 I had bruises all over my body and my ribs were all bruised. At one point he was pushing, threatening, cursing at me. Each week in the United States, an average of 33,000 workers are assaulted on the job and 17 are murdered. Disasterous, a nightmare. I felt violated. I felt that angry. Homicide remains among the leading causes of workplace violence for both men and women. We've had at least one death recently and several in the past decade. From 1993 to 1999, workplace violence accounted for 18% of all violent crime. It was outrageous the amount of murders that were going on. You can't wait for an incident to occur. You've got to be ahead of the curve on it. Being assaulted is not part of the job. I'm Ken Strunk for the National Institute for Occupational Safety and Health. Today violence is generally viewed as a social problem, the result of poverty, lack of education and many other factors. The solutions to these problems tend to be complex and require long-term interventions. Obviously, we cannot wait to address workplace violence solely as a social issue. Because practical solutions are needed now, it must be viewed as a serious workplace hazard, just like any other threat to worker safety. Some people might think that workplace violence is just another cost of doing business, or that it comes with the territory in certain jobs. NIOSH rejects this type of thinking. Exposure to violence is never an acceptable consequence of earning a living. Injury and death on the job must be eliminated no matter the cause. So stay with us as we look at the nature of violence in today's workplace and how to protect the lives of workers at risk. Acts of violence are not spread evenly across all workplaces. Rather, violence tends to occur in specific work settings. More than half of all workplace homicides occur in retail or service settings, such as convenience stores, taxi cab services and gas stations. Homicide is the leading cause of death in these industries. That's right, the number one cause. About three-fourths of these homicides occur during robberies. Fernando Mateo is president of the New York State Federation of Taxi Drivers. We always believed that if you can rob someone at gunpoint, the time is going to come when you're going to graduate and you're going to murder someone to take their money. And that's exactly what had happened. Our security department, along with operations, our main goal is safety of the employees and the customers. Our biggest concern would be robberies. Stores and service industries are particularly vulnerable to violence because they generally involve the exchange of money, working alone or in small numbers, and delivering passengers, goods or services. They may also involve working in high crime areas or during late night or early morning hours. All of these factors can increase the risk of violence in any workplace. Although the most common form of violence is crime related, a significant number of workplace assaults occur where the aggressor has a legitimate business relationship with the victim. I was visiting a place of public assembly doing a routine compliance call when just out of the blue I was assaulted by a cook. I managed to extricate myself and I went running towards the front door. And he told me that the door was locked and that I wouldn't be able to escape. But fortunately, being a diligent inspector, I had them put a crash bar on a few years earlier so I was able to escape. It doesn't make any difference what size you are. If somebody is irritated or agitated or mentally unbalanced, they'll come after a man just as easily as they will a woman. In these cases, the attacker may be a client, patient, inmate or any other individual to whom services are provided. A large proportion of these assaults happen to medical personnel and social workers. Take for example the case of Nancy Fitzgivans, a children's services worker in Franklin County, Ohio. While on a home visit to check on a child in her care, Nancy was stabbed to death, leaving behind her husband and three children. We have records of people every day getting broken noses, broken jaws, broken teeth. And it has become a litany of terror for folks. They want to do their job, but they have to deal with the issue of violence in the workplace. So for public sector employees, the issue of dealing with difficult clients, inmates, and the mentally retarded and the mentally ill is a very serious issue. In healthcare and drug treatment facilities, nurses are often the targets of violent outbursts. We had 27 male patients and three female staff on duty. One of the patients was not allowed to go smoking that day, so decided to cause some disruption. When he started to disrupt, then when we went to intervene, he began to attack me. Even though the other two staff immediately came to my aid, he slammed my head into a butcher block counter four or five times and was punching me on my shoulder and my arm and my back on counted times. During the attack, he hit me so hard my tied shoes came off underneath the desk and my glasses ended up about 25 feet down the hallway. The whole time he was hitting me, he was saying how he was going to continue to try to kill me. We had brought all the patients up to the dining room and there was one patient that stayed back. I heard him yelling and threatening another nurse that had stayed back at the nurses station and he had attempted to go over the counter. So I called to him and tried to get his attention away from her and he just bolted at me. He just started hitting my face with his fist and probably the third blow I went down on the floor. There was one patient that had stayed back and that patient heard pounding, it was my head hitting the wall as he would punch my face. And this patient that was left back ran up the hall and jumped on this man. This man was so big he was carrying this other patient that was back. If it wasn't for this other patient, there is no way I would have lived through what was coming. Stories like these are not uncommon. Violence in treatment settings is usually caused by clients and occasionally their family members who feel frustrated, vulnerable and out of control. And what about cases of worker on worker violence, the kind that figure prominently in newscasts and headlines? Contrary to popular belief, worker on worker violence accounts for only about 8% of workplace homicides. But no industry is immune to this type of violence since it is usually motivated by interpersonal or work-related disputes. Another type of workplace violence stems from a personal relationship between the attacker and victim. This type of violence spills over from personal life to the workplace. For example, domestic disputes in which the victim is assaulted or threatened while at work. Laws and regulations regarding workplace violence vary by locality. There is no national legislation that specifically addresses workplace violence. OSHA, the Occupational Safety and Health Administration and NIOSH have published voluntary guidelines and recommendations for taxi services, late night retail establishments and health care agencies. A list of these voluntary measures can be accessed through the main menu. Only two states, California and Washington, have OSHA plans that enforce regulations requiring comprehensive safety programs in all workplaces that address preventing assaults on workers. These states have also enacted specific legislation to protect