What is Type 2 Workplace Violence?

Workplace violence is classified into four types based on the perpetrator’s relationship to the workplace:

  • Type 1: Violence committed by a person with no legitimate connection to the employer, like a robber or trespasser
  • Type 2: Violence committed by a customer, client, patient, student, visitor, or another person receiving services from the employer
  • Type 3: Violence between current or former employees
  • Type 4: Violence arising from a personal relationship that enters the workplace

Type 2 is the most prevalent category of workplace violence in client-facing industries, and in healthcare it accounts for nearly three-quarters of all nonfatal workplace assault cases. OSHA has been citing employers for unaddressed Type 2 hazards for years, and state legislatures in California, Washington, New York, and Texas have since passed laws specifically targeting client-on-worker violence.

Type 2 Workplace Violence Defined

The National Institute for Occupational Safety and Health (NIOSH) classifies Type 2 workplace violence as client-on-worker violence. The perpetrator is someone with a customer or client relationship with the employer, and the violence occurs in the course of receiving services. Depending on the workplace, perpetrators may be:

  • Patients
  • Family members accompanying patients
  • Customers
  • Clients
  • Students
  • Visitors
  • Inmates or detainees

NIOSH defines workplace violence as any act of physical assault or threatening behavior occurring in the work setting. California Labor Code § 6401.9 adopts a broader definition for covered employers, and recognizes written and electronic threats through text messages, emails, social media posts, or other online communications as Type 2 workplace violence as well, as long as the threat results in, or has a high likelihood of resulting in, physical injury or psychological trauma.

High-Exposure Settings

NIOSH and OSHA research consistently identify the following settings as highest-risk for Type 2 violence. In all of them, employees cannot control who they serve or remove a patient or client who becomes aggressive.

  • Emergency and psychiatric care: Patients in crisis or involuntarily committed may become physically aggressive toward the nurses and aides delivering their care. Emergency departments are high-risk because employees have no advance notice of a patient’s condition or history before the patient arrives.
  • Geriatric care: Patients with dementia or other cognitive impairments may not recognize caregivers as people there to help them, and physical aggression in geriatric settings is frequently directed at the staff providing the most hands-on care.
  • Schools: Teachers and aides are the primary targets of Type 2 violence in educational settings, where students with behavioral or developmental challenges may become physically aggressive in the classroom.
  • Home health: Home health workers operate in the patient’s own residence rather than a facility the employer controls. A private home cannot be modified with secured entry points or panic alarms, so home health employers depend on pre-visit safety screening and clear check-in protocols to reduce Type 2 exposure.

Type 2 Workplace Violence by the Numbers

Federal agencies do not publish workplace violence statistics broken out by type, so there is no dataset that isolates Type 2 cases specifically. What the data does show is which industries and perpetrator categories account for the overwhelming majority of nonfatal workplace assault cases, and by examining the industries where employees have the most direct interaction with the people they serve, the available data points clearly to where Type 2 violence is most concentrated.

According to the Bureau of Labor Statistics, the industries and occupations with the highest rates of nonfatal workplace assault in 2021 and 2022 were:

  • Healthcare and social assistance: 41,960 workers suffered nonfatal workplace assault cases, accounting for 72.8 percent of all private-sector cases resulting in missed work or work restrictions, at a rate of 14.2 per 10,000 full-time workers
  • Psychiatric aides: 543.6 nonfatal workplace assault cases per 10,000 full-time workers, the highest occupational rate reported
  • Educational services: 8.4 nonfatal workplace assault cases per 10,000 full-time workers, above the private-sector average of 2.9

A 2019 Bureau of Labor Statistics analysis identified who was committing those assaults in cases resulting in days away from work:

  • Patients: 43.5 percent of cases, approximately 18,090 workers
  • Students: 22.8 percent of cases, approximately 9,460 workers
  • Customers or clients: 10.4 percent of cases, approximately 4,330 workers
  • Inmates or detainees: approximately 3,600 workers

OSHA Enforcement and the General Duty Clause

Federal OSHA has not adopted a comprehensive workplace violence standard for most employers. Instead, OSHA addresses workplace violence through Section 5(a)(1) of the Occupational Safety and Health Act, known as the General Duty Clause, which requires employers to provide a workplace free from recognized hazards likely to cause death or serious physical harm to employees.

