measurement plan as well as guidance on analyzing injury data and
direct costs, and prioritizing levels of risk.
New resources also include a
Health Care and Law Enforcement Collaboration Road Map
developed by the Minnesota Hospital Association. The road map
includes linked journal articles, expert recommendations,
electronic order sets and other tools to help facilities
implement best practices. One barrier to implementation
cited by several hospitals has been the challenges of
collaborating with local law enforcement; the road map may be a
useful tool to overcome those challenges.
These new tools supplement existing resources that include forms,
policies, checklists and templates to assist hospitals and health
systems in implementing the
workplace violence prevention plan required by
The federal Occupational Safety and Health Administration
(Fed/OSHA) electronic injury and illness reporting requirement
originally required most employers to submit OSHA forms 300, 300A
and 301 electronically beginning July 1. California has its own
safety and health program, but the federal rules apply
differently, which is causing confusion among employers. Cal/OSHA
has drafted a proposed rulemaking package revising Title 8
sections 14300.35, 14300.36 and 14300.41, which is currently
under review and not yet available on the agency’s website.
Reportedly, the regulations will require California employers to
use the federal portal; Cal/OSHA will not create a state-specific
Further confusion stems from the fact that the Fed/OSHA
compliance date for the regulations was moved from July 1 to Dec.
1. In addition, the current federal administration is reviewing
the final rule. Even if the federal rule is implemented on Dec.
1, any federal change must be adopted by Cal/OSHA before it is
effective in California. More information on the rule is
available at www.osha.gov/recordkeeping/finalrule/index.html.
previously reported in CHA News, the California
Division of Occupational Safety and Health (Cal/OSHA) health care
workplace violence prevention regulations require general acute
care, acute psychiatric and special hospitals to report to the
agency specified incidents of workplace violence. The
Cal/OSHA online reporting system went live on June 30, and
hospitals began submitting incident reports July 1. Cal/OSHA
notes it is working to research and resolve issues reported by
some hospitals, including instances in which users did not
receive an email with their user credentials, the appropriate
facility was not linked with a user’s account or technical
difficulties were reported with the form.
Cal/OSHA recognizes that technical difficulties may occur during
the start-up phase of the reporting system and may result in
employers’ inability to report incidents as required, through no
fault of their own. Hospitals encountering problems with the
online reporting system should continue to bring these issues to
Cal/OSHA’s attention and should advise CHA of any unresolved
Hospitals that have not yet registered with Cal/OSHA must do so
immediately. Cal/OSHA sent hospital CEOs a letter in
February describing the online reporting requirement, including
the pre-registration process. The process has changed slightly.
Hospitals registering now must still complete the
pre-registration spreadsheet and email it to the agency at
Last week, Cal/OSHA released a second revised version of its
proposed Cal/OSHA Health Care Workplace Violence Prevention
Regulations. The 15-day comment period closes Sept. 12. CHA
will work with its existing workplace violence prevention
work group to develop comments.
The changes in this version include deletion of “outpatient
medical offices and clinics” and “field operations such as mobile
clinics and dispensing operations, medical outreach services and
other off-site operations.” This is significant news for
physician offices. Now, anything that falls outside a
hospital’s license and is not performed on the hospital’s campus
— e.g., contracted services provided to schools, airports,
retail, etc. — is not covered. Other changes, made as a result of
CHA’s comments, include:
The window to respond to questions posed during
computer-based training was changed from 24 hours to one business
The definition of “injury” for purposes of the reporting
obligation is defined as per 8 CCR 14300.7(b)(1), meaning that it
requires medical treatment beyond first aid.
Cal/OSHA has clarified which injuries must be reported within
The new version deletes the reference to 911 as the threshold
for determining whether an event is urgent or emergent; the
threshold is now defined as “a realistic possibility of death or
serious physical harm.”
On Aug. 2, Cal/OSHA released the attached revision of its
proposed health care workplace violence prevention
regulations. Comments on the revisions are due Aug. 17. CHA
will convene its health care workplace violence prevention
workgroup to develop a comment letter, and individual hospitals
may submit comments to CHA for incorporation into its letter, or
may submit comments to Cal/OSHA directly.
While CHA continues to have concerns about the proposed
regulations, several significant changes were made, consistent
While the obligation to maintain a violent incident log and
comply with record keeping obligations will be required as of the
regulations’ effective date, employers will have an additional
year to comply with the remaining obligations (plan development,
assessment and correction of current hazards and training).
At its July 21 meeting, the Cal/OSHA Standards Board staff
reported that Cal/OSHA was striving to release the next version
of its proposed workplace violence prevention regulations in the
next few weeks, and to have the final regulations heard at the
Sept. 15 board meeting in Sacramento. Though this might be
considered aggressive, Cal/OSHA must finalize the regulations by
October or it will be required to start the process anew. The
final regulations could be heard as late as the Oct. 20 board
meeting. If finalized by the end of October, the regulations
would go into effect Jan. 1, 2017.
Earlier this month, the Government Accountability Office (GAO)
issued a report on workplace violence in health care facilities
and efforts to address the issue by the federal Occupational
Safety and Health Administration (OSHA). The report — the
result of a request from several congressional representatives —
examines what is known about workplace violence in health care
facilities and the associated costs; steps OSHA has taken to
protect health care workers from workplace violence and the
usefulness of those efforts; how selected states have addressed
this issue; and research on the effectiveness of workplace
violence prevention programs in health care facilities. As part
of its review, the GAO met with Cal/OSHA as well as CHA’s health
care workplace violence prevention workgroup.
The report focuses on health care workplace violence prevention
at the federal level and offers recommendations to OSHA, which
does not have a health care workplace violence prevention
Workers in hospitals, nursing homes, and other health care
settings face significant risks of workplace violence. In fact,
health care accounts for nearly as many serious violent injuries
as all other industries combined. Many more assaults or threats
go unreported. Workplace violence comes at a high cost; however,
it can be prevented.
OSHA has compiled a suite of resources to help build and
implement a comprehensive workplace violence program in your
health care facility.
This tool may be useful for California hospitals and health
systems as they begin to prepare for Cal/OSHA Healthcare
Workplace Violence Prevention Regulations, expected to go into
effect in Oct 2016.