health care workers, such as nurses. Washington, along with Virginia and Florida, has passed state laws aimed at preventing robbery-related homicides in late night retail establishments such as convenience stores. Local ordinances to protect taxi cab drivers from violence can be found in major cities including Los Angeles, Chicago, New York, Boston, Albany and Baltimore. It's important to note that while the potential to reduce workplace violence is great, there is no conclusive scientific information on which specific approaches are most effective. Research is in progress to determine which interventions are most appropriate for different work environments. Violence is a serious workplace hazard that demands focused attention. Because we have a diverse economy with all kinds of jobs, there will never be a single violence prevention strategy that will work in every setting. But by examining the specific situations and activities that put people at risk, employers and workers can together begin to develop a comprehensive violence prevention program. The goal of any such program should be to implement a system of controls that addresses the unique needs of the workplace. We'll talk about how to do that next. Strategies for preventing workplace violence fall into three categories, environmental, administrative and behavioral. Environmental controls are often found in workplaces where cash is exchanged. Measures such as using locked drop safes, keeping small amounts of cash on hand and posting signs to this effect are used to deter robbery. We have a limit in the registers that the register will automatically notify the cashier or clerk to make a drop in order to keep the money low in the till and keep it unattractive. Accepting credit and debit cards also reduces the amount of available cash, especially in retail settings and taxi cabs. Some safety advocates have proposed using prepaid cab fare cards similar to those used in subways. Physical separation of workers from customers and the general public should also be considered. Creating distance between workers and others may reduce the chances of a physical attack. One way to achieve this is to increase the height and depth of counters. Bullet resistant enclosures and barriers provide physical protection in a range of environments from taxi cabs to emergency rooms and social service agencies. When selecting methods of separation, companies must take into account the need to conduct business in a reasonable fashion. A safety device that is obtrusive or impractical may be self-defeating because it frustrates workers and customers. Visibility and lighting are also important environmental considerations. High risk areas should be made clearly visible to as many people as possible. Ample outdoor lighting is also essential. Access to the workplace needs to be addressed as well. Obviously, access to work areas by non-employees should be restricted. Some things to consider include the number of entry and exit points, the use of panic bar doors that allow doors to be locked from the outside but still allow exit, and areas on the premises where potential attackers can hide. Keep in mind that a trespasser can be hidden by a variety of environmental characteristics such as landscaping, signage, and outlying buildings. And of course there are numerous safety devices on the market to help secure the work environment. For example, closed circuit cameras, alarms, key card entry systems in fixed workplaces, cell phones and other communication equipment in mobile workplaces, and trouble lights and geographic locating devices in cabs. All of our employees are aware of where the quickest escape is for an exit. We also have video cameras of very bright lighting. Approximately 15 years ago we had an average of 158 robberies a year as we implemented closed circuit TV and alarm systems throughout the stores. We cut our robberies down to approximately 58 last year and so far half of this year we're at 18 for the company. We were able to get Mayor Giuliani to give the industry five million dollars to help protect the industry by putting in partitions and or cameras and making it law that one of these two items had to be in these cars. Today our robberies are down from 2,500 a month to maybe two or three hundred a month. Murders are down from 25 a year to maybe one or two a year. Administrative controls are workplace policies and practices designed to reduce the risk of violence. Administrative controls include appropriate staffing. Security experts recommend the use of guards or receptionists to screen visitors and otherwise control access to work areas. In retail, service and healthcare settings increasing the number of workers on duty at certain times should be considered. Work practices that increase the risk of assault on workers should be thoroughly examined and revised as needed. These practices include carrying money or valuables and disposing of or storing materials in outlying areas of the work site. Employers should develop an overall policy on workplace violence that has a clear message. Violence will not be tolerated and is never a part of doing business. This policy should provide for reporting violent incidents, threats and behaviors whether they originate outside the organization or within. Methods for diffusing potentially violent situations and instruction on how to use security devices should also be covered. In addition, violence policies should include provisions for medical care and psychological support following a violent incident as well as training, which brings us to the third violence prevention strategy, behavioral. Providing employees with training in nonviolent response and conflict resolution is believed to reduce the risk that volatile situations will escalate to physical violence. An effective training program will address hazards associated with specific tasks and appropriate prevention strategies. Ensuring that all employees know how to use safety devices properly is also critical. Increased employee knowledge and adherence to administrative controls will result in behavior that contributes to a safer workplace. I really think it's important for all our employees to be educated on it because I know that if it was one of my family members or one of my friends that was hurt or for that case even murdered on the job, it would devastate me and I want everybody else to understand that. Any program for preventing workplace violence should incorporate these three strategies. A successful program also requires a commitment by management and active employee involvement. To learn what some people are doing to prevent violence at work, check out the case study accessible through the main menu. When addressing workplace violence or any other safety issue, prevention is the ultimate goal. Any threats of violence should be reported and dealt with right away. Ignoring potential problems or failing to take them seriously can have deadly consequences. And in case violence does occur, employers should be ready to utilize all available internal and community resources to minimize its effects. Most important, remember that workplace violence can be prevented with appropriate policies and controls. It's definitely not something that workers should have to live with or just hope never happens to them. A safe workplace doesn't happen by accident. It requires that we take action to protect ourselves and others. I'm Ken Strunk. Stay safe.