Overview

Health care workers have the right to do their jobs in a safe and healthy workplace, free of violence.

According to Ontario's Workplace Safety and Insurance Board, workplace violence accounted for 13% of all lost-time injuries in the health care sector in 2018.

There must be zero tolerance for workplace violence — one incident is one too many. Addressing this issue in Ontario's hospitals, long-term care homes and home care settings will help create safer environments for workers and improve patient care.

This resource is meant to help employers, supervisors and workers understand their obligations under the Occupational Health and Safety Act (OHSA) and O. Reg. 67/93 – Health Care and Residential Facilities Regulation including workplace violence prevention.

Read case studies from health care organizations committed to violence prevention. These stories serve as examples of how organizations can implement continual improvement and multi-stakeholder participation.

Key terms

Workplace

Workplace is defined in subsection 1(1) of the Occupational Health and Safety Act (OHSA).  For the purpose of this resource, examples include a:

  • hospital
  • long-term care home
  • patient or client home while the worker is present
  • worker's vehicle while used for work purposes

The OHSA does not apply to work done in or around a private residence by its owner, one of its occupants, or by a servant of the owner or occupant.

Internal responsibility system

One of the primary purposes of the OHSA is to facilitate a strong internal responsibility system (IRS) in the workplace. Learn more about the IRS and how everyone in the workplace has a role to play in keeping workplaces safe and healthy, and free from violence.

Workplace violence

Under the OHSA, workplace violence means:

  • the exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker
  • an attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker
  • a statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker

Examples of workplace violence can include exercising, or attempting to exercise, physical force against a worker by:

  • spitting
  • punching
  • using weapons, or objects that can be used as weapons, to injure
  • throwing objects
  • kicking a worker 

A verbal or written intention to do these things could be reasonable for a worker to interpret as a threat of violence.

Workplace violence can be a one-time event or may involve repeated behaviours over time. An individual does not need to intend to hurt the worker for the behaviour to meet the OHSA definition of workplace violence.

Responsive behaviours or aggression may meet the definition of workplace violence. These behaviours are often a form of communication of an unmet need for an older adult living with dementia, complex mental illness, substance use and/or other neurological disorder.

Some examples of responsive behaviours include:

  • verbal or physical aggression (striking, self-harm)
  • wandering and exit seeking
  • resistance to personal care
  • refusal to eat or take medication

Learn more about responsive behaviour and behaviour change in older adults.  

Workplace parties

Workplace parties are individuals working in a hospital, long-term care home or home care workplace.

The OHSA imposes duties on:

  • employers
  • constructors
  • supervisors
  • owners
  • suppliers
  • licensees
  • officers of a corporation
  • workers, among others

Learn more about general duties of workplace parties and how these apply to workplace violence.

Self-employed health professionals

A health professional may be an employer, supervisor or worker under the OHSA, for example, a(n):

  • employer when they have staff that work for them at a private practice or clinic
  • supervisor when they oversee staff or direct their work in a private practice, clinic or operating room
  • worker when they are an employee or independent contractor that provides services in hospitals, long-term care homes or clinic

If you are self-employed, you must meet the duties for an employer in the OHSA, with necessary modifications for a self-employed person. For example, you must:

  • notify a director of the Ministry of Labour, Training and Skills Development, in writing, if you sustain a critical injury or an occupational illness
  • permit an inspector, under the authority of a warrant, to enter a dwelling being used as a workplace

Worker safety and patient care

There is a strong connection between worker safety and the care of patients, clients and residents. Health Quality Ontario's health care system framework, Quality Matters, aims to improve both:

  • patient care and overall health
  • the work life of clinicians and health care staff

One example of this goal is the Behavioural Supports Ontario (BSO) initiative, which aims to provide:

  • insight into the meaning and causes behind responsive behaviours
  • guidance on how to address these behaviours related to a person's condition and their specific environment, at both the individual and system level

Providing behavioural supports for patients, residents and clients can protect workers and assist in the prevention of workplace violence. Learn more about the BSO framework.

Case study: Sharing Leadership Expertise – Connecting Worker Safety and Resident Care in a Long-Term Care Home

Role of the joint health and safety committee or health and safety representative

The joint health and safety committee (JHSC) (in workplaces with 20 or more workers who are regularly employed) and the health and safety representative (HSR) (in workplaces with 6–19 workers) are essential to health care workplace violence prevention. The JHSC is particularly important because it brings workers and the employer together to identify and prevent workplace incidents, including workplace violence.

