Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Scope and Application.
(1) Scope. This section applies to work in
the following health care facilities, service categories, and operations:
(A) Health facilities, as defined
below;
(B) Home health care and
home-based hospice;
(C) Emergency
medical services and medical transport, including these services when provided
by firefighters and other emergency responders;
(D) Drug treatment programs;
(E) Outpatient medical services to the
incarcerated in correctional and detention settings.
(2) Application.
(A) Employers with employees in operations
identified in subsections (a)(1)(A) through (a)(1)(E) shall comply with
subsections (c), (d), (e), (f), and (h).
(B) General acute care hospitals, acute
psychiatric hospitals, and special hospitals shall also comply with subsection
(g).
(3) The employer
shall provide all safeguards required by this section, including provision of
personal protective equipment, training, and medical services, at no cost to
the employee, at a reasonable time and place for the employee, and during the
employee's paid time.
(4)
Implementation. Employers with employees in operations identified in
subsections (a)(1)(A) through (a)(1)(E) shall implement subsections (d), and
(h) by April 1, 2017. General acute care hospitals, acute psychiatric
hospitals, and special hospitals shall also implement subsection (g) by April
1, 2017. Employers with employees in operations identified in subsections
(a)(1)(A) through (a)(1)(E) shall implement the requirements of subsections
(c), (e), and (f) by April 1, 2018.
EXCEPTION: 1: This section does not apply to the
following facilities operated by the California Department of Developmental
Services (DDS) and scheduled to close by the end of 2021:
(1) Porterville Developmental Center General
Treatment Area;
(2) Fairview
Developmental Center; and
(3) Sonoma
Developmental Center. These facilities shall still comply with Section
3203 during the closure process.
Any DDS facility or portion of a DDS facility that is not closed by the end of
2021 or is not planned to be closed by the end of 2021 must comply with this
section.
EXCEPTION: 2: This section shall not apply to
facilities operated by the California Department of Corrections and
Rehabilitation. These facilities shall still comply with Section
3203.
(b) Definitions.
"Acute psychiatric hospital" (APH) means a hospital,
licensed by the California Department of Public Health as such meeting the
definition provided in Health and Safety Code Section
1250(b)
or California Code of Regulations, Title 22, Section 71005; and all services
within the hospital's license.
"Alarm" means a mechanical, electrical or electronic
device that does not rely upon an employee's vocalization in order to alert
others.
"Chief" means the Chief of the Division of Occupational
Safety and Health of the Department of Industrial Relations, or his or her
designated representative.
"Dangerous weapon" means an instrument capable of
inflicting death or serious bodily injury.
"Division" means the Division of Occupational Safety
and Health of the Department of Industrial Relations.
"Emergency" means unanticipated circumstances that can
be life-threatening or pose a risk of significant injuries to the patient,
staff or public, requiring immediate action.
"Emergency medical services" means medical care
provided pursuant to Title 22, Division 9, by employees who are certified
EMT-1, certified EMT-II, or licensed paramedic personnel to the sick and
injured at the scene of an emergency, during transport, or during
inter-facility transfer.
"Engineering controls" means an aspect of the built
space or a device that removes a hazard from the workplace or creates a barrier
between the worker and the hazard. For purposes of reducing workplace violence
hazards, engineering controls include, as applicable, but are not limited to:
electronic access controls to employee occupied areas; weapon detectors
(installed or handheld); enclosed workstations with shatter-resistant glass;
deep service counters; separate rooms or areas for high risk patients; locks on
doors; furniture affixed to the floor; opaque glass in patient rooms (protects
privacy, but allows the health care provider to see where the patient is before
entering the room); closed-circuit television monitoring and video recording;
sight-aids; and personal alarm devices.
"Environmental risk factors" means factors in the
facility or area in which health care services or operations are conducted that
may contribute to the likelihood or severity of a workplace violence incident.
Environmental risk factors include risk factors associated with the specific
task being performed, such as the collection of money.
"General acute care hospital" (GACH) means a hospital,
licensed by the California Department of Public Health as such meeting the
definition provided in Health and Safety Code Section
1250(a)
or California Code of Regulations, Title 22, Section 70005, and all services
within the hospital's license.
