Safety Manual:
Worksite Emergency Plan

The purpose of this plan is to minimize the risk to the safety and health of all staff and visitors at every NKY Health site and to provide for a safe response to an emergency or evacuation event. 

This plan applies to all NKY Health staff while working in a NKY Health facility. Section 3: Home and Field Visit Safety of the Safety Manual provides additional guidance for NKY Health staff who perform NKY Health activities in other settings.

In order to ensure the safest possible response to an emergency:

• All staff will be trained in the procedures and information presented in this plan at the time of employment, annually thereafter, and any time the plan changes.

• Those staff whose designated responsibilities or actions under the plan change will be trained at the time the responsibilities change.

• A sufficient number of staff will be trained to implement a safe and orderly evacuation of other staff members and visitors at their work site. Those designated to receive this training are the usual site coordinators and those designated to assist and/or provide back-up for the site coordinator.

• Periodic fire, tornado, and other safety drills will be held at the discretion of the site coordinator in conjunction with other appropriate staff. Records of the drills will be maintained on a Google drive. 

Initial training is in the form of self-paced modules and training records for NKY Health Employees are maintained in a learning management system and/or personnel files.

The following staff shall function as the usual site coordinators:

• The Clinic Manager at each of the clinic sites

• The Buildings and Accounting Administrator at the District Office

Each usual site coordinator will designate two (2) staff at their site to assist and provide back-up in an emergency event.

As soon as practical, the site coordinator for the affected site must notify by phone the Director of Environmental Health and Safety (EH&S). The Director of EH&S will notify the Division Director of the affected Division. The Director of EH&S will instruct the site coordinator on the recommended actions to be taken at the affected site.

If the Director of EH&S cannot be reached immediately, notification must be attempted in the order listed below until a person-to-person contact is made:

1. Division Director of the affected division

2. Deputy Director of Health

3. District Director of Health

The Director of EH&S will ensure the District Director of Health, the Human Resources Administrator, and all Directors are notified of the incident using the most appropriate and expedient communication methods available. Contact information for the Directors is disseminated and updated as needed.

In the event of a building evacuation, use the primary assembly area for that site. The site coordinator will direct all persons to an alternate area if the primary area is inaccessible, unsafe or if the incident requires. Primary assembly areas for each NKY Health building are as follows:

Boone County Heath Center

Upper level grassy area parallel to KY 18/Burlington Pike

Campbell County Health Center

Primary for fire and other emergencies:  Far end of the parking lot 

Secondary location: Newport City Hall, 998 Monmouth Street 

Grant County Health Center

Far side of the parking lot toward St. Elizabeth Healthcare

Kenton County Health Center

Far (south) side of the main parking lot 

District Office

Small (auxiliary) parking lot parallel to Veterans Memorial Drive

Emergency shut off valves are labeled and accessible (with an appropriate key) in each of the NKY Health buildings. In the event of a fire or other emergency, the site coordinator may be asked the location of the following utilities by emergency services personnel.

Boone County Heath Center

• Electricity: Lower level storage area, right wall

• Gas: Lower level office area, back office wall

• Water: Lower level storage area, far left wall

Campbell County Health Center

The administration of the Campbell County Administration Building where the Health Center is located will be responsible for shutoff of utilities.

• Electricity: Electrical closet across from break room

• Gas: Room 118

• Water: Room 119

Grant County Health Center

• Electricity: Maintenance room

• Gas: Front yard, outside

• Water: Maintenance room

Kenton County Health Center

• Electricity: Maintenance closet off the lower level atrium near elevator

• Gas: No gas in building

• Water: Storage/maintenance room near kitchen, lower level 

District Office

• Electricity: Lower level closet perpendicular to elevator door

• Gas: Lower level closet outside conference/training room

• Water: Lower level closet, across from the Information Technology office

In the event of an emergency that requires evacuation of a NKY Health facility, all staff must take appropriate measures to remove themselves from danger. 

During an evacuation event at any NKY Health facility:

1. Staff must remain calm and assist visitors to immediately evacuate the building with them. The primary evacuation routes for each NKY Health facility are posted in various locations at each site. (In general, quickly go to and leave by the closest available exit.)

2. All persons must assemble in the primary designated assembly area for that site. When the primary designated assembly area is unsafe, the site coordinator will direct all persons to an alternate assembly area.

