Skip to main content

How to avoid the most common OSHA violations & comply with the OSHA ETS

As a result of the COVID-19 pandemic, several regulatory bodies have issued updates for healthcare workers, including the Occupational Safety and Health Administration's (OSHA) Emergency Temporary Standard (ETS) for healthcare workers.

The OSHA ETS affects hospitals, primary care and long-term care providers; failure to adhere could result in serious penalties, fines and even potential closure.

These requirements are complex and things continue to change. For example, there are multiple COVID-19 vaccine mandates in addition to the OSHA ETS. Legal action has delayed implementation of some mandates and state vaccine mandates continue to change daily.

On December 20, 2021 the 6th Circuit Court of Appeals lifted the stay on OSHA ETS mandatory COVID-19 vaccinations and testing for employers with 100 or more employees. This decision reinstates the ETS mandates, but OSHA is allowing covered employers to comply by January 10, 2022. Vaccinations aside, healthcare organizations still need to have risk assessment in accordance with OSHA ETS. 

Read on to learn how you can prepare your risk assessment and help avoid the most common OSHA violations.

What is the OSHA ETS?

Published on June 21, 2021, the OSHA Emergency Temporary Standard requires certain procedures to apply in healthcare settings for treating suspected or confirmed COVID-19 patients to limit exposure for both staff and patients.1

"This is a temporary standard, so it's not a final rule, but it's the framework for it," says Brian Williams, MHA MBA, vice president of compliance and learning at MedTrainer®. "It creates a new standard that's enforceable by OSHA that encompasses the CDC [Centers for Disease Control and Prevention recommendations]."

Some key elements of the OSHA ETS include:

  • Developing and implementing a COVID-19 plan for minimizing the transmission of COVID-19 to employees
  • Training employees on COVID-19 transmission, policies and procedures
  • Providing paid time off for all employees to receive vaccinations and, if necessary, recovery time from vaccine side effects
  • Providing and ensuring that all employees properly wear personal protective equipment (PPE)
  • Enforcing social distancing and installing physical barriers where social distancing is not possible
  • Regularly utilizing, servicing and maintaining ventilation systems
  • Reporting all work-related COVID-19 hospitalizations and fatalities to OSHA2

Check out this quick 10-minute video for a simplified review of the ETS, including effective dates, key requirements and resources for healthcare providers.

Who must adhere to the OSHA ETS?

Healthcare regulations and compliance apply to settings where an employee provides healthcare or support services to patients. However, there are some exceptions to the OSHA ETS.

In general, it doesn't apply to healthcare support services such as offsite medical billing or laundry services that don't occur in a healthcare setting. And where there is no reasonable expectation that anyone with suspected or confirmed COVID-19 will be present. Also, if non-employees are subject to screening before entry and non-hospital ambulatory care settings bar anyone with suspected or confirmed COVID-19, the OSHA ETS does not apply.3

"The temporary standard requires non-exempt healthcare organizations to conduct a risk analysis to see if they are exempt, and the exemptions are very small," Williams says. "If they are not exempt, they have to maintain a COVID-19 prevention plan." All facilities are important, but long term care providers will be the highest priority for OSHA visits.

What are the most common OSHA violations?

When OSHA released its top 10 OSHA violations for 2020, several related to COVID-19 regulations, including:4

  • The number one violation involved respiratory protection, specifically the medical evaluation component of the respiratory protection standard. Essentially, the respirator medical evaluation was missing required information, or the employer did not provide an evaluation before the worker used the respirator or was fit-tested for a respirator
    • Employers were also cited for not setting up, using or updating a written respiratory protection program
  • Failing to report or underreporting work-related injuries and illnesses was the third-highest-ranked OSHA violation
  • Several violations related to recording work-related injuries and illnesses per OSHA record-keeping standards also landed in the top ten OSHA violations, indicating that healthcare providers may not clearly understand these healthcare regulations and compliance for each
  • Violating the OSHA PPE standard was the number five violation, demonstrating that employers did not properly provide PPE, adequately educate employees on using PPE, or choose PPE that fit employees properly

How can you avoid the most common OSHA violations?

One way to avoid the most common OSHA violations is to educate yourself on healthcare regulations and compliance requirements.

One way to do this is to work with a company like MedTrainer to perform a risk assessment and, if necessary, develop a COVID-19 plan, Williams says. This plan should go out to all employees and include training that coincides with the policies in the COVID-19 plan.

"It's also important to have incident reporting procedures in place to document any violations, illnesses or close calls, so they have an automated mechanism for monitoring what's going on," Williams says.

"Of course, making sure you have the right type and proper amount of PPE on hand is imperative, as is utilizing qualitative fit tests to meet the OSHA respiratory standard."

Another option is to familiarize yourself with OSHA's mini respiratory protection program, which applies to healthcare facilities where workers are not exposed to suspected or confirmed sources of COVID-19 but could reap the benefits of additional protection.

The goal is to implement respirators more quickly than following the comprehensive respiratory protection program under the Respiratory Protection standard. With the mini respiratory protection program, employers have to adhere to the training and user seal check requirements, while the main program requires an additional written program and medical evaluation.5

Using an automated system to monitor and document your COVID-19 plan and program can go a long way toward proving to OSHA that your facility is doing its due diligence to adhere to the OSHA ETS should there be an OSHA inspection.

You can also stay up to date on the state vaccine mandates for healthcare organizations using the National Academy of State Health Policy (NASHP) map for health worker mandates, updated daily. More information on ETS vaccine and testing mandates can be found on the OSHA website.

If you have any questions regarding whether the OSHA ETS applies to your healthcare office or business, contact your local or state OSHA office for a consultation. This could help you understand what standards apply to your specific healthcare facility and business so you can avoid violations.

What happens if you fail to comply with the OSHA ETS?

If you're making a good-faith effort to comply with the OSHA ETS, OSHA may use its discretion regarding enforcement, meaning you may avoid hefty fines. However, if there is no good-faith effort to comply, the maximum penalty for serious OSHA violations is $13,653 per violation. If you have a willful or repeated violation, OSHA may charge you a maximum of $136,532 per violation.6

Though these amounts are staggering, OSHA states that many healthcare employers are already complying with at least some elements of the OSHA ETS, such as those related to PPE, implementing physical barriers, social distancing, and cleaning and disinfection.3

Conducting a risk assessment, as Williams mentioned, can reveal weak spots regarding the OSHA ETS so that healthcare facilities can address and achieve compliance to avoid OSHA violations.

Learn more about MedTrainer and how they can help you manage your healthcare compliance training — including OSHA, HIPAA & accreditation training — in an affordable, easy-to-use learning management system.


All trademarks and registered trademarks are the property of their respective owners.

© 2021 McKesson Medical-Surgical Inc.