"Health facility" means 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. (Ref: Health and Safety Code
Section
1250).
For the purposes of this section, a health facility includes hospital based
outpatient clinics (HBOCs) and other operations located at a health facility,
and all off-site operations included within the license of the health facility.
The term "health facility" includes facilities with the following bed
classifications, as established by the California Department of Public
Health:
(1) General acute care
hospital
(2) Acute psychiatric
hospital
(3) Skilled nursing
facility
(4) Intermediate care
facility
(5) Intermediate care
facility/developmentally disabled habilitative
(6) Special hospital
(7) Intermediate care
facility/developmentally disabled
(8) Intermediate care
facility/developmentally disabled-nursing
(9) Congregate living health
facility
(10) Correctional
treatment center
(11) Nursing
facility
(12) Intermediate care
facility/developmentally disabled-continuous nursing (ICF/DD-CN)
(13) Hospice facility
"Patient classification system" means a method for
establishing staffing requirements by unit, patient, and shift based on the
assessment of individual patients by the registered nurse as specified in Title
22, Sections 70053.2 and 70217, for General Acute Care Hospitals.
"Patient contact" means providing a patient with
treatment, observation, comfort, direct assistance, bedside evaluations, office
evaluations, and any other action that involves or allows direct physical
contact with the patient.
"Patient specific risk factors" means factors specific
to a patient that may increase the likelihood or severity of a workplace
violence incident, such as use of drugs or alcohol, psychiatric condition or
diagnosis associated with increased risk of violence, any condition or disease
process that would cause confusion and/or disorientation, or history of
violence.
"Threat of violence" means a statement or conduct that
causes a person to fear for his or her safety because there is a reasonable
possibility the person might be physically injured, and that serves no
legitimate purpose.
"Work practice controls" means procedures, rules and
staffing which are used to effectively reduce workplace violence hazards. Work
practice controls include, as applicable, but are not limited to: appropriate
staffing levels; provision of dedicated safety personnel (i.e. security
guards); employee training on workplace violence prevention methods; and
employee training on procedures to follow in the event of a workplace violence
incident.
"Workplace violence" means any act of violence or
threat of violence that occurs at the work site. The term workplace violence
shall not include lawful acts of self-defense or defense of others. Workplace
violence includes the following:
(A)
The threat or use of physical force against an employee that results in, or has
a high likelihood of resulting in, injury, psychological trauma, or stress,
regardless of whether the employee sustains an injury;
(B) An incident involving the threat or use
of a firearm or other dangerous weapon, including the use of common objects as
weapons, regardless of whether the employee sustains an injury;
(C) Four workplace violence types:
1. "Type 1 violence" means workplace violence
committed by a person who has no legitimate business at the work site, and
includes violent acts by anyone who enters the workplace with the intent to
commit a crime.
2. "Type 2
violence" means workplace violence directed at employees by customers, clients,
patients, students, inmates, or visitors or other individuals accompanying a
patient.
3. "Type 3 violence" means
workplace violence against an employee by a present or former employee,
supervisor, or manager.
4. "Type 4
violence" means workplace violence committed in the workplace by someone who
does not work there, but has or is known to have had a personal relationship
with an employee.
(c) Workplace Violence Prevention Plan. As
part of the Injury and Illness Prevention Program (IIPP) required by Section
3203, the employer shall establish,
implement and maintain an effective workplace violence prevention plan (Plan)
that is in effect at all times in every unit, service, and operation. The Plan
shall be in writing, shall be specific to the hazards and corrective measures
for the unit, service, or operation, and shall be available to employees at all
times. The written Plan may be incorporated into the written IIPP or maintained
as a separate document, and shall include all of the following elements:
(1) Names or job titles of the persons
responsible for implementing the Plan.
(2) Effective procedures to obtain the active
involvement of employees and their representatives in developing, implementing,
and reviewing the Plan, including their participation in identifying,
evaluating, and correcting workplace violence hazards, designing and
implementing training, and reporting and investigating workplace violence
incidents.
