April 28, 2009


Violence has been defined as the expression of intentional use of physical force and compelling action against another person or oneself which either results in or has a high likelihood of injury or death. For workplace violence, the National Institute for Occupational Safety and Health (NIOSH) defines this as “violent acts (including physical assaults and threat of assaults) directed toward persons at work on duty.”1 It can occur at or outside the workplace2. The type of violence problem includes suicide, threats, verbal abuse, physical assaults and homicide. In general, we usually pay less attention to violence because of lack of a clear definition of the problem.3 Thus, work-related violence recently has been recognized as a major public health problem.

Types of violence

In the World Report on Violence and Health, violence is categorized according to who performs the violence act into three different types: self-directed violence, interpersonal violence and collective violence.3 Self-directed violence included suicidal behavior and self-abuse. Interpersonal violence is divided into two subcategories; one is family and intimate partner violence, which includes child, intimate partner and elder and the other is community, which includes acquaintance and stranger. Violence occurs between strangers; they may or may not know each other. Collective violence occurs arrange people who want to achieve political, economic or social objectives. Those people think of themselves as a member of a group against another group or individuals. 3

Violence prevention program

In Minnesota, there is a violence prevention program called “Workplace Violence Prevention Program.” This prevention program is state-funded and helps employers and employees to reduce the workplace violence. They provide on-site consultation, telephone assistance, as usual education and training seminars. The Workplace Violence Prevention Program is an investigation and resource center.4

Magnitude of violence

In a 2001 Surveillance of fatal and nonfatal injuries in the United Stated, 92% of non-fatal injuries were unintentional, and 7.3% were violence-related, including assaults, legal intervention and self-harm.5 According to the Bureau of Justice Statistics each year, from 1993 to 1999, an average 1.7 million people experienced violent crime while working or on duty in the United States.6 In the Annual Survey of Occupational Injuries and Illnesses data, it was indicated that 22,400 workplace assaults occurred in 1992 and, of those, the non-fatal workplace assaults accounted for 44% in men and 56% in women.7

Between 1999 and 2000, 135,000 teachers were physically attacked by a student and over 300,000 elementary and secondary school teachers were threatened with injury in the United States.8 From 1999 to 2003, annually, an estimated 183,000 teachers were victims of non-fatal crimes at school. Translated into an annual rate, there were 39 crimes per 1,000 teachers. 8

From a study of nonfatal assault injuries to public school teachers in Los Angeles, it was indicated that violence would have a direct impact on the quality of education from teachers and the retention rates of teachers. 9 Also, in an analysis of 600 random sample claims (1993-1996) in 51 US jurisdictions, schools had the highest percentage of non-fatal workplace violence claims.10

Estimated costs

The financial cost of violence, like other injuries, includes lost work-time, medical care cost, costs of replacing staff who leave their positions after an assault incident, and indemnity components. From a study in a cost of work-related physical assaults in Minnesota, in 1992, the total costs were estimated at $5,885,448 (1996 dollars) for 344 non-fatal work-related assaults. 11 Special education teachers had assault injury rates of 27.2 per 100,000 employees, with an average cost of $4,888 per case. Secondary teachers and elementary teachers had assault injury rates of 9.9 and 8.0 per 100,000 employees, respectively, with average costs of $ 6,483 and $16,062 per case. 11

As identified on the OSHA Safety Pays Program website, the estimated direct cost for mental stress per injured person was $ 27,004, with an indirect cost of $29,704 (under 3% profit margin). In addition, the estimated direct cost for mental disorder per injured person was $ 37,420, and the indirect cost, $41,162 (under 3% profit margin).12

Haddon’s Matrix- physical violence


Human (victim)
‧ Race
‧ Gender
‧ Personality
‧ Illness history
‧ Work experience
‧ Violence training

Agent (perpetrator)
‧ History of violent behavior
‧ Socioeconomic status

‧ Frequency of violence in the media
‧ School location
‧ School type
‧ Violence tolerance
‧ Physical design


Human (victim)
‧ Age
‧ Gender
‧ Body mess
‧ Violence management

Agent (perpetrator)
‧ Drug or alcohol use
‧ Weapon used
‧ Number of perpetrators

‧ Security system in use


Human (victim)
‧ Age of victim general health condition
‧ Reaction time
‧ Rehabilitation

Agent (perpetrator)
‧ Mental impairment
‧ Other relevant activities

‧ Public support for injury care and mental health clinic
‧ Employee assistance

Total losses/costs

Human (victim)
‧ Damage to people
‧ Lost work time

Agent (perpetrator)
‧ Damage to equipment

‧Damage to society

Haddon’s Ten Strategies- prevent violence in workplace

1. Prevent the creation of the hazard in the first place:
‧ Ensure enough light both indoors and outdoors. Otherwise, install bright lighting in workplace.

