Bill 168 is Ontario’s workplace violence and harassment law — a core part of Bill 168 workplace violence regulations and an amendment to the Occupational Health and Safety Act (OHSA) enacted in 2010.

The law requires all Ontario employers — including hospitals — to implement written violence prevention programs and provide workers with a reliable, immediate way to summon help when violence occurs or is likely to occur.

More than 15 years after Bill 168 came into force, many Ontario hospitals still struggle to meet its requirements. In practice, gaps remain between the intent of the law and how hospitals apply it. The biggest gap is the obligation to give workers a reliable, immediate way to call for help during a violent incident.

Workplace violence in healthcare is a well-documented crisis, as reflected in data from both the Canadian Federation of Nurses Unions and international bodies including OSHA. This article explains what Bill 168 requires from Ontario hospitals, outlines penalties for non-compliance, and shows how RTLS-based staff duress technology addresses these obligations while helping leading hospitals build proactive safety cultures.

Bill 168 amended the OHSA to impose six specific workplace violence obligations on all Ontario employers, including hospitals. Understanding each obligation — and where hospitals most commonly fall short — is the starting point for building a compliant program.

1. Develop a written workplace violence policy and review it annually.

The policy must be specific to the workplace. It cannot be a generic template. Hospitals must review it annually, even if no incidents occur. Many hospitals have this policy in place, but fail the annual review requirement in practice.

2. Conduct a workplace violence risk assessment.

This is not a one-time exercise. The OHSA requires hospitals to assess workplace violence risks arising from the nature of the workplace, the type of work, and working conditions. Risk assessments must be reviewed and updated when conditions change. In practice, many hospitals complete an initial assessment and do not revisit it with the rigour the legislation contemplates.

3. Implement a workplace violence prevention program.

The program must include specific measures and procedures to control the risks identified in the assessment. A written policy without a documented, operational program does not satisfy this requirement.

4. Provide workers with a means of summoning immediate assistance.

This is the most technologically significant obligation, and the one where the gap between legislative intent and hospital practice is most visible. The OHSA requires that workers have access to a reliable means of calling for help when violence occurs or is likely to occur.

Ontario Ministry of Labour inspectors increasingly question whether fixed wall-mounted call stations meet this requirement. This concern is especially relevant in high-risk environments such as psychiatric units, emergency departments, and long-term care floors — settings where workers may be physically unable to reach a fixed station during an incident.

5. Inform workers about persons with a history of violent behaviour.

Where a worker can be expected to encounter a person with a known history of violent behaviour, the employer must provide that information to the worker. This obligation intersects directly with patient flagging systems and is increasingly integrated with RTLS platforms that can deliver proximity alerts to staff near flagged patients.

6. Report and investigate all incidents of workplace violence.

Every incident must be reported and investigated. Hospitals must maintain documentation in a form that supports both internal review and external audit. Manual incident reporting processes frequently produce incomplete records that do not satisfy Ministry of Labour scrutiny during inspections.

Under the OHSA, the Ministry of Labour can issue compliance orders that require immediate corrective action. In cases of imminent danger, inspectors may issue stop-work orders. Corporations can also face fines of up to $100,000 per violation.

Beyond regulatory fines, the civil liability exposure from a workplace violence incident where a hospital demonstrably lacked an adequate response system is substantial. Hospitals that have experienced serious incidents without a documented, functional means-of-assistance system have faced both Ministry of Labour orders and civil claims simultaneously.

The reputational consequences — particularly in a healthcare labour market where nurse recruitment and retention is a persistent challenge — add a further cost that does not appear in compliance budgets but is very real in practice (CFNU White Paper).

Real-Time Location System technology addresses all six Bill 168 obligations directly. It is no longer a workaround. Regulators and accreditors increasingly expect it in high-risk healthcare environments.

The grid below maps each Bill 168 requirement to the RTLS capability that supports it:

The OHSA requirement for immediate assistance was defined before wearable technology became common. In 2010, a wall-mounted call button was a reasonable interpretation of that standard. That interpretation has shifted.

Ontario Ministry of Labour inspectors and accreditation reviewers now regularly ask whether workers in high-risk environments can realistically reach a fixed station during a violent incident. In a psychiatric unit, an emergency department, or a corridor confrontation, the honest answer is frequently no.

A worker restrained, cornered, or physically prevented from moving cannot reach a wall station. In other cases, staff may be in patient rooms without direct access to a fixed call point. Equipment such as radios can also be knocked away, leaving workers unable to summon help.

A wearable RTLS duress badge addresses each of these scenarios. By pressing a button on their badge, the worker triggers an alert instantly. Security receives the alert with the worker’s name and exact room location within seconds. No fixed infrastructure needs to be reachable. No announcement is made that could escalate the situation. The response is faster, more targeted, and more discreet than any fixed-station alternative.

This is why wearable duress systems are now widely regarded — by Ministry of Labour inspectors, accreditation reviewers, and healthcare unions — as the appropriate standard for Bill 168 compliance in clinical environments (OSHA Healthcare Violence Guidance).

Bill 168 compliance is the floor, not the ceiling. The hospitals making the most meaningful progress on workplace violence prevention are using RTLS not just to satisfy a regulatory requirement but to build safety cultures where data drives decisions and staff feel genuinely supported.

Staff Training and Early Adoption

During new hire orientation, staff are trained on duress system use — not during an emergency and not after an incident. The goal is to normalise activation before an incident occurs, eliminating the hesitation that frequently delays real-world alerts.