(3) Methods the employer
will use to coordinate implementation of the Plan with other employers whose
employees work in the same health care facility, service, or operation, to
ensure that those employers and employees understand their respective roles as
provided in the Plan. These methods shall ensure that all employees are
provided the training required by subsection (f) and shall ensure that
workplace violence incidents involving any employee are reported, investigated,
and recorded.
(4) Effective
procedures for obtaining assistance from the appropriate law enforcement agency
during all work shifts. The procedure may establish a central coordination
procedure. This shall also include a policy statement 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) Effective procedures for the employer to
accept and respond to reports of workplace violence, including Type 3 violence,
and to prohibit retaliation against an employee who makes such a
report.
(6) Procedures to ensure
that supervisory and non-supervisory employees comply with the Plan in
accordance with Section
3203(a)(2).
(7) Procedures to communicate with employees
regarding workplace violence matters, including:
(A) How employees will document and
communicate to other employees and between shifts and units, information
regarding conditions that may increase the potential for workplace violence
incidents;
(B) How an employee can
report a violent incident, threat, or other workplace violence
concern;
(C) How employees can
communicate workplace violence concerns without fear of reprisal;
(D) How employee concerns will be
investigated, and how employees will be informed of the results of the
investigation and any corrective actions to be taken.
(8) Procedures to develop and provide the
training required in subsection (f). Employees and their representatives shall
be allowed to participate in developing the training.
(9) Assessment procedures to identify and
evaluate environmental risk factors, including community-based risk factors,
for each facility, unit, service, or operation. This shall include a review of
all workplace violence incidents that occurred in the facility, service, or
operation within the previous year, whether or not an injury occurred.
(A) For fixed workplaces: Procedures to
identify and evaluate environmental risk factors for workplace violence in each
unit and area of the establishment, including areas surrounding the facility
such as employee parking areas and other outdoor areas. Assessment tools,
environmental checklists, or other effective means shall be used to identify
locations and situations where violent incidents are more likely to occur.
Procedures shall specify the frequency with which such environmental
assessments will take place. Environmental risk factors shall include, as
applicable, but shall not necessarily be limited to, the following:
1. Employees working in locations isolated
from other employees (including employees engaging in patient contact
activities) because of being assigned to work alone or in remote locations,
during night or early morning hours, or where an assailant could prevent entry
into the work area by responders or other employees;
2. Poor illumination or blocked visibility of
areas where possible assailants may be present;
3. Lack of physical barriers between
employees and persons at risk of committing workplace violence;
4. Lack of effective escape routes;
5. Obstacles and impediments to accessing
alarm systems;
6. Locations within
the facility where alarm systems are not operational;
7. Entryways where unauthorized entrance may
occur, such as doors designated for staff entrance or emergency
exits;
8. Presence of furnishings
or any objects that can be used as weapons in the areas where patient contact
activities are performed;
9.
Storage of high-value items, currency, or pharmaceuticals.
(B) For home health care and home-based
hospice: Procedures to identify and evaluate -- during intake procedures, at
the time of the initial visit, and during subsequent visits whenever there is a
change in conditions -- environmental risk factors such as the presence of
weapons, evidence of substance abuse, or the presence of uncooperative
cohabitants.
(C) For emergency
medical services and medical transport: Procedures for communicating with
dispatching authorities to identify any risk factors present at the scene and
ensure that appropriate assistance will be provided by cooperating agencies if
needed.
(10) Procedures
to identify and evaluate patient-specific risk factors and assess visitors or
other persons who are not employees. Assessment tools, decision trees,
algorithms, or other effective means shall be used to identify situations in
which patient-specific Type 2 violence is more likely to occur and to assess
visitors or other persons who display disruptive behavior or otherwise
demonstrate a risk of committing workplace violence. This includes, as
applicable, procedures for paramedic and other emergency medical services to
communicate with receiving facilities, and for receiving facilities to
communicate with law enforcement and paramedic and other emergency medical
services, to identify risk factors associated with patients who are being
transported to the receiving facility. Patient-specific factors shall include,
as applicable, but not necessarily be limited to, the following:
(A) A patient's mental status and conditions
that may cause the patient to be non-responsive to instruction or to behave
unpredictably, disruptively, uncooperatively, or aggressively;
(B) A patient's treatment and medication
status, type, and dosage, as is known to the health facility and
employees;
(C) A patient's history
of violence, as is known to the health facility and employees;
(D) Any disruptive or threatening behavior
displayed by a patient.
