Texas Health and Safety Code Chapter 331 — Workplace Violence Prevention
Chapter 331 of the Texas Health and Safety Code requires covered health care facilities in Texas to establish a workplace violence prevention committee, adopt a written workplace violence prevention policy, and adopt and enforce a written workplace violence prevention plan. The chapter took effect September 1, 2023, and required facilities had until September 1, 2024, to be in compliance. The chapter applies in addition to any federal requirements that already cover the facility, including the OSHA general duty obligation and any applicable Joint Commission or CMS standards.
Last revised: April 2026 | Source: Texas Statutes Online, Health and Safety Code Chapter 331 | Owner: Adams Operations Group
Quick Reference — The Five Components of Chapter 331
Chapter 331 has five operational components. Three are facility-level documents and structures (Committee, Policy, Plan). The fourth is the facility’s response after an incident occurs. The fifth is enforcement. The Plan itself contains eight required elements, expanded in Section 4.
| # | Component | Statutory Citation | What It Requires |
|---|---|---|---|
| 1 | Workplace Violence Prevention Committee | Sec. 331.002 | A committee — newly formed or existing — develops the workplace violence prevention plan. Required membership includes one direct-care RN, one direct-care physician licensed in Texas (with a narrow exemption for home and community support services agencies), and one security employee if any and if practicable. |
| 2 | Workplace Violence Prevention Policy | Sec. 331.003 | A written policy adopted, implemented, and enforced by the facility. Must give significant consideration to the committee’s plan, evaluate any existing facility plan, encourage confidential reporting, protect reporters from retaliation, and comply with HHSC rules. |
| 3 | Workplace Violence Prevention Plan | Sec. 331.004 | A written plan adopted, implemented, and enforced by the facility, addressing eight required elements. Reviewed and evaluated at least annually by the committee, with results reported to the facility’s governing body. |
| 4 | Responding to Incidents of Workplace Violence | Sec. 331.005 | After an incident, the facility must offer immediate post-incident services including any necessary acute medical treatment. Facilities may not discourage reports to law enforcement, and retaliation against good-faith reporters is prohibited. |
| 5 | Enforcement | Sec. 331.006 | A facility’s licensing agency may take disciplinary action against a noncompliant facility as if the facility violated an applicable licensing law. No statutory monetary penalty schedule. |
Applicability — Who Must Comply
Chapter 331 applies to six categories of health care facility licensed or operating under Texas law. The chapter does not apply to all health care employers in Texas — applicability is tied to specific facility types listed in Sec. 331.001(3). Two of the six categories carry a staffing threshold: home and community support services agencies and nursing facilities are covered only if they employ at least two registered nurses. The other four categories are covered regardless of employee count.
The applicability rule comes directly from the chapter’s definition of “facility”:
Sec. 331.001(3) defines “facility” for purposes of Chapter 331. A facility is any of the following: a Chapter 142 home and community support services agency providing home health services and employing at least two registered nurses; a Chapter 241 hospital (including a state-operated hospital exempt from licensing); a Chapter 242 nursing facility employing at least two registered nurses; a Chapter 243 ambulatory surgical center; a Chapter 254 freestanding emergency medical care facility; or a Chapter 577 mental hospital. Each covered facility must comply with Sec. 331.002 (committee), Sec. 331.003 (policy), Sec. 331.004 (plan), and Sec. 331.005 (incident response).
AOG’s primary client verticals — ambulatory surgical centers, ambulatory care groups, and behavioral health facilities — fall under Chapter 331 directly. ASCs are covered without a staffing threshold. Behavioral health facilities licensed as mental hospitals under Chapter 577 are covered. Multi-site medical group practices are not covered as a general rule unless one or more of their locations is independently licensed under one of the six facility chapters listed above. Urgent care clinics are typically not covered, because urgent care is generally licensed under physician practice rules rather than as a freestanding emergency medical care facility — but a freestanding emergency medical care facility licensed under Chapter 254 looks similar to urgent care from the outside, so the licensing chapter, not the marketing label, governs.