Elements of a General Duty Clause Citation

Before issuing a General Duty Clause citation for a Type 2 workplace violence hazard, OSHA evaluates four questions:

  1. Did a Type 2 workplace violence hazard exist?
  2. Did the employer or the employer’s industry recognize the hazard?
  3. Was the hazard likely to cause death or serious physical harm?
  4. Could the employer have reduced the hazard through a feasible protective measure?

OSHA Directive CPL 02-01-058, which has governed workplace violence enforcement since January 10, 2017, directs compliance officers to prioritize healthcare facilities, social service settings, and correctional facilities. When a facility in a high-risk sector has a documented history of client-on-worker violence, inspectors evaluate whether the employer has adopted a written prevention program and whether the employer took corrective action after prior Type 2 events.

Federal Rulemaking Status

OSHA has been working toward a dedicated workplace violence prevention standard for healthcare and social assistance employers since 2016. As of the Spring 2025 regulatory agenda, the proposed rule carries Long-Term Action status with the Notice of Proposed Rulemaking date listed as “To Be Determined.”

State Workplace Violence Laws Targeting Type 2 Workplace Violence

Several states have passed workplace violence prevention laws targeting the industries where Type 2 violence is most concentrated. California and Washington have the most developed requirements currently in effect.

California Labor Code § 6401.9 (Effective July 1, 2024)

Senate Bill 553 created the first workplace violence prevention law in the United States to cover general industry employers, not just healthcare. Covered California employers are required to:

  • Maintain a written Workplace Violence Prevention Plan specific to each worksite that identifies responsible parties, employee participation procedures, hazard identification and correction procedures, and anti-retaliation protections
  • Keep a Violent Incident Log documenting every Type 2 event. Verbal threats and near-misses with no physical injury qualify as Type 2 events and each entry needs to include the date, time, location, and post-event response
  • Retain plan and hazard correction records for at least five years and training records for at least one year
  • Provide annual interactive training in the language of the employees being trained that covers the specifics of the worksite plan and the job-specific Type 2 hazards employees face

California’s legislature set a December 31, 2026 deadline for Cal/OSHA to finalize the Title 8 regulation under Section 3343. Conn Maciel Carey is monitoring the advisory process, as the regulation is expected to expand certain obligations beyond what Senate Bill 553 currently requires.

Washington RCW 49.19 (Updated January 1, 2026)

House Bill 1162 updated Washington’s healthcare workplace violence law and tightened requirements for covered healthcare facilities. Covered employers are now required to:

  • Review and update their written workplace violence prevention plan annually using site-specific data, shortened from a prior three-year review cycle
  • Investigate every qualifying Type 2 event, analyze the systemic causes, and compare the number of employees scheduled to work with the number actually on duty at the time
  • Deliver de-identified event summaries and investigation findings to the joint safety committee on a quarterly basis

Other States with Type 2-Specific Mandates

  • Texas SB 240: Covered healthcare facilities are required to establish a multidisciplinary Workplace Violence Prevention Committee that includes direct-care clinical staff and to conduct annual facility-specific hazard assessments.
  • New York (signed December 12, 2025; effective September 2026): General hospitals and nursing homes are required to maintain written workplace violence prevention plans and keep event logs.
  • Rhode Island Workplace Violence Prevention Act: Covered employers are required to establish workplace safety committees and formal mechanisms for employees to report safety concerns.

The state legislative landscape is still developing, and multi-state employers need to track requirements in every state where they operate.

Controls That Reduce Type 2 Exposure

OSHA Directive CPL 02-01-058 requires compliance officers to evaluate whether an employer could have implemented feasible measures to reduce Type 2 violence exposure but failed to do so.