(11) Procedures to correct workplace violence
hazards in a timely manner in accordance with Section
3203(a)(6).
Engineering and work practice controls shall be used to eliminate or minimize
employee exposure to the identified hazards to the extent feasible. The
employer shall take measures to protect employees from imminent hazards
immediately, and shall take measures to protect employees from identified
serious hazards within seven days of the discovery of the hazard, where there
is a realistic possibility that death or serious physical harm could result
from the hazard. When an identified corrective measure cannot be implemented
within this timeframe, the employer shall take interim measures to abate the
imminent or serious nature of the hazard while completing the permanent control
measures. Corrective measures shall include, as applicable, but shall not be
limited to:
(A) Ensuring that sufficient
numbers of staff are trained and available to prevent and immediately respond
to workplace violence incidents during each shift. A staff person is not
considered to be available if other assignments prevent the person from
immediately responding to an alarm or other notification of a violent
incident.
(B) Providing line of
sight or other immediate communication in all areas where patients or members
of the public may be present. This may include removal of sight barriers,
provision of surveillance systems or other sight aids such as mirrors, use of a
buddy system, improving illumination, or other effective means. Where patient
privacy or physical layout prevents line of sight, alarm systems or other
effective means shall be provided for an employee who needs to enter the
area.
(C) Configuring facility
spaces, including, but not limited to, treatment areas, patient rooms,
interview rooms, and common rooms, so that employee access to doors and alarm
systems cannot be impeded by a patient, other persons, or obstacles.
(D) Removing, fastening, or controlling
furnishings and other objects that may be used as improvised weapons in areas
where patients who have been identified as having a potential for workplace
Type 2 violence are reasonably anticipated to be present.
(E) Creating a security plan to prevent the
transport of unauthorized firearms and other weapons into the facility in areas
where visitors or arriving patients are reasonably anticipated to possess
firearms or other weapons that could be used to commit Type 1 or Type 2
violence. This shall include monitoring and controlling designated public
entrances by use of safeguards such as weapon detection devices, remote
surveillance, alarm systems, or a registration process conducted by personnel
who are in an appropriately protected work station.
(F) Maintaining sufficient staffing,
including security personnel, who can maintain order in the facility and
respond to workplace violence incidents in a timely manner.
(G) Installing, implementing, and maintaining
the use of an alarm system or other effective means by which employees can
summon security and other aid to defuse or respond to an actual or potential
workplace violence emergency.
(H)
Creating an effective means by which employees can be alerted to the presence,
location, and nature of a security threat.
(I) Establishing an effective response plan
for actual or potential workplace violence emergencies that includes obtaining
help from facility security or law enforcement agencies as appropriate.
Employees designated to respond to emergencies must not have other assignments
that would prevent them from responding immediately to an alarm to assist other
staff. The response plan shall also include procedures to respond to mass
casualty threats, such as active shooters, by developing evacuation or
sheltering plans that are appropriate and feasible for the facility, a
procedure for warning employees of the situation, and a procedure for
contacting the appropriate law enforcement agency.
(J) Assigning or placing sufficient numbers
of staff, to reduce patient-specific Type 2 workplace violence
hazards.
(12) Procedures
for post-incident response and investigation, including:
(A) Providing immediate medical care or first
aid to employees who have been injured in the incident;
(B) Identifying all employees involved in the
incident;
(C) Making available
individual trauma counseling to all employees affected by the
incident;
(D) Conducting a
post-incident debriefing as soon as possible after the incident with all
employees, supervisors, and security involved in the incident;
(E) Reviewing any patient-specific risk
factors and any risk reduction measures that were specified for that
patient;
(F) Reviewing whether
appropriate corrective measures developed under the Plan -- such as adequate
staffing, provision and use of alarms or other means of summoning assistance,
and response by staff or law enforcement -- were effectively
implemented;
(G) Soliciting from
the injured employee and other personnel involved in the incident their
opinions regarding the cause of the incident, and whether any measure would
have prevented the injury.
