According to OSHA, nearly 2 million cases of workplace violence are reported annually. Many cases are never reported. The costs of workplace violence include diminished productivity, employee turnover, security measures, and legal costs. According to the Bureau of Labor Statistics, workplace homicides accounted for approximately 9 percent of all fatal occupational injuries—a total of 417 workplace homicides—in the U.S. in 2015. Workplace violence is a recognized risk, and companies that take a reactive approach to the problem are doing a disservice to employees. Effective risk management requires the development of controls to reduce the risk of workplace violence, preferably preventing these incidents from occurring. INCREASED FOCUS Under the General Duty Clause of the Occupational Safety and Health Act of 1970, employers have a legal obligation to provide a workplace free of conditions or activities that are recognized as hazardous and that cause—or are likely to cause—death or serious physical harm to employees. In 1992, OSHA released its first communication regarding workplace violence: a letter of interpretation from the Director of Enforcement Programs responding to a question posed by an employer. Since then, communication around the subject has increased, but the general answer has remained the same: workplace violence falls under the General Duty Clause, and employers can only be held accountable for incidents if they are considered a risk that was or should have been recognized. For example, in December 2012, the home healthcare service company Integra Health Management, Inc. was convicted of failure to properly protect a social service worker who was fatally stabbed outside her client’s home during a scheduled visit. The social worker had recorded her interactions with the client and noted how uncomfortable she felt during these visits, but her reports went unnoticed until the incident occurred.
RESOURCES Active Shooter: Preparing for and Responding to a Growing Threat (2015). Association of periOperative Registered Nurses: “Proactive Approach to Workplace Violence: 6 Areas of Focus” (2018). Campus Security Report: “Run, Hide, Fight...Re-evaluate?” (2015).  Firestorm: “Litigation and Liability: A Guide to Active Shooter Insurance in 90 Seconds” (2017).  IndustryWeek: “Preventing and Preparing for Workplace Violence” (2016).  Issues in Science and Technology: “Countering Terrorism in Transportation” (2002). National Fire Protection Association: “In Response to Rising Toll of Active Shooter and Hostile Events, NFPA to Fast-track a New Standard for Unified Response” (2018). National Safety Council: “Is Your Workplace Prone to Violence?” (2018).  OSHA: Workplace ViolenceProfessional Safety: “Addressing Workplace Violence: Taking Proactive Steps” (2015). Professional Safety: “Workplace Violence: Putting Employers on the Horns of a Dilemma” (2015). U.S. Department of Homeland Security: “Active Shooter: How to Respond” (PDF, October 2008).  Vanderbilt Journal of Transnational Law: “The Organizational Model for Workplace Security” (2003). Vanderbilt Journal of Transnational Law: “Workplace Violence and Security: Are There Lessons for Peacemaking? (2003). Workplace Violence Research Institute: “Preventing Violence in the Workplace.”
OSHA citations following workplace violence incidents that result in injuries or fatalities are not unusual—and they are increasing.  An August 2017 news release describes a fine issued by OSHA to a behavioral health facility in Massachusetts for failing to abate a violation involving workplace violence. It was the largest citation for workplace violence in OSHA history, with penalties totaling $207,690.  Just one incident of workplace violence can result in significant financial losses. Failure to prevent incidents may result in costly litigation in addition to costs related to medical, recovery, compliance, and corrective action. Recent examples of costly incidents include the 2015 San Bernardino shooting ($58 million against the county); the 2013 Munchbar shooting in Seattle, Wash. ($3.7 million in losses paid); the 2007 shooting at Virginia Tech ($11 million paid to victims and families of victims); and Yowan Yang v. ActioNet, Inc. (victim of workplace violence awarded $7.4 million in damages in 2016).  No one is immune to workplace violence; however, the risk can be minimized when proper steps are taken. STRATEGIES TO REDUCE THE RISK Many companies have an active shooter policy within their emergency action plan, or EAP.  These policies provide step-by-step procedures for how to respond to an active shooter if or when the situation arises. While an active shooter plan is an important part of the solution, it should only be used as a last resort if all other layers of protection fail. The plan should never be to force employees to utilize these procedures.  An active shooter policy often includes the “Run, Hide, Fight” method (see Figure 1 below), which was publicized by the Department of Homeland Security in 2008 and outlines the recommendations of several government agencies on how to respond to an active shooter. The three steps involve evacuating or escaping the dangerous area if possible, hiding from the shooter if evacuation fails, and fighting the attacker as a last resort. As the situation unfolds, people who are potentially in the line of fire are responsible for contacting the police and waiting on a response. Run, Hide, Fight does not sufficiently control the risk. While Run, Hide, Fight is not sufficient for workplace violence risk management, many firms have developed effective strategies to reduce the likelihood of a workplace violence incident by implementing administrative and engineering controls. Organization-specific controls are best developed as part of an overall risk management process. Risk management requires a process for identifying and analyzing workplace violence risks, prioritizing those risks, and developing controls to reduce the risks in the workplace.
