Text For Citation: 01 Item/Group: 001 Hazard:

OSH ACT of 1970 Section (5)(a)(1): The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employees were exposed to acts of violence in the workplace: (a) Acadia Montana, 55 Basin Creek Rd, Butte, MT 59701: On or about August 04, 2016, and at times prior thereto, the employer failed to keep the workplace free of hazards. Employees were exposed to incidents of violent behavior by clients that have resulted in amputations, contusions, bruising from thrown objects, bites, and injuries to the head and torso from punches and kicks. Employees were exposed to the hazard of physical assaults during routine interactions while working with clients who have a history of violent behavior. The employer has not established or implemented effective measures to protect employees from assaults or other physical violence in the workplace. Among other methods, feasible and acceptable means to abate the hazard of workplace violence include: Establish and implement a written comprehensive and effective workplace violence prevention (WPV) program which includes, but not limited to elements of: 1) Management Commitment and Worker Participation: A written WPV prevention program should include the following elements: a. A zero-tolerance policy on workplace violence. Managers and supervisors must share the policy with employees, clients, family members, and visitors and must verbally advise them that violence is not permitted or tolerated; b. A policy statement regarding potential violence in the workplace and assignment of oversight and prevention responsibilities. The policy must clearly define workplace violence hazards employees may encounter including, but not limited to, verbal and physical assaults. Ensure the policy is conveyed to employees, clients, and anyone else that may come in contact with clients; c. Procedures and responsibilities to be taken in the event of a violent incident in the workplace. Advise employees of company procedures for requesting police assistance or filing charges when assaulted and help them do so, if necessary. Provide prompt medical and psychological evaluations and treatment after the incident; d. Develop a policy requiring employees report all assaults or threats to a supervisor or manager, regardless of severity. Investigate all violent incidents and threats. Implement appropriate recommendations resulting from incident investigations. Document these reports and review the trends of these reports. Such review shall set forth any mitigating steps taken in response to any workplace violence incidents. e. Establish a system such as chart tags or log books to identify clients with assaultive behavior problems. Be cognitive of patient confidentiality and worker safety issues. Update clients? behavioral histories as needed. Review workplace violence incidents from the previous shift during change-in shift meetings. f. Annually review the workplace violence program and update as necessary. 2) Worksite Analysis and Hazard Identification: a. Implement workplace controls and prevention strategies to maximize safety and minimize the likelihood of assaultive behavior; b. Conduct Hazard/Threat/Security assessment including records review, inspection of the worksite, and employee survey; c. Identify clients who pose the most risk to employees and ensure employees are aware by using signage or charts to inform them of the risk in dealing with aggressive clients. d. Institute procedures that would communicate to staff any incident of workplace violence so that employees who might not have access to client charts would be aware of a client?s previous acts of violence or aggression. e. Utilize all available tools to fully investigate each WPV incidence directed at staff by clients/family members/ visitors. For example, one such tool would include but is not limited to video footage captured on the security cameras; 3) Safety and Health Training: a. Supplement the workplace violence training program with site specific training and incidence trending for all employees so they are aware of the specific hazards and relevant means to protect themselves and coworkers. The training shall include the employer's workplace violence prevention program and what procedures and practices to follow in the workplace and when clients are transported. Include in the program elements how to identify and defuse a situation prior to it becoming an escalated incident. b. Conduct the site specific training at the beginning of employment, when significant changes are made to the policies and/or procedures and annually thereafter. 4) Hazard Prevention and Control: a. Prepare contingency plans to treat clients who are acting out; b. Implement and maintain a buddy system as appropriate based upon a complete hazard assessment, especially where clients have a history of violence; c. Ensure the client to staff ratio on all shifts is in accordance with State regulations and adequate to handle aggressive clients when they are in crisis; d. Evaluate current security camera locations and determine if any modifications or additions would be helpful for the times in which assistance is summoned; e. Evaluate current locations of panic buttons/alarms[TAA-S1] , and assess the capacity to maintain clear communication via the radios in the locations where employees rely on their use. Evaluate other efficient and effective means of engineering controls such as GPS tracking systems, and door locks for staff quarters; f. Update and modify current procedures associated with the panic buttons/alarms and radio use to minimize ambiguity and achieve greater reliability in the use of this system as a valid, efficient and effective means of employee protection; g. Remove unsecured items (i.e. glass cups, bowls, and metal silverware) to prevent the items from becoming a weapon for the clients to use against employees. When appropriate, make sure furniture is bolted to the floor to prevent clients from using them as a weapon; h. Provide personal protective equipment (PPE) such as spit masks for clients who have a tendency to spit in the face of employees. Provide impact cushions to protect employees from clients who head butt and train them to use the cushion as a shield of protection from aggressive clients; i. Provide "No-Slam" doors so employees cannot be caught in doors slammed closed by aggressive clients; j. When code is called provide a sufficient number of employees to respond to the incident to ensure employees' safety during the crisis; k. Employ security personnel and provide training to them that includes the psychological components of handling aggressive clients, types of disorders and ways to handle aggression and defuse hostile situations; l. Establish a liaison with law enforcement representatives; m. Develop a safety committee that implements appropriate recommendations based on the monthly evaluation of injuries that occur at the facility.