OSHA Enforcement: A Guide to Federal OSHA and State OSH Programs

OSHA; Regulations

United States law requires worker safety to be enforced either through an approved state-level occupational safety and health (OSH) program or the federal Occupational Safety and Health Administration (OSHA). In other words, each workplace is regulated by either Federal OSHA or a state OSH program. Whether your facility is covered by a federal or state program depends on your state. If your state has an approved program, you will respond to your state-level OSH agency, rather than Federal OSHA.  

Some states choose to develop state-level OSH programs because they can tailor workplace safety regulations to the specific needs of their states – as long as they meet or exceed the minimum requirements set by Federal OSHA. 

There are currently 22 State Plans covering both private sector and public employees, including:  
  • Alaska 
  • Arizona 
  • California 
  • Hawaii 
  • Indiana 
  • Iowa 
  • Kentucky 
  • Maryland 
  • Michigan 
  • Minnesota 
  • Nevada 
  • New Mexico 
  • North Carolina 
  • Oregon 
  • Puerto Rico 
  • South Carolina 
  • Tennessee 
  • Utah 
  • Vermont 
  • Virginia 
  • Washington 
  • Wyoming 

There are seven additional state plans covering only public employees. This means privately owned facilities would still only follow federal requirements – including:
  • Connecticut 
  • Illinois 
  • Maine 
  • Massachusetts 
  • New Jersey 
  • New York 
  • Virgin Islands  
A map of all OSHA Approved State Plans is available here, and specific State Plans are available here.  

Even for LTC communities covered by a state plan, it is generally helpful to view the Federal OSHA standards to understand the baseline requirement they must meet. From there, providers can evaluate any additional state requirements that should be met. 

Several state OSH programs have established their own regulations or guidelines related to Bloodborne Pathogens, Workplace Violence, and Infectious Diseases. Below are links to state programs with specific standards applicable to health care. 

Alaska: Alaska has additional healthcare requirements related to bloodborne pathogens and needle stick injury protections.  

California: California's Cal/OSHA has a comprehensive Aerosol Transmissible Diseases (ATD) standard that addresses the protection of workers in healthcare settings where there is a risk of exposure to airborne infectious agents. California also has regulations related to Workplace Violence Prevention in healthcare settings, requiring employers to develop and implement violence prevention plans. 

Maryland: Maryland's OSH program has developed guidance on preventing workplace violence in health care settings. 

Michigan: Michigan OSHA has a unique Bloodborne Infectious Diseases standard that applies to healthcare facilities. 

Minnesota: Minnesota OSHA has guidelines for preventing workplace violence in healthcare and social service settings. Minnesota also has additional training requirements for infectious agents that are likely to occur in the individual workplace. 

Nevada: Nevada has workplace violence requirements specifically for medical facilities. 

New Jersey: New Jersey has its own Infectious Disease Standard that applies to healthcare facilities and addresses measures to protect workers from exposure to infectious diseases. Note that this standard only applies to facilities owned by state or local governments. 

Oregon: Oregon OSHA has provided guidelines for employers on addressing workplace violence hazards, including a focus on the healthcare industry. Oregon OSHA also has additional rules for Bloodborne Pathogens and SHARPS Injury logs. 

Puerto Rico: PR OSHA has enacted a standard to address workplace violence situations, including procedures for handling domestic violence incidents in the workplace. 

Tennessee: Tennessee OSHA has additional requirements related to Bloodborne Pathogens and Sharps Injury Prevention. 

Washington: Washington state's Department of Labor and Industries (L&I) has specific regulations concerning Workplace Violence Prevention in health care settings. There are also unique State requirements for Bloodborne Pathogens and Airborne Contaminants including biological agents, such as viruses. 

In conclusion, as you are implementing your employee safety and health programs, you should know whether your facility is regulated by Federal OSHA or a state-run OSH agency. Based on that, you will be able to determine what, if any, additional requirements apply to you and your company.