3. The site coordinator will ensure she/he and her/his backup(s) have all of the following at the assembly area:

   • a cell phone

   • access to the Safety Data Sheets (SDSs) on NKY Health's Google site and emergency contact phone numbers for NKY Health leadership

   • staff and visitor sign in sheets (electronic, paper, or photo of the in/out board)

4. The site coordinator will designate a staff member (likely the back-up coordinator) to utilize any sign-in sheets as well as the buddy system to account for all staff and visitors.

5. The site coordinator will call 9-1-1.

6. The site coordinator will report anyone not accounted for and all that is known about the incident to emergency services personnel upon their request/arrival.

7. The site coordinator will take all necessary steps to ensure the continued safety of staff and visitors at the assembly area.

8. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency and wait for further instructions.

9. The site coordinator will maintain communications with emergency services personnel.

10. The site coordinator will issue an “all clear” to re-enter the building when appropriate.

Each NKY Health facility has at least one eyewash station to be used when any individual's eyes have been exposed to a chemical, dust, or any substance that could impact eye health. 

Based on medical consultation and industry experience, the recommended time, in most instances, for flushing eyes is 15 minutes while holding eyelids open in clean cool running water. Use only cool water to prevent harmful burns and retard chemical reaction rates. 

To use the eyewash station, follow these steps:

1. Make sure hands are clean and free from any chemicals or debris.

2. Lean over sink. aligning eyes with plastic caps.

3. Remove plastic caps.

4. Pull out knob on nozzle.

5. Turn on cold water faucet. 

6. Align eyes under both streams of water. Hold eyelids open with fingers. 

7. Flush open eyes with cold water for 15 minutes.

8. A supervisor must always be notified when someone has been injured or exposed to a harmful substance. Please see Incident Management section of the Safety Manual for guidance. 

The following are the locations of emergency eyewash stations throughout NKY Health facilities:

District

At the sink in each coffee station

Boone County Heath Center

• Upper level:  lab

• Lower level:  kitchen

Campbell County Health Center

Lab and hallway entering exam room area

Grant County Health Center

Lab

Kenton County Health Center

Lab in upper level

All NKY Health buildings are protected by automatic smoke detectors linked to NKY Health’s fire alarm / security system. When smoke is detected and the alarm is activated, a siren (an intermittent tone) or a clanging bell will sound throughout the entire building. There will also be a verbal warning expressed as "Fire, fire, leave the building immediately." As soon as the alarm is activated, emergency services will be dispatched to the site.

All NKY Health buildings are equipped with fire extinguishers for the use of those who have been formally trained by a certified professional in the proper use of fire extinguishers.

When the fire alarm is activated with no apparent cause, follow these steps:

1. Staff and visitors must evacuate the building immediately.

2. No one is to remain in the building to investigate.

3. The site coordinator will call 9-1-1 from the designated assembly area and report what is known about the incident to emergency services personnel upon request/arrival.

In the event of a known fire, follow these steps:

1. Staff must remain calm and assist visitors to immediately evacuate the building.

2. When smoke is present, crawl along the floor to the nearest exit.

3. When the alarm has not been triggered, the site coordinator will manually pull the alarm (red fire alarm boxes in most buildings.)

4. Do not use a building’s elevator during a fire event.

The following NKY Health buildings are protected by a sprinkler system:

• District Office

• Boone County Health Center

• Campbell County Health Center

• Kenton County Health Center - Lower Level

When a fire occurs, the heat from the fire will activate the sprinkler system. Water will discharge from one or more sprinkler head(s) to contain the fire and continue to spray water until the system is shut off (by the fire department). As soon as the sprinkler system is activated, the alarm will be activated. As soon as the alarm is activated, emergency services will be dispatched to the site.

Severe weather in the NKY Health’s jurisdiction may include but not be limited to: tornados, straight line winds, severe thunderstorms, flooding, or severe winter weather conditions.

• The site coordinator for each building will designate one staff member to monitor the weather band radio when alerted to the possibility of severe weather conditions.

• The designated staff member will alert the site coordinator when a severe weather warning and/or a seek shelter advisory has been issued for the site’s immediate vicinity.

In the event of a tornado warning and/or a seek shelter alert, follow these steps:

1. Staff must remain calm and assist visitors to immediately assemble in the designated shelter area. When the primary shelter area is unsafe, the site coordinator will designate an alternate shelter area. The shelter area is marked in each NKY Health building.