Figure 1. Run, Hide, Fight Response Method (image courtesy of Ready Marine Corps)
ADMINISTRATIVE CONTROLS Administrative controls are likely the most cost-efficient measures that employers can take to reduce the risk of a violent incident. Beginning with the hiring process, pre-employment screening allows employers to evaluate a  potential employee in several areas. Thorough background checks, drug and alcohol testing, and follow-up with past employers can reveal information about a person’s behavior before they ever enter the establishment. However, it has become more difficult to gain useful information from previous employers as more organizations choose to provide nothing more than dates of employment for past workers.  After a person becomes an employee, it is important for the employer to regularly evaluate behavior. Coworkers are the employer’s best source of information about someone’s behavior. Often it takes an accumulation of events for people to report inappropriate behavior, but by then it may be too late. According to researchers, employers must ensure that they provide employees with training on warning signs of workplace violence and encourage reporting by maintaining an effective channel for employees to voice their concerns. Another way for employers to monitor employees without breaching privacy is through their use of company resources. Telephone communication, emails, copies, faxes, and internet usage can be valuable observational tools that do not violate employees’ rights. These resources, when owned and provided by the company, belong to the business and can be monitored freely. It should be noted, however, that electronics monitoring can have the unwanted effect of being perceived as an invasion of employee privacy. An employer may find that an employee has a new or preexisting mental health issue that has the potential to affect their work or lead to violence. These types of issues must be addressed properly to avoid violating an employee’s rights. Mental health concerns may be protected by the Americans with Disabilities Act and must be handled accordingly. Although mental health should be treated with care, the employer cannot ignore perceived threats or future problems. Possibly the riskiest situation an employer might face is a disgruntled employee. Following a disagreement between coworkers or with a superior, disciplinary action, or termination, employees are likely to be very stressed or dissatisfied with the company or its employees. Other “trigger events” that can cause an unwanted reaction from an employee may include performance reviews, downsizing, or minor changes from the norm. Any conversation concerning these matters should be done in a manner that follows company policy and shows the employee that the decision is not up for debate. Employees should be treated with respect, told why the decision was made, and encouraged to use avenues at their disposal to express their concerns. Human resources or labor unions can be helpful in these situations. If an employee is terminated, more complete action should be taken. The employer should immediately confiscate and deactivate the employee’s company identification; block the person’s access to company resources such as computers, intranet, and email; and notify site security that the person is no longer allowed on the premises. ENGINEERING CONTROLS Engineering controls for workplace violence prevention are tangible solutions that can prevent a dangerous person—an employee, former employee, or member of the public who could be attempting to harm others—or object from entering a work site. The following measures are suggestions that many security companies include in their workplace security plan proposals. Employers should evaluate each of the following controls for feasibility.  Securing entry into the building. Doors, walls, locks, fences, guards, and lighting are all examples of physical controls to reduce dangerous individuals’ access to employees. Establishing predetermined entrances where employees, customers, and visitors are expected to enter and exit the site is an effective control. Other doors around the building or work site should remain locked and designated for emergency uses only. This method will allow for easier tracking of who is in the building at what times and will ensure that unauthorized personnel are not allowed into secured areas. Even a receptionist with a sign-in sheet can deter an act of violence. If the workplace includes outdoor elements such as workstations, pathways, break areas, or patios, the employer may choose to install fencing. A fence will create controlled-access areas for authorized personnel. These efforts instill a sense of security for employees while preventing potential threats to the property.
No one is immune to workplace violence; however, the risk can be minimized when proper steps are taken.
