Workplace Violence

Code: Plain Speech/Text

Defined: Workplace violence is defined as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty” (National Institute for Occupational Safety and Health (NIOSH).

Actions or words that endanger or harm employees or that result in others having a reasonable belief that they are in danger include:

  • Verbal or physical harassment
  • Verbal or physical threats
  • Assaults or other violence made directly/indirectly by words, gestures, or symbols
  • Any other behavior that causes others to feel unsafe (e.g. bullying, sexual harassment)
  • Use or possession of a weapon on the facility premises

Workplace violence incidents can be categorized by the relationship of the assailant and the worker/workplace. They are as follows:

  • Violence by strangers—persons who have no connection to the workplace
  • Violence by customers, clients, residents, etc.
  • Violence by co-workers—former or current employment relationship. Incidents that occur outside the workplace, but which resulted or arose from the employment relationship
  • Violence by personal relations—incidents committed by someone who has a personal relationship with the worker, such as a current or former spouse or partner, relative or friend

Immediate Action: “Run, Hide, Fight.”

General Staff Assignments:

  1. While personal safety is the primary consideration in any emergency, helping others to safety increases the survivability for all potential victims. Rendering aid can be as simple as rallying likely victims to “Follow me!” or aiding non-ambulatory persons and performing immediate first aid in safer areas. Consideration should be given to residents who have difficulty evacuating without assistance.
  2. Workplace violence incidents are unpredictable and evolve quickly. Because of this, individuals must be prepared to deal with an incident before law enforcement personnel arrive on the scene.
  3. When an incident occurs, follow the emergency plans and any instructions given, taking into consideration their particular circumstances. The safety of residents, other staff, visitors, and vendors is the most important factor to consider when making decisions.
  4. Staff closest to the public address or other communications system should communicate the danger and necessary action.
  5. As the situation develops, it is possible that those present will need to use more than one option. While they should follow the “Run, Hide, Fight” plan and any instructions given by appropriate facility representatives during an incident, they will often have to rely on their own judgment to decide which option will best protect lives.

Run – Best option

  1. Run out of the facility or away from the area under attack and move as far away as possible until in a safe location. Simply exiting the building and going to an evacuation site via practiced fire drill routes may put individuals at risk.
  2. Recent research shows the best method to reduce loss of life in an active shooter incident is for people to immediately evacuate or be evacuated from the area where an active shooter may be located or attempting to enter.
  3. Leave personal items behind.
  4. Visualize possible escape routes, including physically accessible routes for residents, visitors, or staff with disabilities and others with access and functional needs.
  5. Avoid escalators and elevators.
  6. Take others if possible, but do not stay behind because others will not go.
  7. Call 911 when safe to do so.

Call 911 to Report:

  1. Location and description of attackers.
  2. Types of weapons, methods and direction of attack, and flight of attackers.
  3. Don’t assume that someone else has called.

Hide – if Exits are Inaccessible

  1. If running is not a safe option, hide in a safe space with thick walls and few windows. For residents who cannot “run” because of mobility issues (e.g., they are unable to leave their bed) hiding may be their only option.
  2. Lock the doors.
  3. Barricade doors with heavy furniture or wedge items under the door.
  4. Secure the unit entrance(s) by locking the doors and/or securing the doors by any means available (e.g., furniture, cabinets, bed, and equipment).
  5. Close and lock windows and close blinds or cover windows.
  6. Turn off lights.
  7. Silence all electronic devices.
  8. Remain silent.
  9. Look for other avenues of escape.
  10. Identify items (fire extinguishers, chairs, lamps) that could be used as weapons.

Communicate Nonverbally with First Responders

In rooms with exterior windows, make signs to silently signal law enforcement and emergency responders to indicate the status of the room’s occupants).

  1. Hide along the wall closest to the exit but out of view from the hallway (which would allow the best option for ambushing the shooter and for possible escape if the shooter enters or passes by the room).
  2. Remain in place until given an all clear by identifiable law enforcement.

