The SBREFA Panel for a potential standard to address Prevention of Workplace Violence in Healthcare and Social Assistance sectors concluded on May 1, 2023.

The Final SBREFA Report Can Be Downloaded Here. See the Findings and Recommendations Here.

OSHA will continue to welcome comments to the public docket at OSHA-2016-0014-0286 through July 3, 2023 from all interested parties on the Final Report, the Preliminary Initial Regulatory Flexibility Analysis (PIRFA), the draft regulatory framework, alternatives and options that OSHA is considering, or any other aspect of the materials presented.

Workplace Violence SBREFA

Prevention of Workplace Violence in Healthcare and Social Assistance SBREFA

OSHA is in the early stages of developing a potential standard, Prevention of Workplace Violence in Healthcare and Social Assistance. OSHA convened a Small Business Advocacy Review (SBAR) Panel in March 2023 and heard from representatives from small businesses and who served as small entity representatives (SERs). OSHA received input from SERs representing from the following industry sectors:

  • Hospitals, including emergency departments;
  • Residential behavioral health facilities;
  • Ambulatory mental healthcare and ambulatory substance abuse treatment centers;
  • Freestanding emergency centers;
  • Residential care facilities;
  • Home healthcare;
  • Emergency medical services;
  • Social assistance (excluding child day care centers): and
  • Correctional health settings


In accordance with the requirements of the Small Business Regulatory Enforcement Fairness Act (SBREFA) OSHA convened a Small Business Advocacy Review (SBAR) panel in March 2023. The panel, comprised of members from the Small Business Administration's (SBA's) Office of Advocacy, OSHA, and the Office of Management and Budget's Office of Information and Regulatory Affairs (OIRA), listened to Small Entity Representatives (SERs) who could potentially be affected by the draft rule and issued a report following the panel. Each SER was sent information to review, and was asked to participate in a small-group teleconference to discuss any concerns or other input related to the information provided – specifically relating to how the draft regulation might potentially affect the operations of their workplace.

OSHA hosted five SBAR Panel teleconferences between March 14th - 22nd 2023. These teleconferences were open for the public to listen to but not participate in. Each SER was asked to participate in one of the teleconferences.

About a Prevention of Workplace Violence in Healthcare and Social Assistance Standard

Nonfatal workplace violence is more widespread in the Healthcare and Social Assistance sectors than in any other industry. In 2019, the rate of nonfatal workplace violence incidents that required the worker to take time off was nearly five times greater in privately operated healthcare and social assistance establishments than in private industry overall. For certain segments within these industries, the rate is much higher. While workplace violence also occurs in other industries, healthcare and social assistance services have a common set of risk factors related to the unique relationship between the care provider and the patient, client, or their visitors.

Workplace violence is often categorized according to the relationship between the perpetrator and the victim as follows: Type-I (criminal intent; the perpetrator has no legitimate relationship to the business), Type-II (customer/client/patient), Type-III (worker-on-worker), and Type-IV (personal relationship). This rulemaking action will focus on Type-II workplace violence perpetrated by patients, clients, and visitors, because it is both prevalent in the healthcare industry and can be reasonably anticipated and mitigated by employers.

OSHA recognizes that workplace violence in healthcare and social assistance is a sensitive issue. This is not only due to the nature of the injuries sustained by workers, but also because it involves patients and clients who may be experiencing psychiatric, behavioral, or substance abuse issues that may require specialized methods and protocols for the delivery of care.

OSHA is taking all of these factors into consideration in the development of a potential standard. Through the SBREFA process, OSHA will present to SERs a programmatic approach for the prevention of workplace violence, and seek input from SERs on how these approaches might affect the operations of their workplace.

Topics in the potential draft standard to be considered by the SBAR panel include:

  • A programmatic approach to workplace violence prevention;
  • Workplace violence hazard assessments;
  • Workplace violence control measures;
  • Preventive training;
  • Violent incident investigations and recordkeeping;
  • Anti-retaliatory provisions; and
  • Approaches that avoid stigmatization of healthcare patients and social assistance clients.

Who Qualifies as a "Small Entity"?

The definition of a "small entity" varies widely across the broad range of industry sectors potentially covered by the standard. The size standards vary by industry sector, but are usually based on either number of employees or revenue (expressed in millions of dollars. A size standard is the largest size that an entity can be and still qualify as a small business for Federal Government programs. For the most part, size standards are the average annual receipts or the average employment of a firm.