Using RTLS Data for Continuous Improvement

Safety committees review RTLS incident data on a quarterly basis, rather than simply filing it for audit. Alerts that recur in the same room, unit, or time window reveal clear patterns. These insights support staffing adjustments, environmental changes, and patient placement decisions. The risk assessment becomes a living document instead of an annual administrative task.

Real-Time Patient Risk Awareness

Hospitals integrate patient risk flags with the RTLS platform so that staff receive automated alerts when approaching patients with a documented history of violent behaviour. This approach directly satisfies the Bill 168 requirement to inform workers, while delivering that information in real time rather than through a manual handoff process.

From Compliance to Proactive Safety

The result is a workplace violence prevention program that satisfies Bill 168 requirements across all six obligations, generates the documentation needed for Ministry of Labour inspections and accreditation reviews, and produces measurable improvements in staff safety outcomes.

Ontario’s Bill 168 is the most explicitly detailed workplace violence legislation in Canada, but equivalent obligations exist in every major province.

Provincial Legislation Overview

BC’s WorkSafe regulations require employers to develop and implement a workplace violence prevention program, conduct risk assessments, and provide workers with means of summoning assistance. Alberta’s Occupational Health and Safety Act contains parallel provisions. Manitoba’s Workplace Safety and Health Act addresses workplace violence prevention with similar specificity.

National Enforcement Trends

Across all provinces, enforcement is becoming stronger and expectations are clearer. Regulators are also increasing scrutiny of fixed-station solutions in clinical environments. Ontario is further along that curve than other provinces, but the gap is narrowing.

Implications for Hospital Procurement

For Canadian hospital procurement teams evaluating staff duress systems, designing to Ontario’s Bill 168 standard effectively means designing to the most stringent provincial requirement — which will satisfy equivalent obligations in BC, Alberta, and Manitoba simultaneously. For a full comparison of system types and costs, see our guide on staff duress systems for Canadian hospitals.

What is Bill 168 workplace violence and what does it require from Ontario hospitals?

Bill 168 is an amendment to Ontario’s Occupational Health and Safety Act, enacted in 2010. It requires all Ontario employers, including hospitals, to develop a written workplace violence policy, conduct ongoing risk assessments, implement a workplace violence prevention program, provide workers with an immediate means of summoning assistance, inform workers about patients with a history of violent behaviour, and report and investigate all incidents.

Does Bill 168 require hospitals to use RTLS or wearable panic buttons specifically?

No. Bill 168 specifies the outcome — a reliable, immediate means of summoning assistance — not the technology used to achieve it. However, Ontario Ministry of Labour inspectors have increasingly questioned whether wall-mounted call stations alone meet this requirement in high-risk clinical environments such as psychiatric units and emergency departments, where workers may be unable to reach a fixed station during an incident. Wearable RTLS duress systems are now widely regarded as the appropriate standard.

What is the penalty for Bill 168 non-compliance in an Ontario hospital?

Under the OHSA, the Ministry of Labour can issue compliance orders, stop-work orders, and fines of up to $100,000 per violation for corporations. In addition to regulatory penalties, hospitals that lack adequate response systems face substantial civil liability exposure if a serious workplace violence incident occurs.

How does an RTLS system help with the Bill 168 risk assessment requirement?

The OHSA requires ongoing risk assessment, not a one-time exercise. RTLS systems generate continuous incident data — where alerts are triggered, how frequently, at what times of day, and by which departments — transforming risk assessment from a periodic administrative task into a live, data-driven safety management process. This continuous data record also supports Ministry of Labour inspections and accreditation reviews.

What is the difference between a Bill 168-compliant duress system and a legacy panic button?

A legacy wall-mounted panic button tells security that a worker is in distress somewhere on a unit. An RTLS-based staff duress system tells security which worker, in which specific room, right now — with a timestamped, automatically generated log for compliance documentation. The difference in response effectiveness and audit readiness is substantial, and it directly maps to the Bill 168 requirement for an immediate means of summoning assistance.

Do other Canadian provinces have legislation equivalent to Bill 168?

Yes. BC’s WorkSafe regulations, Alberta’s OHS Act, and Manitoba’s Workplace Safety and Health Act all require employers to address workplace violence risks and provide means of summoning assistance. Ontario’s Bill 168 is the most explicitly detailed, and the trend across all provinces is toward stronger enforcement and clearer expectations around technology standards in clinical environments.

How does RTLS help hospitals meet the Bill 168 requirement to inform workers about violent patients?

RTLS platforms integrate with patient flagging systems to deliver automated proximity alerts to staff approaching patients with a documented history of violent behaviour. This satisfies the Bill 168 obligation to inform workers in real time — at the point of potential contact — rather than relying on manual handoff processes that are inconsistent and difficult to audit.

Bill 168 established a clear legal framework for workplace violence prevention in Ontario hospitals in 2010. More than 15 years later, the six obligations it created remain the compliance standard — written policies, ongoing risk assessments, prevention programs, immediate assistance, worker notification, and incident documentation.

Ministry of Labour expectations for what counts as adequate assistance have increased significantly since then. RTLS-based staff duress systems address all six obligations simultaneously. They provide the immediate, wearable means of assistance the legislation requires. They also generate continuous incident data that transforms risk assessment from a periodic obligation into a live safety management process, and produce timestamped, room-specific audit logs that satisfy incident reporting requirements and withstand Ministry of Labour inspection.

For Ontario hospitals still relying on fixed call stations or manual reporting processes, the compliance gap is measurable, the penalty exposure is real, and the technology that closes that gap is now accessible at a cost that reflects how significantly this market has matured.