(d) Violent Incident Log. The employer shall
record information in a violent incident log (Log) about every incident,
post-incident response, and workplace violence injury investigation performed
in accordance with subsection (c)(12). Information about each incident shall be
based on information solicited from the employees who experienced the workplace
violence. The employer shall omit any element of personal identifying
information sufficient to allow identification of any person involved in a
violent incident, such as the person's name, address, electronic mail address,
telephone number, or social security number, or other information that, alone
or in combination with other publicly available information, reveals the
person's identity. The Log shall be reviewed during the annual review of the
Plan required in subsection (e). The information recorded in the Log shall
include, but not necessarily be limited to:
(1) The date, time, specific location, and
department of the incident;
(2) A
detailed description of the incident;
(3) A classification of who committed the
violence, including whether the perpetrator was a patient/client/customer,
family/friend of a patient/client/customer, stranger with criminal intent,
coworker, supervisor/manager, partner/spouse, parent/relative, or other
perpetrator;
(4) A classification
of 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;
(5) A classification of where the incident
occurred, including whether it was in a patient or client room, emergency room
or urgent care, hallway, waiting room, restroom or bathroom, parking lot or
other area outside the building, personal residence, break room, cafeteria, or
other area;
(6) The type of
incident, including whether it involved:
(A)
Physical attack, including biting, choking, grabbing, hair pulling, kicking,
punching, slapping, pushing, pulling, scratching, or spitting;
(B) Attack with a weapon or object, including
a gun, knife, or other object;
(C)
Threat of physical force or threat of the use of a weapon or other
object;
(D) Sexual assault or
threat, including rape/attempted rape, physical display, or unwanted
verbal/physical sexual contact;
(E)
Animal attack;
(F)
Other.
(7) Consequences
of the incident, including:
(A) Whether
medical treatment was provided to the employee;
(B) Who, if anyone, provided necessary
assistance to conclude the incident;
(C) Whether security was contacted and
whether law enforcement was contacted;
(D) Amount of lost time from work, if
any;
(E) Actions taken to protect
employees from a continuing threat, if any.
(8) Information about the person completing
the Log including their name, job title, phone number, email address, and the
date completed.
(e)
Review of the Workplace Violence Prevention Plan. The employer shall establish
and implement a system to review the effectiveness of the Plan for the overall
facility or operation at least annually, in conjunction with employees and
their representatives regarding the employees' respective work areas, services,
and operations. Problems found during the review shall be corrected in
accordance with subsection (c)(11). The review shall include evaluation of the
following:
(1) Staffing, including staffing
patterns and patient classification systems that contribute to, or are
insufficient to address, the risk of violence;
(2) Sufficiency of security systems,
including alarms, emergency response, and security personnel
availability;
(3) Job design,
equipment, and facilities;
(4)
Security risks associated with specific units, areas of the facility with
uncontrolled access, late-night or early morning shifts, and employee security
in areas surrounding the facility such as employee parking areas and other
outdoor areas.
(5) The Plan, in
accordance with Section
3203(a)(4)(B) and
(C), as it applies to units within a
facility, the facility as a whole, or the particular operation, shall also be
reviewed for the unit, facility or operation, and updated whenever necessary as
follows:
(A) To reflect new or modified tasks
and procedures which may affect how the Plan is implemented, such as changes in
staffing, engineering controls, construction or modification of the facilities,
evacuation procedures, alarm systems and emergency response;
(B) To include newly recognized workplace
violence hazards;
(C) To review and
evaluate workplace violence incidents which result in a serious injury or
fatality; or
(D) To review and
respond to information indicating that the Plan is deficient in any
area.
(E) When a revision to the
Plan is needed for only part of the facility or operation, the review process
may be limited to the employees in the unit(s) or operation(s) affected by the
revision, independently of the annual review for the Plan for the facility as a
whole.