Engineering Controls

Engineering controls reduce employee exposure to Type 2 violence by modifying the physical environment before a client or patient reaches the point of assault. OSHA Publication 3148 identifies the following measures as appropriate for healthcare and social service settings:

  • Redesign waiting areas to reduce crowding and noise, which lowers the environmental stress that escalates agitated clients or patients
  • Secure furnishings in client-facing areas to remove objects that can be used as weapons during an assault
  • Install concealed panic alarms at reception desks and on staff badges so employees can call for help without directly confronting an aggressive client or patient
  • Install break-resistant glazing at service windows to reduce the risk of physical contact at intake and payment points
  • Restrict staff area access with key-card entry and video surveillance to limit uncontrolled visitor movement
  • Designate staff retreat rooms with a secondary exit so employees have a safe option during an escalating Type 2 event

Administrative Controls

Administrative controls address Type 2 exposure at the operational level. The controls that receive the most scrutiny during OSHA inspections are:

  • Post a zero-tolerance policy for threatening behavior in client-facing areas and build it into employee training so both employees and the people they serve know the policy exists
  • Flag clients and patients with a documented history of aggressive behavior in electronic health record or case management systems and carry those notes into shift handovers so employees going on duty have advance notice
  • Maintain adequate staffing during high-risk periods, because CPL 02-01-058 directs inspectors to evaluate the number of employees on duty at the time of any serious Type 2 event, and Washington’s RCW 49.19 requires post-event investigations to document that comparison
  • Provide de-escalation training that includes direct role-play practice with the specific scenarios employees face in their work setting
  • Establish post-event response pathways that give employees access to medical evaluation and psychological support after a Type 2 assault

Where Type 2 Programs Fail Under OSHA Examination

When OSHA investigates a Type 2 workplace violence event, the inspection extends beyond the assault itself. Compliance officers evaluate whether the employer had feasible protective measures in place before the employee was injured.

Incomplete Event Recordkeeping

OSHA builds its case largely through the employer’s own records, and the Form 300 log is typically the first document a compliance officer asks for during a Type 2 inspection. A log that shows a history of client-on-worker assaults without any documentation of how the employer responded gives OSHA most of what it needs to satisfy the first two elements of a General Duty Clause citation.

Staffing as a Safety Variable

When a facility is short-staffed, clients and patients wait longer and fewer employees are available to intervene when someone becomes aggressive. OSHA has cited inadequate staffing as evidence that an employer could have reduced Type 2 exposure but did not, and employers who document staffing levels as part of their Type 2 prevention program are in a stronger position during an inspection than those who made staffing decisions without any record of how those decisions were evaluated against safety needs.

Washington’s updated RCW 49.19 goes further by requiring post-event investigations to compare the number of employees scheduled to work with the number actually on duty at the time of a qualifying Type 2 event.

Patient Rights and Security Controls

Healthcare employers sometimes decline to put Type 2 controls in place because they assume HIPAA or state patient rights laws prohibit them. OSHA has cited employers for failing to implement feasible Type 2 controls when the only reason the employer gave for not acting was a legal assumption that turned out to be wrong.

Conn Maciel Carey’s labor and employment practice counsels healthcare employers on building Type 2 prevention programs that satisfy OSHA’s requirements without running into patient rights obligations.

Conn Maciel Carey LLP’s Labor & Employment Practice helps employers build Type 2 workplace violence prevention programs that satisfy OSHA’s enforcement standards and hold up under inspection. For employers navigating new state mandates in California, Washington, or elsewhere, the firm’s attorneys are available to assess existing programs and identify gaps before a compliance officer does. Call (202) 715-6244 for a free consultation or send us an email.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. Laws and regulations change, errors may occur, and this content may not address every aspect of the relevant legal requirements. Reading this article does not create an attorney-client relationship. For guidance on your specific situation, consult your attorney.