The JHSC or HSR are responsible for, among other things:

  • monitoring and contributing to the employer’s workplace violence prevention program and the internal responsibility system (IRS)
  • identifying situations that may be a source of danger or hazard to workers (for example, workplace violence hazards can be identified as part of the workplace inspection)
  • making recommendations to the employer for improving workers’ health and safety

Recommendations by the JHSC or HSR

The JHSC or HSR have the power to recommend workplace violence prevention practices beyond the legislative requirements of the OHSA to the employer. The employer must respond to written recommendations of the JHSC, JHSC co-chair and HSR within 21 days.

Recommendations can include:

  • enhancing the workplace violence program, based on a review of workplace violence trends (for example, incidents, notifications received for critical injuries, fatalities and accidents, violence causing injury and investigation results) 
  • training or educating JHSC members or HSR on workplace violence prevention, as applicable and related to their roles
  • making workplace violence prevention presentations at employee orientation or when on-boarding new, transferred and returning workers
  • having health and safety champions in every unit
  • establishing a workplace violence sub-committee under the JHSC, led by a senior person (for example, a CEO and co-chaired with a worker member of the JHSC) to assist with implementing the workplace violence prevention program and making sure it's effective

Suggested best practices

The JHSC or HSR can also be involved with other workplace violence prevention practices beyond the requirements of the Occupational Health and Safety Act, including:

  • sponsoring activities about workplace violence prevention (for example, during health and safety week and nursing week)
  • writing articles on workplace violence prevention for the organization's newsletter
  • posting JHSC meeting minutes on the health and safety board to communicate workplace violence issues and resolution
  • completing the Centre for Research Expertise in Occupational Disease's JHSC Effectiveness Assessment e-tool annually

At all times, employers should respect workers' privacy and sensitivity of issues.

Learn more about the role of the JHSC and HSR.

Requirements under the Health Care and Residential Facilities regulation 

O. Reg. 67/93 – Health Care and Residential Facilities under the OHSA applies to hospitals, and long-term care homes, among other facilities.

The regulation does not have specific requirements related to workplace violence. However, it does require an employer, in consultation with the joint health and safety committee (JHSC) or health and safety representative (HSR), and in consideration of their recommendations, to:

  • develop, establish and put into effect measures and procedures for the health and safety of workers
  • put the measures and procedures in writing
  • develop, establish and provide training and education programs on the measures and procedures that apply to workers (Employers don't have to provide training and education to every worker — only if it is relevant to that worker's work.)

These could include measures and procedures, and training and education programs on preventing workplace violence.

An employer is also required to review the measures and procedures for the health and safety of workers at least once a year and update them, taking into account current knowledge and practices, or more frequently under certain conditions .

Developing a workplace violence policy and program

To develop and maintain a successful violence prevention program, employers, supervisors, workers, the joint health and safety committee or health and safety representative and unions can participate and collaborate to identify, assess and control risks in the workplace.

To protect workers from workplace violence, the OHSA requires the employer to:

  • prepare a workplace violence policy and review it annually, or as often as necessary
  • in workplaces with more than 5 workers, post the workplace violence policies where everyone is likely to see them
  • conduct a workplace violence risk assessment
  • develop and maintain a workplace violence program to implement the policy   

At a minimum, the workplace violence program must set out how employers will investigate and deal with incidents or complaints of workplace violence and include measures and procedures:

  • to control the risks identified in the risk assessment that are likely to expose workers to physical injury
  • for summoning immediate assistance when workplace violence occurs or is likely to occur
  • for workers to report incidents of workplace violence to their employer or supervisor

For health care workplaces covered under O. Reg. 67/93, the employer must consult with the JHSC or HSR to develop, document and put into effect workplace health and safety measures and procedures, including those that are part of the workplace violence program.

Health care workplaces not covered under O. Reg. 67/93 are encouraged to develop their measures and procedures in consultation with the JHSC and HSR to ensure everyone in the workplace is involved in violence prevention.

Read the legislation to learn more about the OHSA requirements for a workplace violence policy and program.