(f)
Training. The employer shall provide effective training to employees, as
specified in subsections (f)(1) through (f)(3), that addresses the workplace
violence risks that the employees are reasonably anticipated to encounter in
their jobs. The employer shall have an effective procedure for obtaining the
active involvement of employees and their representatives in developing
training curricula and training materials, participating in training sessions,
and reviewing and revising the training program. Training material appropriate
in content and vocabulary to the educational level, literacy, and language of
employees shall be used.
(1) All employees
working in the facility, unit, service, or operation shall be provided initial
training as described in subsection (f)(1)(A) when the Plan is first
established and when an employee is newly hired or newly assigned to perform
duties for which the training required in this subsection was not previously
provided, and shall also be provided additional training as described in
subsection (f)(1)(B).
(A) Initial training
shall address the workplace violence hazards identified in the facility, unit,
service, or operation, and the corrective measures the employer has implemented
and shall include:
1. An explanation of the
employer's workplace violence prevention plan, including the employer's hazard
identification and evaluation procedures, general and personal safety measures
the employer has implemented, how the employee may communicate concerns about
workplace violence without fear of reprisal, how the employer will address
workplace violence incidents, and how the employee can participate in reviewing
and revising the Plan;
2. How to
recognize the potential for violence, factors contributing to the escalation of
violence and how to counteract them, and when and how to seek assistance to
prevent or respond to violence;
3.
Strategies to avoid physical harm;
4. How to recognize alerts, alarms, or other
warnings about emergency conditions such as mass casualty threats and how to
use identified escape routes or locations for sheltering, as
applicable;
5. The role of private
security personnel, if any;
6. How
to report violent incidents to law enforcement;
7. Any resources available to employees for
coping with incidents of violence, including, but not limited to, critical
incident stress debriefing or employee assistance programs;
8. An opportunity for interactive questions
and answers with a person knowledgeable about the employer's workplace violence
prevention plan.
(B)
Additional training shall be provided when new equipment or work practices are
introduced or when a new or previously unrecognized workplace violence hazard
has been identified. The additional training may be limited to addressing the
new equipment or work practice or new workplace hazard.
(C) Training not given in person shall
fulfill all the subject matter requirements of subsection (f)(1) and shall
provide for interactive questions to be answered within one business day by a
person knowledgeable about the employer's workplace violence prevention
plan.
(2) Employees
performing patient contact activities and those employees' supervisors shall be
provided refresher training at least annually, applicable to those employees,
to review the topics included in the initial training and the results of the
review(s) required in subsection (e). Refresher training shall include an
opportunity for interactive questions and answers with a person knowledgeable
about the employer's workplace violence prevention plan. Training not given in
person shall fulfill all the subject matter requirements of subsection (f)(2)
and shall provide for interactive questions to be answered within one business
day by a person knowledgeable about the employer's workplace violence
prevention plan.
(3) Employees
assigned to respond to alarms or other notifications of violent incidents or
whose assignments involve confronting or controlling persons exhibiting
aggressive or violent behavior shall be provided training on the following
topics prior to initial assignment and at least annually thereafter. This is in
addition to the training required in subsection (f)(1). This additional
training shall include:
(A) General and
personal safety measures;
(B)
Aggression and violence predicting factors;
(C) The assault cycle;
(D) Characteristics of aggressive and violent
patients and victims;
(E) Verbal
intervention and de-escalation techniques and physical maneuvers to defuse and
prevent violent behavior;
(F)
Strategies to prevent physical harm;
(G) Appropriate and inappropriate use of
restraining techniques in accordance with Title 22;
(H) Appropriate and inappropriate use of
medications as chemical restraints in accordance with Title 22;
(I) An opportunity to practice the maneuvers
and techniques included in the training with other employees they will work
with, including a meeting to debrief the practice session. Problems found shall
be corrected.
(g) Reporting Requirements for General Acute
Care Hospitals, Acute Psychiatric Hospitals, and Special Hospitals.