2. The site coordinator will ensure she/he and her/his backup(s) have all of the following at the assembly area:

   • a cell phone

   • access to the Safety Data Sheets (SDSs) on NKY Health's Google site and emergency contact phone numbers for NKY Health leadership

   • staff and visitor sign in sheets (electronic, paper, or photo of the in/out board)

3. The site coordinator will utilize any sign-in sheets, in/out boards, and the buddy system to account for all staff members, clients and visitors.

4. The site coordinator will take all necessary steps to ensure the continued safety of the staff, clients and visitors in the shelter area.

5. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency and wait for further instruction.

6. The site coordinator will designate a staff member to monitor the weather radio to obtain updated weather information.

7. The site coordinator will issue an “all clear” when appropriate. 

Each county has warning sirens that are activated for a tornado warning and are used to alert residents who are outside. If you are caught outdoors, first try to seek shelter inside. If you are unable to seek shelter inside, lie flat in a nearby ditch or depression and cover your head with your hands. Be aware of the potential for flooding. Do not try to out-run a tornado. Retrieve any equipment only when it is safe to do so. 

In the event a tornado, high winds, or other severe weather has adversely impacted a NKY Health building and its staff:

1. The site coordinator will take all necessary steps to ensure the continued safety of the staff, clients and visitors.

2. The site coordinator may issue an evacuation of the building following the evacuation plan in this manual or request that all persons remain in the shelter area dependent upon the impact of the severe weather.

3. The site coordinator will call 9-1-1 to request emergency assistance when needed.

4. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency and wait for further instruction.

A primary shelter area is designated for each NKY Health building. The site coordinator will direct all persons to an alternate area if the primary area is inaccessible, unsafe or as the incident requires. Primary shelter areas for each NKY Health building are as follows:

Boone County Heath Center

Stairwell

Campbell County Health Center

Hallway outside exam rooms

Grant County Health Center

Hallway outside conference room

Kenton County Health Center

Lower level kitchen

District Office

Depending on where you are located in the building at the time of the alert, go to the closest of the following areas:

If you are in the…                         Then go to the…

Population Health Wing                  Case Management Suite

Environmental Health Wing            Environmental Health Laboratory

Clinical Services Wing                    Environmental Health Laboratory

Administrative Wing                        Environmental Health Laboratory

Conference/Training Room            Case Management Suite

• Interior rooms without windows are much better than exterior rooms.

• Restrooms are generally safer spaces.

• Stay away from all windows and glass doors.

• Lower stairwell areas are generally safer spaces, but may not be designated as shelter areas because they are limited in size.

Earthquakes occur with little or no warning.

In the event that an earthquake or tremor is occurring, follow these steps:

1. Staff and visitors must remain calm and “duck, cover and hold.” Crouch under workstations or under tables located on an inside wall, away from glass and doors. Stay clear of anything that could fall off the desk, the walls, or the shelving units.

2. All persons must remain at their workstation or area of safety until the site coordinator has issued an “all clear.” Aftershocks are a common occurrence after an earthquake.

3. The site coordinator will utilize any sign-in sheets and the buddy system to account for all staff members, clients, and visitors.

4. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the situation, any harm to individuals, and any damage to the building or grounds and wait for further instruction.

In the event an earthquake has adversely impacted a NKY Health building and its staff:

1. The site coordinator will take all necessary steps to ensure the continued safety of the staff, clients and visitors.

2. The site coordinator may issue an evacuation of the building following the evacuation plan in this manual or request that all persons remain in their area of safety dependent upon the impact of the earthquake.

3. The site coordinator will call 9-1-1 to request emergency assistance when needed.

4. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency and wait for further instruction.

Following are some tips from the Kentucky Division of Emergency Management Earthquake Preparedness Program:

• When you take cover under a sturdy piece of furniture, hold onto it and be prepared to move with it. Hold your position until the ground stops shaking and it is safe to move.

• When driving, pull over to the side of the road and stop. Avoid overpasses and power lines. Stay inside your vehicle until the shaking stops.

• When outdoors, move to a clear area away from trees, signs, buildings, or downed electrical wires and poles.

A hazardous material incident would involve the intentional or accidental spill or release of any substance that could harm persons or the environment.

A hazardous material incident or other type of environmental incident may occur at any of the NKY Health’s buildings. These incidents may include but not be limited to spilling an entire bottle of bleach. In the event of a location-specific hazardous incident:

1. The site coordinator will take all immediate steps to ensure the safety of the staff, clients and visitors at the site.