Fight – If Running and Hiding aren’t Options

  1. Disrupt or incapacitate the shooter by using aggressive force and items in their environment, such as fire extinguishers, chairs, etc.
  2. Research shows the strength in numbers; potential victims themselves disrupted 17 of 51 active shooter incidents before law enforcement arrived.

Interacting with First Responders

Police officers, firefighters, and EMS personnel (i.e., first responders) who come to the facility because of a 911 call involving gunfire face a daunting task. Though the objective remains the same—protect residents, visitors, vendors and staff—the threat of an active shooter incident is different than responding to a natural disaster or many other emergencies. Information coming in can be inaccurate and conflicting. This violence might be directed not only in or at facilities, staff, residents, visitors and vendors, but also at nearby buildings off site.

Law enforcement’s first priority is to locate and stop the person or persons believed to be the shooter(s); all other actions are secondary.

  1. Do not interfere with the law enforcement response.
  2. Follow directions and display empty hands with open palms.
  3. Law enforcement may instruct everyone to get on the ground, place their hands on their heads
  4. Individuals may be searched. Don’t resist.

Specific Staff Assignments/following the workplace violence situation:

After the active shooter has been incapacitated, management should engage in post-event assessments and activities:

  1. Account for all individuals at one or more designated assembly points to determine who, if anyone, is missing or potentially injured.
  2. Coordinate with first responders to account for any residents, visitors, vendors and staff who were not evacuated.
  3. Determine the best methods for notifying families of individuals affected by the active shooter, including notification of any casualties; this must be done in coordination with law enforcement.
  4. Assess the behavioral health of individuals at the scene. Provide information to victims, victim families, staff and others about distress helplines, Office for Victims of Crimes counselors or employee assistance personnel (EAP). Substantial resources and processes are in place to aid victims and their families, most notably through state agencies, the Department of Justice, and the FBI’s Office for Victim Assistance.
  5. Ensure equal access to all such resources and programs for people who are deaf, hard of hearing, blind, have low vision, low literacy and other communication disabilities and individuals with limited English proficiency.
  6. Activate a staff family unification plan, communicating this to staff and providing a safe place, away from press for families to gather.
  7. Identify and fill any critical personnel or operational gaps left in the organization as a result of the active shooter.
  8. Determine when to resume full services.
  9. Nothing should be touched unless it involves tending to the wounded. The situation and the location are an active crime scene.
  10. Plan for an extended, evolving situation and the mass casualty or internal disaster plan to be activated to manage the continuing situation. This may include altering daily activities in order for law enforcement and first responders to adequately investigate and clear the scene.

Preparing Ahead/Training:

  1. Train staff, appropriate residents, and volunteers the “Run, Hide, Fight” response.
  2. Train staff to overcome denial and to respond immediately. For example, train staff to recognize the sounds of danger, act, and forcefully communicate the danger and necessary action (e.g., “Gun! Get out!”).
  3. Repetition in training and preparedness shortens the time it takes to orient, observe, and act.
  4. Training provides the means to regain composure, recall at least some of what has been learned, and commit to action. Training to “Run, Hide, or Fight” prevents inaction.
  5. In many instances, an individual might first need to hide and then run to safety when able.
  6. It is not uncommon for people confronted with a threat to first deny the possible danger rather than respond, hearing firecrackers when, in fact, they are hearing gunfire.
  7. Speaking with staff about confronting a shooter may be daunting and upsetting for some people, but great comfort can come from the knowledge that their actions could save lives. To be clear, confronting an active shooter should never be a requirement of any health care provider’s job; how each individual chooses to respond if directly confronted by an active shooter is up to him or her.

See Also: Kentucky Community Crisis Response Board (KCCRB), Mental Health Resources, Psychological First Aid, Workplace Violence


Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

OSHA website with resources on Workplace Violence.

Items listed below are a few from the OSHA website.

