By | March 23, 2017

Although the media pays close attention to workplace homicides, the majority of violent incidents in the workplace involve nonfatal but serious injuries. According to the most recent statistics available from The National Crime Victimization Survey (NCVS) and Bureau of Labor Statistics (BLS) between 2011 and 2013, the majority of workplace assaults occurred in social service and healthcare settings.  As such, the Occupational Safety and Health Association (OSHA) has set forth guidelines designed to prevent workplace violence for those who work in these kinds of industries.


1. Track Client Behavior

It may be difficult to gather information related to the behavioral history of new clients; however, any violent behaviors of current clients must be documented to reduce the likelihood of future events.

  • Establish a System

    • A good system utilizes log books, census reports, and chart tags as a means to recognize clients who have a history of violence. Log book documentation should include potential triggers (e.g., dates, visitors or television programs, etc.), previous violent act information that includes the severity, type, pattern, and client’s intended purpose. A successful system requires ensuring that employees know the protocol for updating a client’s behavioral history.
  • Examine Each Client’s Behavioral History

    • By creating a system that identifies clients who have a history of violence and informing service providers of their triggers, the employee can be prepared to provide the best responses to assist in the de-escalation of the issue at hand.
  • Design Individualized Plans

    • The information collected can be used to create each client an individualized plan to identify and prevent any future acts of violence.

2. Home Visit Contracts

  • Create an Easy to Understand Contract

    • Construct a clear contract that outlines which services will be provided during a home visit and what issues can lead to an employee’s refusal to provide services.

3. Possible Engineering Controls for Social Service and Home Health Workers

Every violent incident or threat must be reported to management. It is essential that employees know the procedures to follow in the event of a violent incident or threatening situation.

  • Security

    • Incorporate regular use of cell phones with GPS tracking capability. The majority of cell phones have a ‘help’ function that can easily be accessed in the event of an emergency situation.
    • Service providers should take note of the exit routes within each home.
    • A de-escalation area for the patient/client should be established somewhere within the home.
    • All portable equipment must be locked when not in use.
    • Medicine or any other valuables must be secured in a locked container.
    • Ensuring reliable transportation requires following the vehicle manufacturer’s maintenance schedule.
    • Develop and distribute emergency action plans so employees know what to do when they need assistance.

4. Potential Administrative and Work Practice Controls for Home Health and Social Services Workers

  • Acts of Violence Response Policy

    • It must be clearly stated that acts of violence are not permitted and are considered intolerable. By establishing this up front with clients and staff members, all parties involved know that violent behavior will not go unnoticed.
  • Keep Track of Service Providers

    • Require employees to contact their manager following each home health service visit: Managers must establish a set of procedures to follow in case an employee fails to check-in.
    • Allow employees to have discretion related to whether they begin or continue their visit when they feel unsafe or threatened.
    • Technology has provided an array of valuable tools that have mobile apps with GPS tracking, as well as employee log-in and log-out capabilities. A recent blog post by JP Medved offers information related to the top free and open source time clock software systems.

5. Create and Implement Log-In and Log-Out Procedures

  • These Procedures Should Include:

    • The client’s name and address.
    • A contact number.
    • The scheduled time of the visit.
    • Expected length of visit.
    • A natural-sounding code word to use in the event of an incident or threat. For example, the worker may say “I think I forgot to lock my desk, can you check it for me?” The code word could be ‘forgot.’
    • If the employee will be traveling with a client, detailed information as to the departure time, planned route, destination(s), expected arrival times etc., must be documented and given to the supervisor/manager.
    • Each service provider’s license plate number and vehicle description must be documented and then placed in his or her file.
    • Employees should contact their supervisor if any changes to the planned appointment/journey arise.

6. Establish an Employee Dress Code

  • Dress Code Tips

    • Staff members should have an identification badge with their first name on it: Avoid including the employee’s last name as this could be used to gather personal information.
    • Encourage workers to keep items that could be used as weapons on his/her person (e.g., keys).
    • In the event of a confrontation, a staff member’s hair may be pulled or grabbed; therefore, encourage those with long hair to wear it up, use head netting and/or wear a cap.
    • Discourage employees from carrying money, wearing chains/necklaces, or expensive jewelry while they are working. Chains/necklaces can be used to grab a hold of and choke an individual.

7. Following-Up After an Incident

  • Management Support Is Essential

    • Provide employees with an outline of company procedures to follow and assist them when necessary (i.e., requesting assistance from the police, filing charges against the perpetrator, etc.).
    • All complaints must be addressed promptly.
    • Contingency plans should be in place for providing services to clients who tend to act out with verbal threats and/or physical attacks.

8. Every Incident Must Be Investigated

To have an effective prevention program, responding to and evaluating each incident is mandatory. The goal of each investigation is to identify the ‘root cause’ of the violent act. If the root cause of an incident is not discovered and addressed, the chance of another violent act occurring for the same reason increases. By investigating these incidents, a roadmap designed to assist in the prevention of injuries and/or fatalities related to future incidents is created.

  • Make a Report

    • Notify the appropriate individuals within the organization that an incident occurred. When necessary, notify outside sources (e.g., the police).
  • Speak With Other Employees

    • Needless to say, speaking with the victim is one of the first steps in starting an investigation. However, other employees working in home health services may have useful insight to share.
  • Review Information Related to the Employee Involved in the Incident

    • Take the time to review records related to past incidents and training that the employee received.

9. Investigate Situations That Could Have Led to an Illness, Injury, or Fatality

  • Investigate Near Misses

    • A violent outburst or situation ending with no one being physically harmed still needs to be investigated. A near miss one time can turn into a violent act at some point in the future: Consider a near miss as a sign that some of the potential hazards are not being controlled adequately or there are still some unidentified hazards that need to be addressed.

10. Safety Awareness and Training Are Two of the Key Elements in Protecting Employees

  • Reducing Violence Through Awareness

    • Once staff members are aware of the potential hazards they face and learn how to protect themselves using established policies/procedures, violent acts and threats may be reduced or avoided altogether.

OSHA Is Seeking Assistance in Creating a Violence Prevention Standard

OSHA is requesting information related to the creation of a potential standard designed to prevent violence in healthcare and social assistance work environments. Those interested in commenting or providing materials related to this topic can submit their documentation electronically, via mail, fax, or deliver the information to OSHA in person. To learn more about submission requirements, click here. All submissions must be received no later than April 6, 2017.

Trina McMillin

Trina brings to Relias a wealth of knowledge and personal experience related to the medical field, dental issues, mental health, and physical therapy techniques. She has worked in various positions over her career which includes being a phlebotomist, laboratory assistant and medical transcriptionist.

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