| Covered Facility Type | Texas Licensing Chapter | Statutory Reference |
|---|---|---|
| Home and community support services agency providing home health services and employing at least two registered nurses | Chapter 142 | Sec. 331.001(3)(A) |
| Hospital — licensed under Chapter 241 or operated by a state agency exempt from licensing under that chapter | Chapter 241 | Sec. 331.001(3)(B) |
| Nursing facility employing at least two registered nurses | Chapter 242 | Sec. 331.001(3)(C) |
| Ambulatory surgical center | Chapter 243 | Sec. 331.001(3)(D) |
| Freestanding emergency medical care facility | Chapter 254 | Sec. 331.001(3)(E) |
| Mental hospital — private mental hospital or other mental health facility | Chapter 577 | Sec. 331.001(3)(F) |
The Eight Required Elements of the Workplace Violence Prevention Plan
Sec. 331.004(b) lists eight required elements that every workplace violence prevention plan must contain. The chapter sets these as the minimum bar — a plan that does not address all eight elements does not satisfy the statute. The plan may satisfy any of the elements by reference to other internal facility policies and documents per Sec. 331.004(c). Each accordion item below covers one required element, what the statute requires, what a compliant approach looks like, and where AOG sees facilities most often fall short.
Practice Setting (Sec. 331.004(b)(1))
The plan must be based on the practice setting. The statute does not define “practice setting” further, but the meaning is operational: a plan written for a 200-bed acute care hospital is not a compliant plan for a 4-suite ASC, and a plan written for a freestanding emergency medical care facility is not a compliant plan for a home health agency.
A compliant approach starts with a hazard inventory of the actual facility — entrance and egress points, parking lots and approach paths, waiting areas, clinical areas, behavioral health holding areas if any, drug storage areas, and after-hours staffing patterns. The plan addresses the violence risk profile that those characteristics produce.
Most common gap AOG sees: facilities adopt a generic template plan from a parent system or a vendor and never tailor it to the specific site. A surveyor or a plaintiff’s attorney reading the plan can tell within two pages whether the plan was written for that building.
Definition of Workplace Violence (Sec. 331.004(b)(2))
The plan must adopt a definition of “workplace violence” that includes both: (A) an act or threat of physical force against a health care provider or employee that results in, or is likely to result in, physical injury or psychological trauma; and (B) an incident involving the use of a firearm or other dangerous weapon — regardless of whether a provider or employee is actually injured by the weapon.
The second prong matters operationally. A weapon brandished in a waiting area is workplace violence under Chapter 331 even if no one is hit. A drawn firearm during a verbal dispute is a reportable incident under the plan. The plan should make this prong explicit so that staff are clear that “no one was hurt” does not mean “no incident occurred.”
Most common gap: facilities import a definition that covers only completed physical assaults and silently omits the weapon-presence prong. That omission narrows the plan’s reporting scope below what the statute requires.
Annual Training (Sec. 331.004(b)(3))
The plan must require the facility to provide workplace violence prevention training or education at least annually. The training requirement applies to direct-care health care providers and employees. The statute permits this training to be incorporated into other required training — it does not have to stand alone as a separate course.
The chapter does not specify a minimum number of hours, a curriculum, or a credentialing requirement for the trainer. That silence is a vulnerability — a facility can technically check the box with a 10-minute LMS module and still satisfy Chapter 331 on its face. A compliant-and-defensible approach addresses three things at minimum: how to recognize warning signs of escalating behavior, how to de-escalate a confrontation, and how to report an incident through the facility’s reporting system.
Most common gap: training documentation. Facilities deliver training but do not capture attendance, content covered, and date in a way that survives a survey or a deposition. Training that cannot be documented might as well not have happened.
Incident Response and Investigation System (Sec. 331.004(b)(4))
The plan must prescribe a system for responding to and investigating violent incidents and potentially violent incidents at the facility. The statute requires both response and investigation, and it covers both completed incidents and near-miss potentially violent incidents.
A compliant system has a defined activation trigger (who calls what code, who calls 911, who notifies leadership), a defined post-incident sequence (scene security, medical assessment, employee support, evidence preservation, law enforcement coordination), and a defined investigation process (who reviews, on what timeline, with what output). The output of the investigation feeds back into the plan — that loop is the difference between a plan that improves and a plan that drifts.
Most common gap: the response side gets attention; the investigation side gets neglected. After an incident, the facility provides medical care and writes an occurrence report, then nothing else happens. The plan stays unchanged. The next similar incident plays out the same way.
Physical Security and Safety (Sec. 331.004(b)(5))
The plan must address physical security and safety. The statute does not prescribe specific physical security measures, but the plan must show that the facility has considered and addressed them.