2. The site coordinator may instruct clients and staff to evacuate the building following the evacuation plan in this manual. Alternatively, the site coordinator may isolate the environmental hazard (close off the room, or etc.)

3. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency, any harm to individuals, and any damage to the building or grounds and wait for further instruction.

In the event of an outside threat involving a hazardous material related emergency for any NKY Health building, the site coordinator will follow instructions from emergency services personnel. Emergency services may order evacuation of an area that includes a NKY Health building or may order shelter-in-place at a NKY Health building. With a shelter-in-place order:

1. Staff, clients and visitors must remain calm and shelter-in-place. Shelter-in-place refers to all persons remaining indoors in a secure environment until given notice that the emergency is over. All persons will remain at their workstations, meeting rooms, or other area until given further instructions.

2. The site coordinator will utilize any sign-in sheets, the in/out board, and the buddy system to account for all staff members, clients and visitors.

3. The site coordinator will take all necessary steps to ensure the continued safety of the staff, clients and visitors.

4. When directed, the site coordinator will shut down all air handling equipment.

5. When directed, the site coordinator will take steps to seal off all outside doors.
   
   (A shelter-in-place kit with instructions is located with the site coordinator of each NKY Health building.)
   
   (In the event of a hazardous material incident at or in the vicinity of Campbell County Health Center, the administration of the Campbell County Administration Building and Health Center will be responsible for maintaining shelter-in-place guidelines, shutting down the elevators and turning off the air handling equipment).
   
   

6. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency/incident and wait for further instruction.

7. The site coordinator will maintain communications with emergency services personnel.

8. The site coordinator will issue an “all clear” when appropriate.

9. In the event of a widespread hazardous material related incident, the NKY Health Disaster Response and Recovery Plan would be activated. All staff and management would be instructed to take specific safety and response measures as appropriate for the incident.

In the event of a shelter-in-place order, the site coordinator will implement shelter-in-place guidelines and will take steps to seal off all entrance and exit doors from the inside and turn off air handling equipment. The following are the site-specific actions: 

Boone County Heath Center

• Seal off lower level entrance door as well as upper level entrance and side doors

• Turn off air handling equipment

Campbell County Health Center

• Campbell County Fiscal Court Chambers located on the first floor of 1098 Monmouth (same location as CCHC) is the designated gathering area for shelter-in-place. Further guidance may be issued based on the incident. 

• Air handling equipment will be turned off by building administration.

Grant County Health Center

• Seal off front, side and back entrance doors

• Turn off air handling equipment

Kenton County Health Center

• Seal off first floor front entrance, as well as side and back entrance doors

• Turn off air handling equipment

District Office

• Seal off first floor front and side exterior doors, as well as back entrance door

• Turn off air handling equipment

All NKY Health buildings are equipped with monitors for evacuation level carbon monoxide gas detection (except for the Kenton County Health Center which has no gas). When the monitors sense an evacuation level of CO gas, a continuous alarm sounds at the keypad, a clanging bell rings throughout the building and the monitor that detected CO gas beeps at 5-second intervals. As soon as the alarm is activated, the security company notifies emergency services.

When the CO alarm is activated, staff and visitors must evacuate the building immediately following the evacuation plan in this manual.

Natural gas is almost pure methane which does not have any odor. For safety purposes, odorants are added to natural gas.

When you smell odorized natural gas inside the building, follow these steps:

1. Notify the site coordinator immediately.

2. The site coordinator will implement the evacuation plan for staff members, clients and visitors following the evacuation plan in this manual.

3. Staff must leave their work areas as is. Do NOT turn off the lights or close the doors because any spark or buildup of fumes may be hazardous.

4. All persons must follow the instructions from the first arriving emergency services personnel. Emergency services personnel may ask persons to assemble farther away from the building or to completely evacuate the area dependent upon the extent or severity of the incident or potential hazard.

When you detect odorized natural gas outside the building/in the parking lot, follow these steps:

1. Stay away from the suspected leak area.

2. Notify the site coordinator as quickly as possible.

3. The site coordinator will call the gas company and follow their instructions.

When a bomb threat is received in person (for example, a person walks in the door and states or displays that she/he has a bomb), follow the localized threat guidance.