Please see the SBA Table of Size Standards for the exact definition of a small entity for your industry sector or contact OSHA or SBA for assistance. Examples of small entities include:

Sector 62 – Health Care and Social Assistance
NAICS Codes NAICS Industry Description Size Standards in millions of dollars
Subsector 621 – Ambulatory Health Care Services
621112 Offices of Physicians, Mental Health Specialists $12.0
621330 Offices of Mental Health Practitioners (except Physicians) $8.0
621420 Outpatient Mental Health and Substance Abuse Centers $16.5
621493 Freestanding Ambulatory Surgical and Emergency Centers $16.5
621610 Home Health Care Services $16.5
621910 Ambulance Services $16.5
Subsector 622 – Hospitals
622110 General Medical and Surgical Hospitals $41.5
622210 Psychiatric and Substance Abuse Hospitals $41.5
622310 Specialty (except Psychiatric and Substance Abuse) Hospitals $41.5
Subsector 623 – Nursing and Residential Care Facilities
623110 Nursing Care Facilities (Skilled Nursing Facilities) $30.0
623210 Residential Intellectual and Developmental Disability Facilities $16.5
623220 Residential Mental Health and Substance Abuse Facilities $16.5
623311 Continuing Care Retirement Communities $30.0
623312 Assisted Living Facilities for the Elderly $12.0
623990 Other Residential Care Facilities $12.0
Subsector 624 – Social Assistance
624110 Child and Youth Services $12.0
624120 Services for the Elderly and Persons with Disabilities $12.0
624190 Other Individual and Family Services $12.0
624210 Community Food Services $12.0
624221 Temporary Shelters $12.0
624229 Other Community Housing Services $16.5
624230 Emergency and Other Relief Services $35.0
624310 Vocational Rehabilitation Services $12.0

Public entities from these sectors must be in OSHA state plan states and serve populations of fewer than 50,000 to participate. Private entities must meet the SBA definition of a small entity.

Additionally, OSHA considers all non-profit entities to be small entities regardless of number of employees or revenue, and welcomes participation from entities that operate in a non-profit status, regardless of size.

For more information contact Bruce Lundegren at the Small Business Administration,, (202) 205-6144 or Jessica Stone at OSHA,, (202) 693-1847.

For additional information about the rulemaking, please see: Prevention of Workplace Violence in Healthcare and Social Assistance Rulemaking.

Emergency Response SBREFA | Occupational Safety and Health Administration (

As an initial rulemaking step, and prior to publication of any changes to existing rules or enforcement policies, OSHA is convening a SBAR Panel in accordance with the Small Business Regulatory Enforcement Fairness Act (SBREFA). This Panel consists of members from OSHA, the Small Business Administration's Office of Advocacy (SBA's Office of Advocacy), and the Office of Information and Regulatory Affairs (OIRA) in the Office of Management and Budget (OMB).

The SBAR Panel provides an opportunity for Small Entity Representatives ("SERs"), which include small businesses, small non-profit organizations, and small governmental jurisdictions with a population less than 50,000, to convey how the Agency's potential regulatory framework may impact small businesses and other small entities, and to suggest ways to minimize those impacts while meeting OSHA's statutory goals.

SERs are sent documents outlining the potential regulatory framework, alternatives to the potential framework, and preliminary analyses of the costs and impacts of the conceptual framework, for comment. The Panel's primary role is to report to the Assistant Secretary of Labor for OSHA on the comments of the SERs and on the Panel's findings as to issues related to small entity impacts and significant alternatives that accomplish the Agency's objectives while minimizing the impact on small entities. The report will contain recommendations for the Agency on its analysis and on possible approaches to regulatory action that may minimize impacts on small entities.

OSHA conducted this SBAR Panel early in the regulatory process in the interest of assuring that the Panel's report and recommendations can be fully considered in any subsequent rulemaking activities by the Agency. Through this process, OSHA intends to do additional research to refine its cost and benefit estimates.

OSHA provided estimates of the number of affected entities, the unit costs they might be expected to incur to comply with the potential standard being considered in this rulemaking, and the existing anecdotal and quantitative data pointing to the need for the standard.

SBAR Panel teleconferences with SERs were held during the weeks beginning March 13 and March 20, 2023.

Each SER had the opportunity to provide comments to the SBAR Panel during a teleconference call. The SBAR Panel scheduled several teleconference calls. Each teleconference call was open to the public, but only the SERs and the members of the SBAR Panel were permitted to participate in the discussions.

Contact OSHA for questions:

Contact SBA's Office of Advocacy for questions:

  • Bruce Lundegren (office represents the views of small entities in the SBREFA process), or (202) 205-6144.