Workplace Violence: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (OSHA 3148)

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   work io ence

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   • OSHA 3148-06R 2016
   • of Labor
   • w U.S.
   • w Department
   • w.osh a.g
   • ov
   • www.osha.gov
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   Occupational Safety and Health Act of 1970

   • “To assure safe and healthful working conditions for working men and women; by authorizing enforcement of the standards developed under the Act; by assisting and encouraging the States in their efforts to assure safe and healthful working conditions; by providing for research, information, education, and training in the field of occupational safety and health...”
   • This publication provides a general overview of worker rights under the Occupational Safety and…
   • …
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   Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

   • U.S. Department of Labor
   • Occupational Safety and Health Administration
   • OSHA 3148-06R 2016
4. Page 4
   • This guidance document is advisory in nature and informational in content. It is not a standard or regulation, and it neither creates new legal obligations nor alters existing obligations created by the Occupational Safety and Health Administration (OSHA) standards or the Occupational Safety and Health Act of 1970 (OSH Act or Act). Pursuant to the OSH Act, employers must comply with safety and health standards and regulations issued and enforced either by OSHA or by an OSHA-approved state plan. …
   • …
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   Table of Contents

   • Overview of the Guidelines … 1
   • Violence in the Workplace: The Impact of Workplace Violence on Healthcare and Social Service Workers … 2
   • Risk Factors: Identifying and Assessing Workplace
   • Violence Hazards … 3
   • Violence Prevention Programs … 5
   • 1. Management Commitment and Worker Participation … 6
   • 2. Worksite Analysis and Hazard Identification … 8
   • 3. Hazard Prevention and Control … 12
   • 4. Safety and Health Training … 24
   • 5. Recordkeeping and Program Evaluation … 27
   • …
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   Overview of the Guidelines

   • Healthcare and social service workers face significant risks of job-related violence and it is OSHA’s mission to help employers address these serious hazards. This publication updates OSHA’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers. …
   • …
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   Violence in the Workplace: The Impact of Workplace Violence on Healthcare and Social Service Workers

   • social workers, emergency medical care personnel, physicians, pharmacists, physicians’ assistants, nurse practitioners, and other support staff who come in contact with clients with known histories of violence. Employers should use these guidelines to develop appropriate workplace violence prevention programs, engaging workers to ensure their perspective is recognized and their needs are incorporated into…
   • …
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   Risk Factors: Identifying and Assessing Workplace Violence Hazards

   • In 2013, a large number of the assaults involving days away from work occurred at healthcare and social assistance facilities (ranging from 13 to 36 per 10,000 workers). By comparison, the days away from work due to violence for the private sector as a whole in 2013 were only approximately 3 per 10,000 full-time workers. …
   • …
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   • high volume urban emergency departments and residential and day social services present the highest risks. Pain, devastating prognoses, unfamiliar surroundings, mind and mood altering medications and drugs, and disease progression can also cause agitation and violent behaviors.
   • While the individual risk factors will vary, depending on the type and location of a healthcare or social service setting, as well as the type of organization, some of the risk factors include:
   • …
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    Violence Prevention Programs

    • Long waits for patients or clients and overcrowded, uncomfortable waiting rooms;
    • Unrestricted movement of the public in clinics and hospitals; and
    • Perception that violence is tolerated and victims will not be able to report the incident to police and/or press charges.
    • A written program for workplace violence prevention, incorporated into an organization’s overall safety and health program, offers an effective approach to reduce or eliminate the risk of violence in the…
    • …
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    Effective management

    • 1. M
    • anagement Commitment and Worker Participation
    • Management commitment and worker participation are essential elements of an effective violence prevention program. The leadership of management in providing full support for the development of the workplace’s program, combined with worker involvement is critical for the success of the program. Developing procedures to ensure that management and employees are involved in the
    • creation and operation of a workplace
    • leadership begins
    • …
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    • Establishing a comprehensive program of medical and psychological counseling and debriefing for workers who have experienced or witnessed assaults and other violent incidents and ensuring that trauma-informed care is available; and
    • Establishing policies that ensure the reporting, recording, and monitoring of incidents and near misses and that no reprisals are made against anyone who does so in good faith.
    • Additionally, management should: (1) articulate a policy and establish goals; (2) allocate…
    • …
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    Cooperation between