When non-specific bomb threat is received (by letter, phone call, text, or e-mail) targeted to NKY Health staff or a NKY Health building, follow these steps:

1. Notify the site coordinator immediately.

2. The site coordinator will make the necessary notifications to the appropriate Director and wait for further instruction.

3. When necessary, the site coordinator will implement the evacuation plan for staff members, clients and visitors following the evacuation plan in this manual.

4. The site coordinator may manually pull the fire alarm to help ensure all staff, clients, and visitors have exited the building.

A suspicious object may be a box, mailer, duffel bag, or other item that is left unattended inside or on the grounds of a NKY Health building. Inappropriate or unusual labeling or appearance; powder or other residue on the box or bag; weight, sounds and/or protruding wires may indicate the object may be a threat. A dangerous object may be drugs, drug paraphernalia, weapons, or anything else you perceive as a threat. In the event a suspicious or dangerous object is found inside or on the grounds of a NKY Health building, follow these steps:

1. Notify the site coordinator immediately. Do NOT open, move, or handle the object. Do NOT allow other staff, clients or visitors to come into contact with the object.

2. The site coordinator will make the necessary notifications to the appropriate Director regarding the emergency and wait for further instruction.

3. When deemed a threat, the site coordinator will call 9-1-1, follow the instructions from the 911 operator regarding any immediate actions to take (continue to isolate persons from the object, evacuate the building, etc.)
   
   The 911 operator will ask what is known about the object (what it looks like, any suspicious activity before the object was found, etc.).If anyone unintentionally handled the package, especially if the package appeared to have powder or residue on the outer surface, that person must remain calm, not touch any other surface or person, sit on a chair away from others, and await further instructions from emergency services personnel. (A staff may offer disinfectant wipes for the exposed person’s hands and a biohazard bag to dispose of the wipes.)
   
   The site coordinator will follow the instructions from first arriving emergency services personnel (evacuate persons to the outdoor assembly area, note all clients, visitors, staff in the building or etc.).
   
   The site coordinator will maintain communications with emergency services personnel.
   
   

4. The site coordinator will issue an “all clear” to re-enter the building when appropriate.

When a suspicious object arrives by mail, follow the guidelines in the "Suspicious Mail / Package" section of the Mail and Packages policy.

A localized incident or threat may occur in the vicinity or on the grounds of any of the NKY Health’s buildings.

In the event of gunfire or other threatening disturbance in the vicinity of a NKY Health building:

1. The site coordinator will take all immediate steps to ensure the safety of the staff, clients and visitors.

2. The site coordinator may be advised by law enforcement or otherwise may initiate the steps to lockdown the facility.

3. Under facility lockdown, the site coordinator will:

• • Instruct designated staff to lock all entrance and exit doors and lock all windows (as applicable).

  • Instruct staff and visitors to move to an interior room or hallway that is away from doors and windows.

  • Instruct staff and visitors to remain calm.

  • Follow instructions from emergency services personnel.

  • The site coordinator will make the necessary notifications/situation updates to the appropriate Director as soon as emergency services personnel gives the "all clear". 

  • The Director will advise any additional steps for staff or visitors. 

When someone is inside an NKY Health building brandishing (waiving about) a weapon and/or with the intent and apparent means to do harm, please remember your Active Shooter training including Stop the Bleed techniques. For a refresher, see these on the Orientation site. In general:

1. Staff must remain calm and advise clients and visitors to remain calm.

2. Only if absolutely safe, any and all staff members who have the ability, should press their panic buttons. For example: those staff directly in front of the perpetrator should NOT make any sudden moves (including pressing their panic buttons). Those staff who are in offices surrounding the clerks and hear the commotion, should press their panic buttons. Do not worry if several panic buttons are pressed. 

3. When possible and safe, those staff not near an exit door should lock themselves and their clients/visitors in whatever room they happen to be in at the time of the event, move away from any  windows and doors, duck or crouch near the inside walls, if possible push something in front of the door as a barricade, silence cell phones, call 9-1-1 and follow instructions of emergency services personnel.

4. When possible and safe, those staff and visitors near an exit door and out of sight of the perpetrator should leave the building and quickly proceed to a safe location. The safe location may be another building or hidden area where 9-1-1 could be notified as soon as safely possible. Please do not drive away from the building as you will need to check back in with the site coordinator / back-up to ensure you are safe. 