Security guard. A security guard rather than a receptionist can greatly improve security. If a person contemplating doing harm to the organization is not equipped with weapons or training to address such security measures, the idea of a security guard may be a deterrent. Security should be trained on how to check identification, recognize potential threats or weapons, and report findings quickly to the appropriate personnel. In an emergency, the guard will likely be the first line of defense and the first to contact the authorities. Metal detectors, X-ray scanners, bag search stations, turnstiles, and bulletproof glass are additional measures for employers to consider for a front gate or entrance. These controls are more expensive and are only needed where perceived threats are high. Many employers may be able to utilize clear bags to achieve the level of security needed for their workplace. Security cameras. Cameras are commonplace and are often utilized to improve safety at grocery stores, ATMs, and gas stations. Security cameras serve a wide range of purposes and can improve a workplace in many ways. Many businesses have learned that maintaining a record of activities on their property reduces the chance that a crime will be committed. The knowledge of being recorded reduces the likelihood that someone will attempt to do anything dangerous or threatening to others—with the added benefit of encouraging job performance. THE ROLE OF IH AND SAFETY Industrial hygienists and safety professionals should be active in efforts to reduce workplace violence for three primary reasons: they already have an avenue and rapport with workers to address safety concerns in the workplace; they already conduct training on a variety of topics, and workplace violence requires effective training for employees; and the very nature of their responsibilities requires a multidisciplinary understanding of risks and the development of controls to address those risks—important factors in managing the risk of workplace violence.    An effective IH or safety professional is typically viewed by front-line employees as advocating for their safety. A key component of addressing workplace violence is a reporting system for employees to confidentially report red flags or concerns involving coworkers. In the absence of a formal human resources or security department, an IH or safety professional may be the best person in a facility to receive sensitive information and protect the confidentiality of that information. And since IHs and safety professionals often conduct training of employees, they are good candidates to train workers to help them recognize precursors to workplace violence and how to report that information.  However, IHs and safety professionals don’t typically work alone to reduce the risk of workplace violence. These efforts should encompass the entire workplace and be coordinated with human resources, labor unions (when applicable), management, and at times local law enforcement. IHs and safety professionals generally have experience working with these groups on various safety management and emergency response planning initiatives. They have unique experience and capabilities to best address the risk of workplace violence. A NECESSARY INVESTMENT Concern over workplace violence is increasing in the U.S. and is not likely to fade. Workplace violence canot be effectively addressed with a Run, Hide, Fight policy alone, and—as with other workplace risks—one solution will not fit all companies. Effective workplace violence controls are best developed as part of an overall risk management plan that is reviewed and updated regularly.  The control measures suggested here are only a few of the many options that employers have. Administrative controls can typically be implemented quickly, affordably, and without much participation from others. Those responsible for safety and security in a workplace can accomplish these “wins” with little opposition.  The expense required to implement an effective workplace violence prevention program is insignificant compared to the cost of a violent event. Prevention programs reduce this risk where response policies and trainings do not. Although employees may correctly utilize a response policy during a violent event, the implementation of the plan means that workplace violence has been recognized as a risk. At this point, the employer must be prepared for the citations, lawsuits, medical bills, and potentially negative public response that will follow. Workplace violence prevention is not a cost, it is a necessary investment.    MATTHEW BAILEY, GSP, is an EHS manager with Cargill Protein in Nashville, Tenn. He can be reached via email. KRISTEN SPICER, PHD, is an assistant professor of occupational safety and health at Murray State University in Murray, Ky. She can be reached via email. TRACI BYRD is also an assistant professor of occupational safety and health at Murray State University. She can be reached via email. The Synergist thanks Thomas P. Fuller, ScD, CIH, CSP, MSPH, MBA, associate professor in the College of Applied Science and Technology at Illinois State University, for reviewing this article. Send feedback to The Synergist.
Keith Brofsky/Getty Images
Strategies for Keeping Work Sites Safe
Although the print version of The Synergist indicated The IAQ Investigator's Guide, 3rd edition, was already published, it isn't quite ready yet. We will be sure to let readers know when the Guide is available for purchase in the AIHA Marketplace.
My apologies for the error.
- Ed Rutkowski, Synergist editor
Disadvantages of being unacclimatized:
  • Readily show signs of heat stress when exposed to hot environments.
  • Difficulty replacing all of the water lost in sweat.
  • Failure to replace the water lost will slow or prevent acclimatization.
Benefits of acclimatization:
  • Increased sweating efficiency (earlier onset of sweating, greater sweat production, and reduced electrolyte loss in sweat).
  • Stabilization of the circulation.
  • Work is performed with lower core temperature and heart rate.
  • Increased skin blood flow at a given core temperature.
Acclimatization plan:
  • Gradually increase exposure time in hot environmental conditions over a period of 7 to 14 days.
  • For new workers, the schedule should be no more than 20% of the usual duration of work in the hot environment on day 1 and a no more than 20% increase on each additional day.
  • For workers who have had previous experience with the job, the acclimatization regimen should be no more than 50% of the usual duration of work in the hot environment on day 1, 60% on day 2, 80% on day 3, and 100% on day 4.
  • The time required for non–physically fit individuals to develop acclimatization is about 50% greater than for the physically fit.
Level of acclimatization:
  • Relative to the initial level of physical fitness and the total heat stress experienced by the individual.
Maintaining acclimatization:
  • Can be maintained for a few days of non-heat exposure.
  • Absence from work in the heat for a week or more results in a significant loss in the beneficial adaptations leading to an increase likelihood of acute dehydration, illness, or fatigue.
  • Can be regained in 2 to 3 days upon return to a hot job.
  • Appears to be better maintained by those who are physically fit.
  • Seasonal shifts in temperatures may result in difficulties.
  • Working in hot, humid environments provides adaptive benefits that also apply in hot, desert environments, and vice versa.
  • Air conditioning will not affect acclimatization.
Acclimatization in Workers