Common physical security elements addressed in compliant plans: access control at primary and after-hours entrances, panic-button or duress-alarm coverage in clinical areas, line-of-sight design in waiting and intake areas, lighting in parking lots and approach paths, lockdown capability and procedures, and security personnel coverage if any. The plan does not have to implement every measure — it has to address them and document the rationale for what is and is not in place.
Most common gap: the plan describes physical security in aspirational terms (“the facility maintains a secure environment”) without identifying specific measures, locations, or procedures. That language fails any meaningful review.
Provider and Employee Input (Sec. 331.004(b)(6))
The plan must require the facility to solicit information from health care providers and employees when developing and implementing the plan. The statute treats provider and employee input as a structural requirement, not a courtesy.
A compliant approach documents how input was solicited — staff meetings, surveys, suggestion processes, the workplace violence prevention committee’s solicitation activity — and what input was received. The committee’s annual review under Sec. 331.004(d) is one of the natural points to refresh this solicitation.
Most common gap: the plan was written by leadership and a consultant without any direct staff input, and there is no record of staff being asked. That gap shows up immediately in a survey because surveyors will ask floor staff whether they have ever been asked about workplace violence concerns.
Reporting Through Existing Occurrence Systems (Sec. 331.004(b)(7))
The plan must allow health care providers and employees to report incidents of workplace violence through the facility’s existing occurrence reporting systems. The chapter does not require a separate reporting channel — it requires that the existing channel be available for these incidents.
A compliant approach makes the reporting path explicit in the plan and confirms that the existing occurrence reporting system is configured to capture workplace violence as a category. The path runs all the way through to investigation and committee review under Element 4 and Sec. 331.004(d).
Most common gap: workplace violence incidents are reported through a parallel HR or security path that does not feed into the same occurrence database used for clinical events. That fragmentation hides patterns and weakens the plan over time.
Adjusting Patient Care Assignments (Sec. 331.004(b)(8))
The plan must require the facility to adjust patient care assignments — to the extent practicable — to prevent a health care provider or employee from treating or providing services to a patient who has intentionally physically abused or threatened that provider or employee. The “to the extent practicable” qualifier reflects the operational reality that some facility types cannot freely substitute providers, but the obligation to attempt adjustment is non-negotiable.
A compliant plan describes the assignment-adjustment process: who decides, on what information, how quickly, and how the decision is documented. The plan also describes what happens when adjustment is not practicable — for example, in a small facility where no other qualified provider is available — including any additional protective measures that apply when the provider has to continue treating that patient.
Most common gap: the plan repeats the statutory language verbatim without describing the operational mechanism. Repeating the statute is not a plan — it is an aspiration.
Additional Operational Requirements
Three operational requirements apply across Chapter 331 but are not surfaced as numbered plan elements in Section 4. Each is rooted in a separate statutory section and applies independently of the eight plan elements.
Committee Composition (Sec. 331.002)
Each covered facility must establish a workplace violence prevention committee or authorize an existing facility committee to develop the plan. The committee must include at least one registered nurse who provides direct care to the facility’s patients, one physician licensed to practice medicine in Texas who provides direct care to patients, and one facility employee who provides security services if the facility has security personnel and if including a security employee on the committee is practicable.
The physician requirement carries one narrow exemption: if a home and community support services agency under Sec. 331.001(3)(A) does not have a physician on staff, the agency is not required to include a physician on the committee. The exemption does not extend to the other five facility types, even when a physician on the committee is operationally awkward.
AOG operational note: many small ASCs and freestanding emergency medical care facilities authorize an existing committee — typically a quality, safety, or risk committee — to take on the workplace violence prevention plan rather than standing up a new committee. That approach is statutorily permitted and operationally cleaner. The committee’s charter document should be updated to reflect the added scope so the chain of authority is clear during a survey.
Policy Requirements (Sec. 331.003)
Separate from the plan itself, every covered facility must adopt, implement, and enforce a written workplace violence prevention policy. The policy is a higher-level governance document that sits above the plan. Sec. 331.003(b) sets four explicit policy requirements:
- Significant consideration of the workplace violence prevention plan recommended by the committee, and evaluation of any existing facility violence prevention plan.
- Confidential reporting — the policy must encourage health care providers and employees to provide confidential information on workplace violence to the committee.