    • Ensuring that there is a way to report and record incidents and near misses, and that issues are addressed appropriately;
    • Ensuring that there are procedures to ensure that employees are not retaliated against for voicing concerns or reporting injuries; and
    • Employee training and continuing education programs.
    • 2. Worksite Analysis and Hazard Identification
    • A worksite analysis involves a mutual step-by-step assessment of the workplace to find existing or potential hazards that may lead…
    • …
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    • what circumstances worksite analyses should be conducted. For example, the team may determine that a comprehensive annual worksite analysis should be conducted, but require that an investigative analysis occur after every incident or near miss.
    • Additionally, those conducting the worksite analysis should periodically inspect the workplace and evaluate worker tasks in order to identify hazards, conditions, operations and situations that could lead to potential violence. …
    • …
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    Departments/

    • Possible Findings from Records Review:
    • Units
    • Unit
    • Time of
    • day
    • Work areas
    • Community
    • Care
    • Job titles
    • Residential Treatment
    • Field Workers
    • (Home
    • Healthcare and Social Service)
    • Activities
    • Hospital
    • Non-residential
    • Treatment/
    • Service
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    Job Hazard Analysis

    • A job hazard analysis is an assessment that focuses on job tasks to identify hazards. Through review of procedures and operations connected to specific tasks or positions to identify if they contribute to hazards related to workplace violence and/or can be modified to reduce the likelihood of violence occurring, it examines the relationship between the employee, the task, tools, and the work environment. Worker participation is an essential component of the analysis. …
    • …
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    • work processes. Detailed baseline screening surveys can help pinpoint tasks that put workers at risk. Periodic surveys— conducted at least annually or whenever operations change or incidents of workplace violence occur—help identify new or previously unnoticed risk factors and deficiencies or failures in work practices. The periodic review process should also include feedback and follow-up. The following are sample questions:
    • What daily activities, if any, expose you to the greatest risk of violence?
    • …
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    • In the field of industrial hygiene, these steps are generally categorized, in order of effectiveness, as (1) substitution; (2) engineering controls; and (3) administrative and work practice controls. These principles, which are described in more detail below, can also be applied to the field of workplace violence. In addition, employers should ensure that, if an incident of workplace violence occurs, post-incident procedures and services are in place and/or immediately made available.
    • Substitution
    • …
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    Possible engineering controls for different healthcare and social service settings

    • If new construction or modifications are planned for a facility, assess any plans to eliminate or reduce security hazards.
    • The following are possible engineering controls that could apply in different settings. Note that this is a list of suggested measures whose appropriateness will depend on a number of factors.
    • Hospital
    • Residential Treatment
    • Non-residential
    • Treatment/
    • Service
    • Security/
    • …
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    • Hospital
    • Barrier protection
    • Residential Treatment
    • Non-residential
    • Treatment/
    • Service
    • Community
    • Care
    • Field Workers
    • (or keyless
    • bulletproof
    • door systems)
    • x x Provide
    • glass
    • lockable (or and secure
    • x x Deep
    • keyless door
    • bathrooms for counters
    • staff members
    • systems)
    • at nurses’
    • (with locks on and secure the inside)— stations bathrooms for staff separated from x x Lock doors patient/client members to staff
    • (with locks on and visitor counseling facilities
    • and treatment the inside)—
    • separated
    • rooms
    • from patient/
    • …
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    Hospital

    • Patient/client areas
    • Residential Treatment
    • Non-residential
    • Treatment/
    • Service
    • x x Establish
    • x x Provide
    • areas for areas for comfortable patients/ patients/ waiting areas to clients to clients to reduce stress de‑escalate de‑escalate x x Provide x x Provide comfortable comfortable waiting areas waiting areas to reduce to reduce stress stress x x Divide x x Assess staff waiting areas rotations to limit the in facilities spreading where clients of agitation become among agitated by clients/…
    • …
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    Administrative and work practice controls

    • Hospital
    • Lighting
    • Residential Treatment
    • Non-residential
    • Treatment/
    • Service
    • x x Install bright, effective lighting—both indoors and outdoors on the grounds, in parking areas and walkways
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service) x x Ensure x x Work with lighting is client to ensure adequate lighting is in both the adequate in both indoor and the indoor and outdoor areas outdoor areas x x Ensure burned out lights are replaced immediately.
    • …
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    The following are possible administrative controls that could apply in different settings.