Risk Factors

The following references provide information on risk factors and scope of violence in the workplace and may help increase awareness of workplace violence:

Federal Agency Guidance:

Violence on the Job. National Institute for Occupational Safety and Health (NIOSH) Publication No. 2004-100d, (2004). Discusses practical measures for identifying risk factors for violence at work, and taking strategic action to keep employees safe. Based on extensive NIOSH research, supplemented with information from other authoritative sources.

Violence Occupational Hazards in Hospitals. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2002-101, (2002, April). Increases employee and employer awareness of the risk factors for violence in hospitals and provides strategies for reducing exposure to these factors.

Prevention Programs The following references provide guidance for evaluating and controlling violence in the workplace.

OSHA Guidance:

Updated Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (PDF* | EPUB** | MOBI**). OSHA Publication (OSHA-3148), (2015).

Workplace Violence (PDF* ). OSHA Fact Sheet, (2002). A Spanish version (PDF* ) is also available. Provides basic information about vulnerable occupations, employer/employee roles in prevention and protection, and recommendations for response to violent incidents.

Hospital. OSHA eTool.

Workplace Violence. Includes recommendations for establishing a violence prevention program.


Workplace Violence. OSHA. Contains links to a variety of training and reference materials, including presentations, publications, and handouts.

Workplace Violence Prevention for Nurses. Centers Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH). Provides training to healthcare workers on how to recognize the elements of a workplace violence prevention program and develop skills for preventing and responding to workplace violence.

Other Federal Agency Guidance

Workplace Violence Prevention. Minnesota Department of Labor & Industry. Provides links to prevention resources including workplace violence videos, links to other organizations and training resources.

A Comprehensive Guide for Employers and Employees (PDF). Provides guidance to develop and implement a workplace violence prevention program. Includes model policy, sample forms, threat and assault log, five warning signs of escalating behavior, sample workplace weapons policy, sample policy about domestic violence in the workplace and personal conduct to minimize violence.

Violence Prevention Brochure: Maintaining a Safe Workplace. University of California – Davis (UC Davis). Presents information designed to highlight stresses and risks in the work environment, to enhance workplace safety, and to reduce and prevent disruption and violence.

MINCAVA Electronic Clearinghouse – Workplace Violence. Minnesota Center Against Violence and Abuse (MINCAVA), University of Minnesota (UM).

Provides resources identified by the Minnesota Center Against Violence and Abuse specific to workplace violence.

Most Workplace Violence on Women Hidden, Says Center Report. University of Albany (UA), Center for Women in Government. Summarizes and comments on a report addressing workplace violence, emphasizing data specific to women. Twothirds of the nonfatal attacks on women are committed by patients or residents in institutional settings. Husbands, boyfriends and ex-partners commit 15 percent of all workplace homicides against women. Women are more likely to suffer serious injury from workplace violence than men. Women who are victims of violent workplace crimes are twice as likely as men to know their attackers.


There are currently no specific standards for workplace violence.

However, under the General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act (OSHA) of 1970, employers are required to provide their employees with a place of employment that “is free from recognizable hazards that are causing or likely to cause death or serious harm to employees.” The courts have interpreted OSHA’s general duty clause to mean that an employer has a legal obligation to provide a workplace free of conditions or activities that either the employer or industry recognizes as hazardous and that cause, or are likely to cause, death or serious physical harm to employees when there is a feasible method to abate the hazard.

An employer that has experienced acts of workplace violence, or becomes aware of threats, intimidation, or other indicators showing that the potential for violence in the workplace exists, would be on notice of the risk of workplace violence and should implement a workplace violence prevention program combined with engineering controls, administrative controls, and training.

OSHA Enforcement Standard Interpretations

Staff-to-resident ratio in a nursing home and workplace violence. (2006, August 14).

Request for OSHA national policy banning guns from the workplace and OSHA enforcement policy regarding workplace violence. (2006, September 9).

OSHA’s guidelines are advisory, do not create new employer obligations, and are not basis for citations. (2004, June 7).

OSHA’s policy for scheduling occupational fatality investigations. (1997, March 12).

OSHA policy regarding violent employee behavior. (1992, December 10).

Search all available standard interpretations for workplace violence.