- Anti-retaliation protection — a process that protects providers and employees who provide information to the committee from retaliation.
- Compliance with HHSC rules — the policy must comply with rules adopted by the Texas Health and Human Services Commission relating to workplace violence. HHSC has adopted facility-type-specific rules implementing Chapter 331 (e.g., 26 TAC §509.70 for freestanding emergency medical care facilities); the policy must conform to the rule that applies to the facility type.
Most common gap: facilities have a plan but no separate policy. Sec. 331.003 is a separate statutory obligation. A facility that has only a plan is not in full compliance with Chapter 331.
Multi-Facility Health Care Systems (Sec. 331.002(d))
A health care system that owns or operates more than one facility may establish a single workplace violence prevention committee for all of the system’s facilities, but only if two conditions are met: the committee develops a violence prevention plan for implementation at each facility in the system, and data related to violence prevention remains distinctly identifiable for each facility in the system.
Operational meaning: a system can centralize the committee, but cannot centralize the data. A combined system-wide incident dashboard with no facility-level breakout does not satisfy Sec. 331.002(d). Each facility’s incident data — incidents, near-misses, post-incident actions, training completion — must remain attributable to that specific facility for purposes of plan development, annual review, and any survey or enforcement inquiry.
Review and Update Requirements
Sec. 331.004(d) requires the committee — at least annually — to review and evaluate the workplace violence prevention plan and report the results of the evaluation to the facility’s governing body. Other components of Chapter 331 carry their own cadence or are event-driven rather than calendar-driven.
| Component | Required Review Frequency | Notes |
|---|---|---|
| Workplace Violence Prevention Plan | At least annually | Reviewed and evaluated by the committee. Results of the evaluation reported to the facility’s governing body. |
| Workplace Violence Prevention Policy | No statutory cadence | Chapter 331 requires adoption, implementation, and enforcement, but does not specify a review interval. AOG recommends annual review aligned with the plan review cycle. |
| Training | At least annually | The plan must require workplace violence prevention training or education at least annually. Training may be incorporated into other required training for direct-care providers and employees. |
| Post-Incident Review | After every reportable incident | Not a calendar-driven review. Triggered by an incident of workplace violence; informs plan and policy updates. |
Event-driven review triggers sit alongside the annual cadence. A workplace violence incident — completed or near-miss — should produce a documented post-incident review with findings fed back into the plan and the committee’s evaluation. Operational changes (new entrance, new clinical service line, new patient population, after-hours expansion) should also trigger a review of the plan ahead of the next annual cycle. Documentation of the review — what was reviewed, by whom, on what date, with what findings, with what changes resulting — is what survives a survey or a discovery request.
What Chapter 331 Does Not Require
Chapter 331 is often confused with the more prescriptive workplace violence prevention regimes that exist in California, Washington, Oregon, and other states, and with proposed federal legislation that has not passed. Several requirements that apply elsewhere do not apply under Chapter 331. Other applicable standards — OSHA general duty obligations, Joint Commission accreditation standards, CMS Conditions of Participation — may impose requirements not listed below.
- A specific number of training hours per employee per year. Chapter 331 requires “at least annually” without specifying a minimum hour count, curriculum, or credentialed trainer. California Cal/OSHA Section 3342 prescribes more granular training elements; Chapter 331 does not.
- A statutory schedule of monetary penalties. Chapter 331 has no per-violation fine structure. Sec. 331.006 routes enforcement through the facility’s licensing agency as a disciplinary matter under existing licensing law — not as a separate citation track.
- Mandatory reporting of incidents to a state agency. Chapter 331 does not establish a state-level incident reporting database or a duty to report individual workplace violence incidents to HHSC or any other Texas agency. The reporting obligation runs through the facility’s own occurrence system per Sec. 331.004(b)(7).
- Public posting of the plan or annual incident counts. Sec. 331.004(e) requires the facility to make a copy of the plan available on request to any health care provider or employee at the facility — not to the public. Plan content that would create a security risk if disclosed may be redacted.
- A specific minimum drill cadence for active threat response. Chapter 331 does not require active shooter drills, code silver drills, or any specified exercise frequency. Joint Commission accreditation, CMS Conditions of Participation, and individual licensing rules may impose drill requirements; the source of any drill obligation a facility carries is one of those standards, not Chapter 331.