    • Possible administrative and work practice controls for different healthcare and social service settings
    • Hospital
    • Workplace violence response policy
    • Tracking workers 9
    • Residential Treatment
    • Non-residential Treatment/Service
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service) x x Clearly state to patients, clients, visitors and workers that violence is not permitted and will not be tolerated.
    • …
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    Hospital

    • Residential Treatment
    • Non-residential Treatment/Service
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service) x x Determine the behavioral history of new and transferred patients and clients to learn about any past violent or assaultive behaviors.
    • x x Identify any event triggers for clients, such as certain dates or visitors.
    • x x Identify the type of violence including severity, pattern and intended purpose.
    • …
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    Hospital

    • Residential Treatment
    • Non-residential Treatment/Service
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service)
    • Entry procedures
    • x x Provide
    • x x Institute
    • x x Provide
    • x x Ensure
    • x x Ensure workers
    • responsive, sign-in responsive, timely workers determine how timely procedures information to determine best to enter information with passes those waiting;
    • how best to clients’ homes to those for visitors adopt measures enter facilities waiting;
    • x x Enforce
    • to reduce waiting
    • adopt
    • visitor
    • times
    • …
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    Hospital

    • Residential Treatment
    • Non-residential Treatment/Service
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service) x x Advise workers of company procedures for requesting police assistance or filing charges when assaulted—and assist them in doing so if necessary.
    • x x Provide management support during emergencies. Respond promptly to all complaints.
    • x x Ensure that adequately trained staff members and counselors are available to de-escalate a situation and counsel patients.
    • …
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    Hospital

    • Residential Treatment
    • Non-residential Treatment/Service
    • Transportation x x Develop safety procedures procedures that specifically address the transport of patients.
    • x x Ensure that workers transporting patients have an effective and reliable means of communicating with their home office
    • Community
    • Care
    • Field Workers
    • (Home Healthcare, Social Service) x x Develop safety procedures that specifically address the transport of patients.
    • Post-incident procedures and services
    • …
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    • Consequently, a strong follow-up program for these workers will not only help them address these problems but also help prepare them to confront or prevent future incidents of violence.
    • Several types of assistance can be incorporated into the postincident response. For example, trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs may be provided to assist victims. …
    • …
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    • incidents must be reported, and what information needs to be included. If the incident involves hazardous materials additional reporting requirements may apply.
    • 2. Involve workers in the incident investigation. The employees who work most closely in the area where the event occurred may have special insight into the causes and solutions.
    • 3. Identify Root Causes: Identify the root causes of the incident. Don’t stop an investigation at “worker error” or “unpredictable event.” Ask “why” the patient or…
    • …
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    Training for all workers

    • Training can: (1) help raise the overall safety and health knowledge across the workforce, (2) provide employees with the tools needed to identify workplace safety and security hazards, and (3) address potential problems before they arise and ultimately reduce the likelihood of workers being assaulted. The training program should involve all workers, including contract workers, supervisors, and managers. …
    • …
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    • A combination of training programs may be used, depending on the severity of the risk.
    • In general, training should cover the policies and procedures for a facility as well as de-escalation and self-defense techniques. Both de-escalation and self-defense training should include a hands-on component. The following provides a list of possible topics:
    • The workplace violence prevention policy;
    • Risk factors that cause or contribute to assaults;
    • …
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    Supervisors and