5. Any staff or visitor forced to remain with the perpetrator must do their best to remain calm and utilize any de-escalation skills or techniques they believe may calm the perpetrator. Please remember that any staff member who was able to remove themselves from the situation has called 9-1-1 and emergency services will be on site to assist as soon as possible. 

6. Anyone can take any necessary measures to render aid to staff and visitors who have been injured as long as aid can be safely rendered. Know beforehand where the emergency trauma kits (stop the bleed kits) are located but any items may also be used to render aid. 

7. When the threat has been neutralized, the site coordinator will issue an “all clear” to re-enter or move about the building when appropriate. The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency, any harm to individuals and any damage to the building or grounds and await further instruction as soon as it is safe to do so.

Panic buttons are located at the main receptionist’s desk at the District office, and in clinic rooms and clinic clerical areas (front desks) at the Health Centers. When safe to do so, a panic button may be pressed when a staff member feels she/he is in a threatening situation that may result in harm to themselves or any other individual. When a panic button is pressed, law enforcement is dispatched to the site.

When a panic button is accidentally pressed, notify the site coordinator immediately.

At all NKY Health facilities, the code phrase “Dr. Armstrong” is to be utilized when a staff member feels she/he is in a threatening situation that may result in harm to themselves or any other individual. When a staff member feels threatened, she/he may:

• press the panic button and/or 

• use the code phrase “Dr. Armstrong” in whatever context appropriate and if safe to do so. 

For example: 

• • Staff may call the front desk and say "Please have Dr. Armstrong come to my exam room."

  • Staff may ask another staff member: "Would someone page Dr. Armstrong to come here?"

  • In a conversation with a visitor, staff may say: "Only Dr. Armstrong can answer your question, let me get him."

When any staff hears the code phrase, ”Dr. Armstrong,” s/he must immediately call 9-1-1 and report that a staff member is in danger or perceived danger. The 9-1-1 operator may ask for as many details as is known (clinic nurse in a clinic room with a man and woman, yelling was heard, nurse asked for Dr. Armstrong.) The 9-1-1 operator may relay instructions to the staff (for example, if it is safe, silently move as many persons as possible away from the threatening situation to a safe area inside or outside - locked conference room or neighboring building).     

As soon as practical, the site coordinator must be notified. The site coordinator will report on what is known to first arriving emergency services personnel. The site coordinator will follow the instructions from emergency services personnel (for example, move all persons farther away from the building, write down names of all persons in the building, or etc.)

The site coordinator will make the necessary notifications/situation updates to the appropriate Director regarding the emergency, any harm to individuals and any damage to the building or grounds and await further instruction. 

Visitors (those without previous HD business) or existing clients who are disruptive or aggressive in any NKY Health facility, mobile unit, or at an off-site program event will not be tolerated. 

In this section, visitors are defined as those persons who are not clients, meeting participants, or community partners. 

Any visitor or existing client who is exhibiting threatening or aggressive behavior, or appears intoxicated (under the influence of drugs or alcohol to the extent their faculties and behavior is compromised), will be asked to leave the building, mobile unit, or program without being served. Any staff member may call 9-1-1 or have cause to call 9-1-1 to have law enforcement respond to the site to take appropriate action, including escorting the visitor/client out of the facility or area for the protection of staff and other visitors and clients. Panic buttons may be utilized for this purpose.

If an existing client is agitated or disruptive behavior upon arrival, front office staff should ask for any supervisor to join them at the front desk area. Should an existing client becomes disruptive or aggressive in a clinic room, or at any time during the visit, the staff member serving the client will leave the room and ask for a supervisor to join her/him with the client.  Upon review of the situation, the supervisor will determine the appropriate next steps. These may include such actions as speaking with the client to de-escalate the client's behavior, seeing the client in a conference room with additional staff and a supervisor present, rescheduling the service for another day, or further actions as necessary including asking the clinet to leave and escorting them out of the building. If it is determined that the client must leave, but refuses, a staff member will call 9-1-1 to have law enforcement respond and take appropriate action, including escorting the client out of the facility or area.  Panic buttons may be utilized for this purpose, or if a staff member cannot leave a clinic or exam room due to a client's behavior or actions. 

A return visit for this client will be discussed with the supervisor, affected staff, and chain-of command including the Division Director. Return visits may include using a conference room instead of an office or clinic room, ensuring two staff members or a supervisor are present for this client, or other options as deemed appropriate.