Case studies

Assessing the risk of workplace violence

Under the Occupational Health and Safety Act (OHSA), employers must assess the risks of workplace violence. This is a necessary first step before developing an effective program to protect workers from workplace violence.

Employers must consider the risk of violence that may arise from the:

  • nature of the workplace
  • type of work
  • work conditions

Employers must also consider circumstances both common to similar workplaces and specific to the workplace.

Employers should consider putting their risk assessments in writing to make sharing information with supervisors, workers and the joint health and safety committee (JHSC) or health and safety representative (HSR) easier.

Once the employer identifies workplace violence risks, they should determine control measures to eliminate or minimize workplace violence hazards and better protect workers.

Employers must also:

  • reassess the risk of workplace violence as often as necessary (annually is recommended) to ensure the policy and related program continue to protect workers from workplace violence
  • advise the JHSC or HSR of the results of the assessment and any reassessments, and provide them with a copy if the assessment or reassessment is in writing

Risk factors

Nature of the workplace

The nature of the workplace refers to the physical aspects of the workplace, whether it is a hospital building, long-term care home, patient or client's home or vehicle.

This may include the:

  • size of the health care facility
  • physical design of facility spaces
  • workplace lighting and sightlines
  • parking lots and grounds
  • staff washrooms
  • depth of counters
  • entrances, exits, stairwells
  • objects that could be used to hurt workers

Type of work

The type of work refers to the:

  • activities workers perform (such as handling cash or medication, patient and resident care activities)
  • sector of work (such as health care)
  • people with whom workers interact (for example, patients, residents or clients whose behaviours are dependent on many factors and often unpredictable, acuity and the needs of the patient, resident and client population).

Risk can be higher when staff are performing certain functions, such as moving clients within the health care facility or within the system. Risk can also be higher in certain situations, such as delivering difficult news to patients, residents, clients and family members, or working in high-risk areas such as a hospital emergency room.

Work conditions

Work conditions could include:

  • work hours (day, evening, night)
  • work flow
  • the surrounding neighbourhood
  • inherent attributes of specific units or departments
  • whether workers move from location to location, work alone or in isolation

Workplace circumstances

The assessment must consider circumstances that are common in similar workplaces (for example, other hospitals, long-term care homes or clients' homes serving similar populations). Consider violent incidents that happened in other workplaces with similar types of work or conditions of work as your own.

It must also consider circumstances specific to the workplace. For example, the geographic location and any past violent incidents at your workplace in particular.

Risk assessment resources

Learn more about the OHSA requirements for workplace violence risk assessments.

If you are in an acute care, long-term care or community setting, you may use Public Services Health & Safety Association's Workplace Violence Risk Assessment (WVRA) tool to:

  • identify workplace violence hazards
  • establish a risk ranking
  • determine control measures associated with the risk
  • implement an action plan 

You may also consult PSHSA's Assessing Violence in the Community: A Handbook for the Workplace to:

  • assess the risk of violence in the home or community
  • access tools to use before a visit, before travel and to check for hazards
  • read guidelines and tips for traveling in the community, client communication, safe driving, dealing with personal threats and attacks and client care 

Reassessing the risk of workplace violence

According to subsection 32.0.3 (4) of the OHSA, an employer must reassess the risks of workplace violence as often as necessary to ensure the policy and related program continue to protect workers from workplace violence. For example, you may need to do a reassessment if there has been a(n):

  • increase in the number, frequency or severity of violent incidents in the hospital, long-term care home or home care provider setting
  • change in the patient, resident or client population (for example, if there are more patients, changes in patient acuity or there is a new procedure or type of service)
  • change in the physical environment of the workplace (for example, if the workplace has moved to a new building or your existing workplace was renovated)

You may also determine whether a reassessment is necessary based on the results of individual client risk assessments and how individual patients, residents or clients could affect the type of work in the workplace.

Learn more about the requirements for risk assessment and reassessment in section 32.0.3 of the OHSA.

Assessing the patient, resident or client population

The OHSA does not require employers to assess an individual as part of the workplace violence risk assessment. However, the patient, resident, and client population (collectively) may pose a risk and could be considered in the assessment.

Based on the risk assessment for the patient, resident or client population, employers may consider conducting individual client risk assessments to help control the risk of violence.

An individual client risk assessment identifies behaviours and triggers of the patient, resident or client associated with an increased risk of violence. This helps determine the impact the individual has on the workplace, department or unit. You may refer to the PSHSA Individual Client Risk Assessment toolkit for further information. 