    • Training for supervisors and managers
    • Supervisors and managers must be trained to recognize high-risk situations, so they can ensure that workers are not placed in assignments that compromise their safety. Such training should include encouraging workers to report incidents and to seek the
    • appropriate care after experiencing
    • managers must be
    • a violent incident.
    • trained to recognize
    • Supervisors and managers should
    • high-risk situations, so
    • learn how to reduce safety hazards
    • …
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    • Accurate records of injuries, illnesses, incidents, assaults, hazards, corrective actions, patient histories and training can help employers determine the severity of the problem; identify any developing trends or patterns in particular locations, jobs or departments; evaluate methods of hazard control; identify training needs and develop solutions for an effective program. Records can be especially useful to large organizations and for members of a trade association that “pool” data. …
    • …
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    • violent client should be aware of the person’s background and history, including triggers and de-escalation responses. Log the admission of violent patients to help determine potential risks. Log violent events on patients’ charts and flagged charts. 12
    • Documentation of minutes of safety meetings, records of hazard analyses and corrective actions recommended and taken.
    • Records of all training programs, attendees, and qualifications of trainers.
    • Elements of a program evaluation
    • …
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    • Keeping up-to-date records of administrative and work practice changes to prevent workplace violence to evaluate how well they work;
    • Surveying workers before and after making job or worksite changes or installing security measures or new systems to determine their effectiveness;
    • Tracking recommendations through to completion;
    • Keeping abreast of new strategies available to prevent and respond to violence in the healthcare and social service fields as they develop;
    • …
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    YES

    • NO
    • Notes/Follow-up Action
    • Do employees have contact with the public?
    • Do they exchange money with the public?
    • Do they work alone?
    • Do they work late at night or during early morning hours?
    • Is the workplace often understaffed?
    • Is the workplace located in an area with a high crime rate?
    • Do employees enter areas with a high crime rate?
    • Do they have a mobile workplace (patrol vehicle, work van, etc.)?
    • Do they deliver passengers or goods?
    • …
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    All Areas

    • Some Areas
    • Few Areas
    • No Areas
    • Are nametags or ID cards required for employees (omitting personal information such as last name and home address)?
    • Are workers notified of past violent acts in the workplace?
    • Are trained security and counseling personnel accessible to workers in a timely manner?
    • Do security and counseling personnel have sufficient authority to take all necessary action to ensure worker safety?
    • Is there an established liaison with state police and/or local police and counseling…
    • …
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    3. INSPECTING EXTERIOR BUILDING AREAS

    • All Areas
    • Some Areas
    • Few Areas
    • No Areas
    • NOTES/FOLLOW-UP
    • ACTION
    • Are patients or clients in waiting areas clearly informed how to use the department’s services so they will not become frustrated?
    • Are waiting times for patient or client services kept short to prevent frustration?
    • Are private, locked restrooms available for employees?
    • Is there a secure place for workers to store personal belongings?
    • Yes
    • No
    • NOTES/FOLLOW-UP ACTION
    • …
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    4. INSPECTING PARKING AREAS

    • Yes
    • No
    • Should Add
    • Doesn’t Apply
    • NOTES/FOLLOW-UP ACTION
    • Is there a nearby parking lot reserved for employees only?
    • Is the parking lot attended or otherwise secured?
    • Is the parking lot free of blind spots and is landscaping trimmed back to prevent hiding places?
    • Is there enough lighting to see clearly in the parking lot and when walking to the building?
    • Are security escorts available to employees walking to and from the parking lot?
    • 5. SECURITY MEASURES
    • Does the workplace have:
    • …
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    6. COMMENTS

    • Checklist completed by:
    • Date:
    • Department/Location:
    • Phone Number:
    • Workplace Violence Prevention Program Assessment Checklist
    • Use this checklist as part of a regular safety and health inspection or audit to be conducted by the Health and Safety, Crime/Workplace Violence Prevention Coordinator, or joint labor/management committee. If a question does not apply to the workplace, then write “N/A” (not applicable) in the notes column. Add any other questions that may be appropriate.
    • Yes
    • No
    • NOTES
    • …
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    Yes

    • No
    • TRAINING
    • Are workers trained in the emergency response plan (for example, escape routes, notifying the proper authorities)?
    • Are workers trained to report violent incidents or threats?
    • Are workers trained in how to handle difficult clients or patients?
    • Are workers trained in ways to prevent or defuse potentially violent situations?
    • Are workers trained in personal safety and self-defense?
    • FACILITY DESIGN
    • Are there enough exits and adequate routes of escape?
    • …
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    Yes

    • No
    • NOTES
    • SECURITY MEASURES –
    • Does the workplace have?
    • Physical barriers (Plexiglas partitions, elevated counters to prevent people from jumping over them, bullet-resistant customer windows, etc.)?
    • Security cameras or closed-circuit TV in high-risk areas?
    • Panic buttons – (portable or fixed)
    • Alarm systems?
    • Metal detectors?
    • X-ray machines?
    • Door locks?
    • Internal phone system to activate emergency assistance?
    • Phones with an outside line programmed to call 911?
    • Security mirrors (convex mirrors)?
    • …
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    Yes

