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mitigated through preparation. In addition, workers should understand the importance of a culture of respect, dignity, and active mutual engagement in preventing workplace violence. New and reassigned workers should receive an initial orientation before being assigned their job duties. All workers should receive required training annually. In high-risk settings and institutions, refresher training may be needed more frequently, perhaps monthly or quarterly, to effectively reach and inform all workers. Visiting staff, such as physicians, should receive the same training as permanent staff and contract workers. Qualified trainers should instruct at the comprehension level appropriate for the staff. Effective training programs should involve role-playing, simulations and drills. Training topics Training topics may include management of assaultive behavior, professional/police assault-response training, or personal safety training on how to prevent and avoid assaults. Occupational Safety and Health Administration 2 6 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 handson component. The following provides a list of possible topics: ■ The workplace violence prevention policy; ■ Risk factors that cause or contribute to assaults; ■ Policies and procedures for documenting patients’ or clients’ change in behavior; ■ The location, operation, and coverage of safety devices such as alarm systems, along with the required maintenance schedules and procedures; ■ Early recognition of escalating behavior or recognition of warning signs or situations that may lead to assaults; ■ Ways to recognize, prevent or diffuse volatile situations or aggressive behavior, manage anger and appropriately use medications; ■ Ways to deal with hostile people other than patients and clients, such as relatives and visitors; ■ Proper use of safe rooms—areas where staff can find shelter from a violent incident; ■ A standard response action plan for violent situations, including the availability of assistance, response to alarm systems and communication procedures; ■ Self-defense procedures where appropriate; ■ Progressive behavior control methods and when and how to apply restraints properly and safety when necessary; ■ Ways to protect oneself and coworkers, including use of the “buddy system“; ■ Policies and procedures for reporting and recordkeeping; ■ Policies and procedures for obtaining medical care, traumainformed care, counseling, workers‘ compensation or legal assistance after a violent episode or injury. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers 2 7 Training for supervisors and managers Supervisors and managers must be trained to recognize highrisk 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 a violent incident. Supervisors and managers should learn how to reduce safety hazards and ensure that workers receive appropriate training. Following training, supervisors and managers should be able to recognize a potentially hazardous situation and make any necessary changes in the physical plant, patient care treatment program and staffing policy, and procedures to reduce or eliminate the hazards. Training for security personnel Security personnel need specific training from the hospital or clinic, including the psychological components of handling aggressive and abusive clients, and ways to handle aggression and defuse hostile situations. Evaluation of training The training program should also include an evaluation. At least annually, the team or coordinator responsible for the program should review its content, methods and the frequency of training. Program evaluation may involve supervisor and employee interviews, testing, observing and reviewing reports of behavior of individuals in threatening situations. 5. Recordkeeping and Program Evaluation Recordkeeping and
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