2. Reduce the amount of the hazard brought into being:
‧Clearly inform employees that violence is prohibited and not tolerated.

3. Prevent the release of the hazard that already exists.
‧Providing police assistance in some locations or at night.

4. Modify the rate or spatial distribution of release of the hazard from its source:
‧Provide safety education for workers. Teach employees how to protect themselves when they involve a violence situation or if they witness violence against to others.

5. Separate, in time or space, the hazard and that which is to be protected.
‧Using metal detectors to detect guns, knives or other weapons to ensure all the workers’ safety.

6. Separate the hazard and that which is to be protected by interposition of a material barrier.
‧Separate all the hazardous tools that can be weapons during violent event. For example, lock all unused rooms to limit access. Moreover, provide shelves and lockable cases for sharp tools in the workplace.

7. Modify basic relevant qualities of the hazard.
‧Design a safe workplace for workers. Develop a secure system, appropriately, such as implementation of a surveillance system and alarm system.

8. Make what is to be protected more resistant to damage from the hazard.
‧Provide violence management training to employees. Inform employees to contact the supervisor when they are involved in a violent event.

9. Begin to counter the damage already inflicted by the environmental hazard.
‧Know the employees’ history of disease and history of mental behavior.
‧When violent event occurred, encourage employees to report incidents of violence in the workplace.

10. Provide emergency care and appropriate rehabilitation.
‧Establish a comprehensive injury reporting system and develop a care operation while injury happened.
‧Inform employees how to get assistance when they encounter a violent event.

Not like accidents, injuries can be prevented. The aim of ten strategies is reduce injuries and bases on the technological modification to provide useful concepts for employers to prevent before violent event occurred and control the severity while violent has been event occurred.

Related links

Regional Injury Prevention Research Center:

Center for violence prevention and control:

Midwest Center for Occupational Health and Safety:


1) Guideline for preventing workplace violence for health care & social service workers. U.S Department of Labor. Occupational Safety and Health Administration. OSHA Publication 3148-01R (2004)

2) OSHA Fact Sheets: Workplace-violence. U.S. Department of Labor. Occupational Safety and Health Administration. http://www.osha.gov/OshDoc/toc_fact.html

3) World report on violence and health: summary. World Health Organization Geneva 2002. ISBN 92 4 154562 3 (NLM classification: HV 6625)

4) Brian Zaidman 2008. Minnesota Workplace Safety Report 2006. Policy Department, Research and Statistics

5) Sara B. Vyrostek, Joseph L. Annest, George W. Ryan. Surveillance for fatal and nonfatal injuries --- United
Stated 2001. Office of Statistics and Programming. National Center for Injury Prevention and Control. Septermber 3,
2004 / 53(S S07);1-57

6) Bureau of Justice Statistics Special Report- Violence in the Workplace, 1993-99. U.S. Department of Justice. Office of Justice Programs. December 2001, NCJ 190076

7) David O’Neil Washington. Non-fatal workplace violence- an epidemiological report and empirical exploration of risk factors. University of Nebraska. 199359

8) DeVoe J, Peter K, Noonan M, Snyder T, Baum K. 2005. Indicators of school crime and safety 2005. Washington, DC: U.S. Departments of Education and Justice.

9) Predictors of non-fatal assault injury to public school teachers in Los Angeles City

10) Hashemi L,Webster BS. 1998. Non-fatal workplace violence workers’ compensation claims (1993–1996).

11) McGovern, L Kochevar, W Lohman, B Zaidman, S G Gerberich, J Nyman, and M Findorff-Dennis The cost of work-related physical assaults in Minnesota, 2000

12) OSHA’s $afety pays program- http://www.osha.gov/dcsp/smallbusiness/safetypays/estimator.html

13) DeVoe, J.F., Peter, K., Kaufamn, P., Ruddy, S.A., Miller, A.L., Planty, M., Snyder, T.D., Duhart, D.T., and Rand, M.R. Indicators of school crime and safety: 2002. Washington, DC: U.S. Departments of Education and Justice.

14) Binns, K., and Markow, D. (1999) The Metropolitan Life Survey of the American Teacher, 1999: Violence in America's Public Schools-- Five Years Later

15) Flaherty, L. (2001). School violence and the school environment. In: School Violence: Assessment, Management, Prevention, Shafii and Shafii, eds. American Psychiatric Publishing, Inc. Washington, DC. 25-52