    • No
    • WORKPLACE PROCEDURES
    • Are employees given maps and clear directions in order to navigate the areas where they will be working?
    • Is public access to the building controlled?
    • Are floor plans posted showing building entrances, exits, and location of security personnel?
    • Are these floor plans visible only to staff and not to outsiders?
    • Is other emergency information posted, such as the telephone numbers?
    • Are special security measures taken to protect people who work late at night (escorts, locked…
    • …
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    Yes

    • No
    • NOTES
    • Can workers effectively communicate with people they meet in the field (same language, etc.)?
    • Are people who work in the field late at night or early mornings advised about special precautions to take?
    • FIELD WORK – Work Environment:
    • Is there enough lighting to see clearly in all areas where workers must go?
    • Are there safe places for workers to eat, use the restroom, store valuables, etc.?
    • Are there places where workers can go for protection in an emergency?
    • …
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    Bibliography

    • Yes
    • No
    • NOTES
    • FIELD WORK – Are special precautions taken when workers:
    • Have to take something away from people
    • (remove children from the home)?
    • Have contact with people who behave violently?
    • Use vehicles or wear clothing marked with the name of an organization that the public may strongly dislike?
    • Perform duties inside people’s homes?
    • Have contact with dangerous animals (dogs, etc.)?
    • Adapted from the workplace violence prevention program checklist, California Department of Human Resources…
    • …
46. Page 47
    • Farkas, G. M., & Tsukayama, J. K. (2012). An integrative approach to threat assessment and management: Security and mental health response to a threatening client. Work, 9-14.
    • Ferns, T., & Cork, A. (2008). Managing alcohol related aggression in the emergency department (Part I). International Emergency Nursing, 43-47.
    • Foley, M. (2012). Evaluating progress in reducing workplace violence: Trends in Washington State workers’ compensation claims rates, 1997-2007. Work, 67-81.
    • …
47. Page 48
    • Gillespie, G. L., Gates, D. M., Miller, M., & Howard, P. K. (2012). Emergency department workers’ perceptions of security officers’ effectiveness during violent events. Work, 21-27.
    • Greenspan, A. I., & Noonan, R. K. (2012). Twenty years of scientific progress in injury and violence research and the next public health frontier. Journal of Safety Research, Article in Press.
    • Harthill, S. (2009-2010). The Need for a Revitalized Regulatory Scheme to Address Workplace Bullying in the United States: Harnessing…
    • …
48. Page 49
    • Johns, D. V. (2008-2009). Action Should Follow Words: Assessing the Arbitral Response to Zero-Tolerance Workplace Violence Policies. Ohio State Journal on Dispute Resolution, 263-290.
    • Joint Programme on Workplace Violence in the Health Sector; International Labour Office (ILO); International Council of Nurses (IC); World Health Organization (WHO); Public Services International (PSI). (2002). Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: International Labour Office.
    • …
49. Page 50
    • Lipscomb, J., Silverstein, B., Slavin, T. J., Cody, E., & Jenkins, L. (2002). Perspectives on Legal Strategies to Prevent Workplace Violence. The Journal of Law, Medicine, & Ethics, 166-172.
    • Magnavita, N. (2011). Violence Prevention in a Small-scale Psychiatric Unit: Program Planning and Evaluation. International Journal of Occupational Environmental Health, 336-344.
    • Massachusetts Department of Mental Health Task Force on Staff and Client Safety. (2011). …
    • …
50. Page 51
    • Phillips, S. (2007). Countering Workplace Aggression: An Urban Tertiary Care Institutional Exemplar. Nursing Administration Quarterly, 209-218.
    • Rodriguez-Acosta, R., Myers, D., Richardson, D., Lipscomb, H., Chen, J., & Dement, J. (2010). Physical assault among nursing staff employed in acute care. Work, 191-200.
    • Sawyer, J. R. (2009). Preventing hospital gun violence: best practices for security professionals to review and adopt. Journal of Healthcare Protection Management, 99-103.
    • …
51. Page 52