Physical, psychological, environmental and activity triggers can lead to or escalate violent, aggressive or responsive behaviours. Examples of triggers include:

  • physical: infection, new medication
  • psychological: loss of control, being told to calm down, being lectured
  • environmental: noise, lighting, temperature, scents, privacy, time of day, overcrowding, visitors
  • activity: bathing, medication, past experiences, toileting, changes in routine, resistance to care

Certain behaviours, or a history of violent behaviour, may indicate a risk of violence. Behaviours could include:

  • making verbal threats: raises voice in an intimidating or threatening way, shouts angrily, insults others, swears, makes aggressive sounds
  • making physical threats: raises arms or legs in an aggressive or agitated way, makes a fist, takes an aggressive stance, moves or lunges forcefully toward others
  • attacking objects: throws objects, bangs or breaks windows, kicks objects, smashes furniture
  • acting agitated or impulsive: unable to remain composed, quick to overreact to real or imagined disappointments, seems troubled, nervous, restless, upset, spontaneous, hasty or emotional

Resources

Controlling the risks of workplace violence

A workplace violence program must include measures and procedures to control the risks identified in the risk assessment as likely to expose a worker to physical injury. Risks can also be identified through recommendations from the joint health and safety committee or health and safety representative.

With appropriate risk assessments and reassessments in place, gaps can be identified and risks can be controlled and mitigated. Having measures and procedures in place to control the risks identified may eliminate or minimize the risk of workplace violence. A violent incident or complaint may also indicate the need for additional control measures.

The effectiveness of measures and procedures is largely due to where they are applied. Strategies to control risks can happen:

  • at the source – most effective as it eliminates the risk of violence
  • along the path (between the actual source of the risk and the worker) – reduces workers' exposure to the hazard
  • at the worker – least effective and the last resort (should only be used after you've tried to control risks at the source and along the path first)

You can consider a combination of measures and procedures to reduce the risk to a level where workers are protected from the hazard of workplace violence. 

Examples of controls include:

  • restricting facility access to violent family members
  • training workers to identify the signs and symptoms of violent behaviour
  • training workers to de-escalate violent behaviour
  • introducing environmental design controls such as clear sight lines and improved lighting
  • using personal safety response system devices

Evaluate controls that have been put into place to:

  • measure their success and effectiveness
  • identify opportunities for improvement to further mitigate the risk
  • ensure that a new risk has not been inadvertently introduced

Communicating risks to workers

Under the Occupational Health and Safety Act, employers and supervisors may need to communicate risk information to health care workers to make them aware of:

  • a person with a history of violent behaviour 
  • the risk of violent, aggressive or responsive behaviour by patients, residents or clients in the workplace 

Employers and supervisors must provide information, including personal information, related to a risk of workplace violence from a person with a history of violent behaviour if both the:

  • worker can be expected to encounter that person during his or her work
  • risk of workplace violence is likely to expose the worker to physical injury

An employer or supervisor cannot disclose more personal information in the circumstances than is reasonably necessary to protect the worker from physical injury. 

Workers may not need to know specific information related to a diagnosis or the care of patients, residents or clients, but must understand the risk associated with the person and what to do as part of the workplace violence program. Having this information may also help workers understand what triggers may lead to violence.

The employer and supervisor should consider all workers (for example, clinical and non-clinical workers, permanent and occasional workers) when determining who can be expected to encounter a person with a history of violent behaviour.

Risk communication should alert workers to the risk of violence and instruct them on what to do to mitigate that risk.

Providing personal information about someone with a history of violent behaviour

Some of the current challenges with communicating the risk of violence in the health care sector include:

  • lack of knowledge of privacy laws and legislative obligations (for example the Personal Health Information Protection Act, 2004)
  • how to communicate that an individual poses a risk of violence, without compromising their privacy
  • patients, residents or clients not wanting to wear a physical identifier, which may be a trigger that leads to violence

To learn more about risk communication (sometimes called a "flagging" or behavioural alert program) and related privacy concerns, you may refer to the PSHSA's Communicating the Risk of Violence: A Flagging Program Handbook for Maximizing Preventative Care. Employers may also wish to seek legal advice.