- A federal cause of action. Chapter 331 is Texas state law. The federal Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2663 and predecessors) has not become federal law. A facility cannot be cited under Chapter 331 by OSHA, and cannot be cited under federal law for a violation of Chapter 331.
Enforcement and Consequences
Sec. 331.006 provides the entire statutory enforcement mechanism for Chapter 331 in a single sentence: the facility’s licensing agency may take disciplinary action against a noncompliant facility as if the facility had violated an applicable licensing law. Enforcement is non-monetary on its face. There is no separate Chapter 331 citation, no per-violation fine schedule, and no parallel administrative track.
Consequences of Non-Compliance
Disciplinary action under Sec. 331.006 takes the form already available under the facility’s licensing law. Depending on the licensing chapter and the severity of the noncompliance, that can include:
- Plan of correction with HHSC monitoring during a defined corrective period.
- Civil monetary penalties under the licensing chapter’s existing penalty structure (e.g., civil penalties available under Chapter 241 for hospital licensing violations).
- License conditions, restrictions, suspension, or revocation in serious cases.
No penalty table accompanies this section — Chapter 331 does not establish its own monetary penalty schedule. The penalty exposure for a Chapter 331 violation is the penalty exposure of the licensing law that the violation is treated as having breached.
Operational meaning for an AOG client organization: a Chapter 331 noncompliance finding is not a single-stage event. It often triggers a broader licensing review, can generate a corrective-action timeline that consumes leadership bandwidth for months, and frequently surfaces during the facility’s next survey cycle even after the immediate finding is closed. The post-incident litigation exposure compounds the agency exposure. The cost of compliance is small relative to the cost of a sustained noncompliance finding paired with a serious incident.
Source
Primary source: Texas Health and Safety Code, Title 4, Subtitle H, Chapter 331 — Workplace Violence Prevention. Added by Acts 2023, 88th Leg., R.S., Ch. 31 (S.B. 240), Sec. 1, eff. September 1, 2023. Required compliance date for covered facilities: September 1, 2024.
Available via Texas Statutes Online: https://statutes.capitol.texas.gov/Docs/HS/htm/HS.331.htm
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Interpretive guidance: Texas Health and Human Services Commission has adopted facility-type-specific rules implementing Chapter 331. Examples include 26 TAC §509.70 (freestanding emergency medical care facilities) and parallel adopted rules covering hospitals (Chapter 133), ambulatory surgical centers (Chapter 135), nursing facilities (Chapter 554), home and community support services agencies (Chapter 558), and private mental hospitals (Chapter 510). The HHSC rule that applies to the facility’s license type controls the policy and plan implementation details for that facility.
Related Regulatory References
List 3–6 related Reference pages or regulations.
- OSHA 29 CFR 1910.38 — Federal Emergency Action Plan requirements for all employers with 10 or more employees. Texas health care facilities subject to Chapter 331 are also covered by 1910.38 as employers, and a facility’s emergency action plan and workplace violence prevention plan should reference each other where appropriate. See AOG Academy: OSHA 1910.38 Reference page.
- CMS Emergency Preparedness Rule — Federal Conditions of Participation requirements for Medicare and Medicaid participating providers and suppliers. Several facility types covered by Chapter 331 — hospitals, ASCs, home health agencies — are also subject to the CMS EP Rule. See AOG Academy: CMS Emergency Preparedness Rule Reference page.
- Joint Commission Emergency Management Standards — Voluntary accreditation standards covering emergency management for accredited health care organizations. Joint Commission accredited facilities operating in Texas must satisfy both Chapter 331 and the applicable EM chapter for their accreditation program. See AOG Academy: Joint Commission EM Standards Reference page.
- OSHA Healthcare Workplace Violence Enforcement (CPL 02-01-058) — Federal OSHA enforcement directive directing inspections in health care and social services workplaces with elevated workplace violence rates. Operates under the OSH Act’s general duty clause; predates Chapter 331 and continues to apply alongside it. (Forthcoming AOG Academy Reference page.)
- 26 TAC Chapter 509 — HHSC adopted rules for freestanding emergency medical care facilities, including §509.70 implementing Chapter 331 for that facility type. Equivalent HHSC rule chapters apply to the other five Chapter 331 facility categories. (Forthcoming AOG Academy Reference page on HHSC implementing rules.)
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Last reviewed: April 2026 | Last revised: April 2026 | Page owner: Adams Operations Group