    Workers’ Rights

    • Workers have the right to:
    • Working conditions that do not pose a risk of serious harm.
    • Receive information and training (in a language and vocabulary the worker understands) about workplace hazards, methods to prevent them, and the OSHA standards that apply to their workplace.
    • Review records of work-related injuries and illnesses.
    • File a complaint asking OSHA to inspect their workplace if they believe there is a serious hazard or that their employer is not following OSHA’s rules. …
    • …
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    Compliance Assistance Specialists

    • Injury and illness prevention programs are systems that can substantially reduce the number and severity of workplace injuries and illnesses, while reducing costs to employers. Thousands of employers across the United States already manage safety using injury and illness prevention programs, and OSHA believes that all employers can and should do the same. Thirty-four states have requirements or voluntary guidelines for workplace injury and illness prevention programs. …
    • …
53. Page 54

    Cooperative Programs

    • On-site consultation services are separate from enforcement and do not result in penalties or citations. Consultants from state agencies or universities work with employers to identify workplace hazards, provide advice on compliance with OSHA standards, and assist in establishing safety and health management programs.
    • For more information, to find the local On-site Consultation office in your state, or to request a brochure on Consultation Services, visit www.osha.gov/consultation…
    • …
54. Page 55

    Occupational Safety and Health Training

    • Voluntary Protection Programs (VPP)
    • The VPP recognize employers and workers in private industry and federal agencies who have implemented effective safety and health management programs and maintain injury and illness rates below the national average for their respective industries. In VPP, management, labor, and OSHA work cooperatively and proactively to prevent fatalities, injuries, and illnesses through a system focused on: hazard prevention and control…
    • …
55. Page 56

    NIOSH Health Hazard Evaluation Program

    • To view materials available online or for a listing of free publications, visit www.osha.gov/publications. You can also call 1-800-321-OSHA (6742) to order publications.
    • Select OSHA publications are available in e-Book format. OSHA e-Books are designed to increase readability on smartphones, tablets and other mobile devices. For access, go to www.osha.gov/ebooks.
    • OSHA’s web site also has information on job hazards and injury and illness prevention for employers and…
    • …
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    OSHA Regional Offices

    • Region I
    • Boston Regional Office
    • (CT*, ME*, MA, NH, RI, VT*)
    • JFK Federal Building, Room E340 Boston, MA 02203
    • (617) 565-9860 (617) 565-9827 Fax
    • Region II
    • New York Regional Office
    • (NJ*, NY*, PR*, VI*)
    • 201 Varick Street, Room 670
    • New York, NY 10014
    • (212) 337-2378 (212) 337-2371 Fax
    • Region III
    • Philadelphia Regional Office
    • (DE, DC, MD*, PA, VA*, WV)
    • The Curtis Center
    • 170 S. Independence Mall West
    • Suite 740 West
    • Philadelphia, PA 19106-3309
    • (215) 861-4900 (215) 861-4904 Fax
    • Region IV
    • …
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    Region VI

    • Dallas Regional Office
    • (AR, LA, NM*, OK, TX)
    • 525 Griffin Street, Room 602
    • Dallas, TX 75202
    • (972) 850-4145 (972) 850-4149 Fax
    • (972) 850-4150 FSO Fax
    • Region VII
    • Kansas City Regional Office
    • (IA*, KS, MO, NE)
    • Two Pershing Square Building
    • 2300 Main Street, Suite 1010
    • Kansas City, MO 64108-2416
    • (816) 283-8745 (816) 283-0547 Fax
    • Region VIII
    • Denver Regional Office
    • (CO, MT, ND, SD, UT*, WY*) Cesar Chavez Memorial Building 1244 Speer Boulevard, Suite 551 Denver, CO 80204
    • (720) 264-6550 (720) 264-6585 Fax
    • …
58. Page 59

    How to Contact OSHA

    • These states and territories operate their own OSHA-approved job safety and health plans and cover state and local government employees as well as private sector employees. The Connecticut, Illinois, Maine, New Jersey, New York and Virgin Islands programs cover public employees only. (Private sector workers in these states are covered by Federal OSHA). States with approved programs must have standards that are identical to, or at least as effective as, the Federal OSHA standards.
    • …
59. Page 60

    U.S. Department of Labor

    • For more information:
    • Occupational
    • Safety and Health Administration www.osha.gov (800) 321-OSHA (6742)