Getting help in a violent situation

32.0.2 (2)(b) of the Occupational Health and Safety Act (OHSA), employers must have a workplace violence program that includes measures and procedures for summoning immediate assistance when workplace violence occurs or is likely to occur.

A Personal Safety Response System (PSRS) is one option to meet this requirement. A PSRS includes measures (for example, devices) and procedures to protect workers from harm due to workplace violence or other emergencies.

As a leading practice, a PSRS may also assign roles and responsibilities so everyone knows:

  • who the trained responders are
  • what to do when using, testing and maintaining the devices
  • how to respond appropriately to requests for immediate assistance

Choosing a PSRS

There is a variety of PSRS devices available. Conduct a needs assessment to determine the right type of device(s) based on your workplace violence risk assessment and other information about your organization. The device(s) you choose must be able to alert and call for someone trained to respond and help immediately.

The PSRS device alone may not necessarily work for your workplace. For example, if someone is working alone, there is no other worker or security person to call who is aware, able and trained to help and protect a worker, or permitted to respond in a timely manner. The PSRS should be one part of your emergency management system, security and workplace violence prevention program.

Learn more about a Personal Safety Response System.

Some health care facilities have established devices for workers to summon immediate assistance in the event of a workplace violence incident. These include:

  • personal panic alarms linked to security with Global Positioning System (GPS), two-way voice activation
  • code buttons
  • phones pre-programmed with emergency numbers

Getting help in a home care setting

Due to the nature of home care, most often the police respond in an emergency. Visits may be conducted in urban, rural and remote areas of the province, so a needs assessment for the most appropriate type of PSRS device(s) is required.

As a home care worker, if you feel threatened, you should:

  • terminate the interaction with the client
  • leave the client's home and go to a safe place
  • be prepared to call the police if required
  • phone a manager, supervisor or staffing office
  • complete an incident report

As a supervisor, if a worker reports an incident of workplace violence to you, you should:

  • make sure the worker is safe
  • follow your organization's workplace violence policy and procedures, including reporting and notification requirements for reporting incidents
  • investigate and attempt to resolve the situation to prevent recurrence, which may include reviewing the client care strategy and updating the individual client risk assessment
  • implement control measures as soon as you can
  • alert other workers that may encounter the client and could be exposed to physical injury (see section on Provision of Personal Information Regarding Persons with a History of Violent Behaviour)

Reporting under the Occupational Health and Safety Act

Under section 28 of the Occupational Health and Safety Act (OHSA), workers must report hazards they know about to their employer or supervisor. This may include acts of workplace violence.

Under clause 32.0.2 (2)(c) of the OHSA, employers must have a workplace violence program that includes measures and procedures for workers to report incidents of workplace violence to their employer or supervisor.

Critical injuries (defined in Regulation 834 under the OHSA) or fatalities may result from a workplace violence incident, in which case health care employers must notify certain people.

Who to notify

If there is a death or critical injury resulting from workplace violence, health care employers must immediately notify the:

The employer must also, within 48 hours after the occurrence, send a written report of the circumstances to a Ministry of Labour, Training and Skills Development director. [OHSA subsection 51(1)].

What to report

Under O. Reg. 67/93 – Health Care and Residential Facilities Regulation, subsection 5(1), if a worker is killed or critically injured at a hospital or long-term care home, employers must include the following in the written report required by OHSA subsection 51(1):

  • the name and address of the employer
  • the nature and circumstances of the occurrence and of the injury sustained
  • a description of the machinery or thing involved, if any
  • the time and place of the occurrence
  • the name and address of the person who was critically injured or killed
  • the names and addresses of all witnesses to the occurrence
  • the name and address of the physician or surgeon, if any, who is attending to or attended to the injured or deceased person
  • the steps taken to prevent a recurrence

According to OHSA subsection 52 (1), if a person is disabled from performing his or her usual work or requires medical attention because of an incident of workplace violence that does not result in a critical injury or fatality, health care employers must provide written notification to the JHSC/HSR and trade union, if any, within four days.  The Ministry of Labour, Training and Skills Development may also need to be notified if a ministry inspector requires it.

Learn more about requirements to report workplace incidents.

Case study

Sharing Leadership Expertise - Reflections on Reporting in Home Care

Reporting under the Workplace Safety and Insurance Act

Most health care employers in Ontario are covered under the Workplace Safety and Insurance Act, 1997 (WSIA). Under this legislation, there are employer and worker obligations to report workplace injuries or illnesses to the Workplace Safety and Insurance Board (WSIB).