(1) Every general acute care hospital, acute
psychiatric hospital, and special hospital shall report to the Division any
incident involving either of the following:
(A) The use of physical force against an
employee by a patient or a person accompanying a patient that results in, or
has a high likelihood of resulting in, injury, psychological trauma, or stress,
regardless of whether the employee sustains an injury;
NOTE: "Injury," as used in subsection (g)(1)(A), means
an injury meeting the criteria in Section
14300.7(b)(1).
(B) An incident involving the use of a
firearm or other dangerous weapon, regardless of whether the employee sustains
an injury.
NOTE: to (g)(1): These reports do not relieve the
employer of the requirements of Section
342 to immediately report a serious
injury, illness, or death to the nearest Division district
office.
(2) The
report to the Division required by subsection (g)(1) shall be made within 24
hours, after the employer knows or with diligent inquiry would have known of
the incident, if the incident results in injury, involves the use of a firearm
or other dangerous weapon, or presents an urgent or emergent threat to the
welfare, health, or safety of hospital personnel. For purposes of this
reporting process:
(A) "Injury" means a
fatality or an injury that requires inpatient hospitalization for a period in
excess of 24 hours for other than medical observation or in which an employee
suffers a loss of any member of the body or suffers any serious degree of
permanent disfigurement.
(B) An
"urgent or emergent threat to the welfare, health, or safety of hospital
personnel" means that hospital personnel are exposed to a realistic possibility
of death or serious physical harm.
(3) All other reports to the Division
required by subsection (g)(1) shall be made within 72 hours.
(4) Reports shall include, at a minimum, the
following items:
(A) Hospital name, site
address, hospital representative, phone number, and email address, and the
name, representative name, and contact information for any other employer of
employees affected by the incident;
(B) Date, time, and specific location of the
incident;
(C) A brief description
of the incident, including but not limited to, the type of attacker, the type
of physical assault, the type of weapon or object used by the attacker, if any,
working conditions at the time of attack, and whether the assaulted employee
was alone or isolated immediately prior to the incident;
(D) The number of employees injured and the
types of injuries sustained;
(E)
Whether security or law enforcement was contacted, and how security or law
enforcement assisted the employee(s);
(F) Whether there is a continuing threat, and
if so, what measures are being taken to protect employees by engineering
control modifications, work practice modifications, or other
measures;
(G) A unique incident
identifier;
(H) Whether the
incident was reported to the nearest Division district office as required in
Section 342.
(I) The report shall not include any employee
or patient names. Employee names shall be furnished upon request to the
Division.
(5) The
employer shall provide supplemental information to the Division regarding the
incident within 24 hours of any request.
(6) Reports shall be provided through a
specific online mechanism established by the Division for this
purpose.
(h)
Recordkeeping.
(1) Records of workplace
violence hazard identification, evaluation, and correction shall be created and
maintained in accordance with Section
3203(b)(1), except
that the Exception to Section
3203(b)(1) does
not apply.
(2) Training records
shall be created and maintained for a minimum of one year and include training
dates, contents or a summary of the training sessions, names and qualifications
of persons conducting the training, and names and job titles of all persons
attending the training sessions. Section
3203(b)(2)
EXCEPTION NO. 1 does not apply to these training records.
(3) Records of violent incidents, including
but not limited to, violent incident logs required by subsection (d), reports
required by subsection (g), and workplace violence injury investigations
conducted pursuant to subsection (c)(12), shall be maintained for a minimum of
five years. These records shall not contain "medical information" as defined by
Civil Code Section
56.05(j).
(4) All records required by this subsection
shall be made available to the Chief on request, for examination and
copying.
(5) All records required
by this subsection shall be made available to employees and their
representatives, on request, for examination and copying in accordance with
Section 3204(e)(1) of
these orders.
(6) Records required
by Division 1, Chapter 7, Subchapter 1, Occupational Injury or Illness Reports
and Records, of these orders shall be created and maintained in accordance with
those orders.
1. New
section filed 12-8-2016; operative 4-1-2017 (Register 2016, No.
50).
Note: Authority: Section
142.3, Labor
Code. Reference: Sections
142.3 and
6401.8, Labor
Code.
