Free Texas Workplace Violence Prevention Plan Template

Part 1: the eight items the plan must contain

Section 331.004(b) lists what the written plan must do. The template takes them in that order, with a drafting prompt under each.

• 01. Practice setting and scope (§331.004(b)(1)): The plan must be based on the practice setting. Name your facility class, units, patient population, and known risks, so the plan reads as yours and not as a template a surveyor will spot in seconds.
• 02. Definition of workplace violence (§331.004(b)(2)): The plan must adopt a definition that covers an act or threat of physical force resulting in, or likely to result in, physical injury or psychological trauma, and any incident involving a firearm or other dangerous weapon.
• 03. Training or education at least annually (§331.004(b)(3)): Who is trained, on what, and how often: at least annually for health care providers and employees who provide direct patient care, with rosters retained for the survey file.
• 04. Responding to and investigating incidents (§331.004(b)(4)): The system for responding to violent or potentially violent incidents and for investigating them afterward: who responds, who investigates, and where the findings go.
• 05. Physical security and safety (§331.004(b)(5)): The physical controls your setting relies on, tied to the hazards your worksite analysis found: access, sightlines, alarms, lighting, and visitor management.
• 06. Soliciting information from providers and employees (§331.004(b)(6)): How the facility asks its providers and employees for input when it develops and implements the plan, and how that input is recorded and used.
• 07. Reporting through existing occurrence reporting systems (§331.004(b)(7)): How staff report workplace violence through the occurrence reporting system the facility already has, including threats and near misses.
• 08. Adjusting patient care assignments (§331.004(b)(8)): How the facility adjusts patient care assignments, to the extent practicable, so a provider or employee does not have to treat a patient who intentionally physically abused or threatened them.

Part 2: what a surveyor checks alongside the plan

The plan does not stand alone. The same survey looks for the committee, the written policy, the post-incident response, the annual evaluation, and plan availability, so the template gives each one a section.

• 09. The committee (§331.002): The required membership: an RN providing direct care, a physician providing direct care (the only statutory exemption is an HCSSA with no such physician on staff), and a security-services employee (if any and if practicable), with a roster, a charter, and appointment letters.
• 10. The written policy (§331.003): The policy that sits beside the plan: significant consideration of the committee’s plan, confidential information to the committee, and protection from retaliation.
• 11. Post-incident response (§331.005): Immediate post-incident services including any necessary acute medical treatment, no discouraging contact with law enforcement, and no retaliation for a good-faith report.
• 12. Annual evaluation and governing-body report (§331.004(d)): The committee’s review and evaluation of the plan at least annually, and the report of the results to your governing body, a statutory step that is easy to overlook.
• 13. Plan available on request (§331.004(e)): How a provider or employee gets an electronic or printed copy of the plan when they ask for one.

How to make it facility-specific (the part that matters)

A surveyor can spot a borrowed template in seconds: generic threat language, no named units, no real risk inventory. The template prompts you to name your facility class, your high-risk areas (the ED, behavioral health, after-hours access), and the controls you actually use, so the plan reflects your environment of care and not a download.

Common deficiencies the template helps you avoid

The recurring Chapter 331 findings are predictable: a committee missing a required seat, no documented annual evaluation reported to the governing body, training that misses night shift or contract staff, and a plan that was written once and never reviewed. The surveyor notes in the template show the evidence that prevents each one.