WSIB reporting is separate from the reporting requirements under the OHSA and employers should be aware of all of their reporting obligations.

Learn more about WSIB reporting.

Reporting under the provincial quality improvement plans

Health Quality Ontario (HQO), an agency of the Ministry of Health and the Ministry of Long-Term Care, included workplace violence prevention as a key component of the Quality Improvement Plan process for hospitals in 2018-2019.

Under O. Reg. 187/15 – Annual Quality Improvement Plan, hospitals must complete certain mandatory indicators in their Quality Improvement Plans.

Hospitals, primary care organizations, long-term care homes and local health integration networks (which oversee home and community care) submit the plans annually to describe how the organization will address its quality improvement goals.

Learn more about HQO's Quality Improvement Plan guidance on workplace violence prevention.

Investigating incidents or complaints

Under clause 32.0.2 (2)(d) of the Occupational Health and Safety Act, employers must set out how they will investigate and deal with incidents or complaints of workplace violence as part of their workplace violence program. Subsection 9(31) of the act requires a designated worker member of the JHSC to investigate critical injuries and fatalities.

Under clause 5(1)(h) of O. Reg 67/93, employers of hospitals and long-term care homes are also required to include in the required notices the steps that were taken to prevent the incident from happening again.

The purpose of investigations are to:

  • prevent recurrences of workplace violence incidents
  • gather facts related to the incident in order to identify any hazards
  • identify root and contributing causes of the incident
  • identify corrective actions
  • apply measures and procedures to control the risk

We encourage organizations to resolve health and safety complaints internally, using their internal responsibility system.

If the concerns remain unresolved, call the Health and Safety Contact Centre at 1-877-202-0008.

Learn more about what a JHSC and HSR should do in the event of a critical injury or death

Providing information and training to workers

Under the Occupational Health and Safety Act (OHSA), employers must provide information and instruction:

  • that is appropriate for workers on the contents of the workplace violence policy and program [subsection 32.0.5 (2)]
  • to protect the health and safety of a worker [clause 25 (2)(a)]

Supervisors are also required under the OHSA to advise a worker of any potential or actual danger to their health and safety they are aware of (for example, the risk of workplace violence) [clause 27(2)(a)].

Workers should:

  • be aware of any potential risks in a workplace they are entering
  • follow the measures and procedures in their workplace violence program

Worker education and training are essential components of an effective workplace violence program.

Under O. Reg. 67/93, hospital and long-term care home employers must develop, establish and provide training and educational programs on health and safety measures and procedures for workers that are relevant to the workers' work [subsection 9(4)].

Employers are required to do this in consultation with, and in consideration of recommendations made by, the joint health and safety committee and health and safety representative. These requirements apply to all workplaces where O. Reg. 67/93 apply. Other health care workplaces are encouraged to do the same as a leading practice.

Training helps managers, supervisors and workers understand the risks associated with their specific jobs and teaches them how to prevent and control risks of workplace violence.  Education and training should also be a part of the orientation process for new, promoted or transferred workers, and ongoing training should be provided for workers on a regular basis.

Examples of training topics to prevent workplace violence include:

  • measures and procedures in the workplace violence program
  • de-escalation techniques and strategies
  • self-protection techniques in the event of an assault
  • working in the community and home, if applicable
  • how to conduct patient risk assessments
  • how to communicate risks (flagging and alert system procedures)
  • how to use personal safety response system devices, if applicable (for example, personal panic alarm)
  • responsive behaviours
  • types of emergency responses and what to do (for example, code white)
  • how to handle cash and medication
  • security systems
  • environmental design (for example, objects that could be used to hurt workers)
  • how to document and report incidents

To learn more, refer to Health and Safety Awareness Training for Workers and Supervisors.

Refusing to work due to workplace violence

Under the Occupational Health and Safety Act (OHSA), workers have the right to refuse work or refuse to do particular work where the worker has reason to believe that workplace violence is likely to endanger them.

A health care worker does not need to be in actual or imminent danger before they can initiate a work refusal. However, it is required that the worker has reason to believe that workplace violence is likely to endanger them if they continue to work [OHSA clause 43 (3)(b.1)].

Limitations on the right to refuse

Some workers only have this right in certain circumstances [OHSA subsections 43(1) and 43(2)]. This includes workers at a:

  • hospital, sanatorium, long-term care home, psychiatric institution, mental health centre or rehabilitation facility
  • residential group home or other facility for persons with behavioural or emotional problems or a physical, mental or developmental disability
  • laboratory operated by the Crown or licensed under the Laboratory and Specimen Collection Centre Licensing Act
  • laundry, food service, power plant or technical service or facility used in conjunction with certain institutions, facilities or services

These workers cannot refuse work when either:

  • the circumstance is inherent in their work or is a normal condition of their employment
  • their refusal to work would directly endanger the life, health or safety of another person [OHSA subsection 43(1)]

The employer and supervisor still have a duty to take every precaution reasonable in the circumstances to protect the health and safety of all workers.

Hospitals and long-term care homes

A person employed in a hospital or long-term care home may be able to refuse unsafe work in the context of violent patients, clients and residents. As per OHSA clause 43 (3)(b.1), a worker employed in a hospital or long-term care home may be able to refuse to work or refuse to do particular work where they have reason to believe that workplace violence is likely to endanger themselves and when both the:

  • circumstance is not inherent in their work or is not a normal condition of their employment
  • life, health or safety of another person would not be directly endangered by their refusal to work

In environments where there are limitations on the right to refuse, each situation must be considered based on the particular facts and circumstances.  

Home care organizations

Workers employed by a home care organization (not listed in OHSA subsection 43(2)) have the right to refuse unsafe work when they have reason to believe that workplace violence is likely to endanger them.

Process

The OHSA sets out a specific procedure that workplaces must follow in any work refusal. It is important that workers, employers, supervisors, members of the JHSC, or health and safety representatives understand the procedures for a lawful work refusal.

For more information on the process for work refusals under the OHSA, refer to the:

Domestic violence awareness and response process

Domestic violence is a type of workplace violence when it:

  • crosses over into the workplace
  • affects the targeted worker
  • poses a threat to co-workers

The victim could be stalked or harassed at work by the abuser, absent from work due to injuries, and less productive due to stress and distraction.

The abuser could be a:

  • person who has a personal relationship with a worker, such as a spouse or former spouse
  • current or former intimate partner
  • family member

According to the Public Services Health & Safety Association, while men can also be the victims of domestic violence, in most cases women are the victims.

According to Statistics Canada , women are:

  • eleven times more likely to be sexually victimized
  • three times more likely to be stalked

Under OHSA section 32.0.4, employers must take every precaution reasonable in the circumstances for the protection of workers when they become aware, or ought reasonably to be aware, that domestic violence that would likely expose a worker to physical injury may occur in the workplace.

Reasonable precautions may include:

  • specific measures and procedures to protect a worker (for example, summoning immediate assistance and reporting violent incidents)
  • a safety plan for the worker (for example, escort from and to car before and after work, priority parking closer to entrance of worksite and screening calls and emails for the worker)
  • reasonable modification of work duties and flexible accommodations of the work schedule
  • relocating worker to another area of the workplace
  • security precautions, such as security guards, cameras and response procedures
  • providing direction to other workers, as appropriate, to protect the safety and privacy of the targeted worker (for example, not providing personal information over the switchboard or in-person)
  • directing the worker to the Employee Family and Assistance Plan or community resources, as applicable
  • issuing trespass warnings and letters, as necessary, unless the abuser is seeking medical attention or care
  • encouraging the worker to have the workplace included on any restraining orders

Learn more about domestic violence in the workplace.

Reprisals

The OHSA prohibits employers or a person acting on behalf of an employer from penalizing workers for obeying the law or exercising their rights.

When a worker follows the OHSA or exercises their rights under the OHSA, including the right to refuse unsafe work, an employer is prohibited from:

  • dismissing (or threatening to dismiss) a worker
  • disciplining or suspending a worker (or threatening to do so)
  • imposing (or threatening to impose) any penalty upon a worker
  • intimidating or coercing a worker

For more information on reprisals and the process for reprisal complaints, you can refer to:

This resource does not replace the Occupational Health and Safety Act (OHSA) and its regulations, and should not be used as or considered legal advice. Health and safety inspectors apply the law based on the facts in the workplace.