Regulations require that employers provide specific training to employees and that employers document that training. This article describes the required training, training frequency and training documentation. Required training must be provided during working hours and at no cost to the employee. Some training may be provided off-site as long as facility-specific information is provided to the employee at another time. Should required training be provided off-site during nonworking hours, nonexempt employees must be compensated at their regular rate of pay or in accordance with a practice’s C.E. compensation policy for the time spent during training. Knowledgeable staff may conduct the training; certified trainers are not required in most instances. Cal/OSHA does require the trainer for bloodborne pathogens/exposure control to be “knowledgeable in the subject matter.” For HIPAA training, the U.S. Department of Health and Human Services states:
The (HIPAA) training requirement may be satisfied by a small . . . practice’s providing each new member of the workforce with a copy of its privacy policies and documenting that new members have reviewed the policies.
This article does not include information on required training for newly employed unlicensed dental assistants nor on continuing-education requirements for licensed dental personnel. These can be found in separate CDA Practice Support resources – “Dental Assisting Categories” and “Continuing Education Requirements.”
An employer should provide basic safety training to all new employees soon after the start of employment. Retraining is required when an employee is not following policies or procedures. Training is required when new procedures or materials are introduced to the work site. Use the written site-specific plans required by Cal/OSHA as instructional material. Every employer must have written plans for hazard communication, injury and illness prevention and fire prevention and emergency procedures. Employees may be instructed verbally and should have opportunities to review the written plans and to ask questions of the trainer. Training topics include but are not limited to:
- Provide effective information and training on hazardous substances in respective work areas at the time of the initial assignment and whenever a new hazard is introduced. Information and training may relate to general classes of hazardous substances to the extent appropriate and related to reasonably foreseeable exposures of the job.
- Explain the purpose of the hazard-communication regulation (§ CCR 5194). Note location and availability of the written hazard communication plan, the list of hazardous substances in the practice and the collection of safety data sheets.
- Provide information on operations where hazardous substances are present. Include information on airborne contaminants such as nitrous oxide and formaldehyde, if used.
- Train on the methods and observations that may be used to detect the presence or release of a hazardous substance in the work area (such as monitoring conducted by the employer, continuous monitoring devices, visual appearance or odor of hazardous substances when being released, etc.).
- Provide training in the physical and health hazards of the substances in the work area and the measures employees can take to protect themselves from these hazards, including specific procedures the employer has implemented to protect employees from exposure to hazardous substances, such as appropriate work practices, emergency procedures and personal protective equipment to be used.
- Provide training in the details of the dental practice’s hazard-communication plan, including an explanation of the labeling system and safety data sheets and how employees can obtain and use the appropriate hazard information.
- Inform employees of their rights: (1) to personally receive information regarding hazardous substances to which they may be exposed, (2) for their physician to receive information regarding hazardous substances to which the employee may be exposed and (3) against discharge or other discrimination due to the employee’s exercise of the rights afforded pursuant to the provisions of the Hazardous Substances Information and Training Act.
Injury and Illness Prevention
- Provide training to all new employees and to all employees given new job assignments for which training has not been previously provided. Note location of exits, fire extinguisher (if one is available), eyewash station and first-aid kit. Note location of personal protective equipment and operations where they are required.
- Provide training whenever new substances, processes, procedures and equipment are introduced to the workplace and represent a new hazard and whenever the employer is made aware of a new or previously unrecognized hazard.
- Provide for supervisors to familiarize themselves with the safety and health hazards to which employees under their immediate direction and control may be exposed.
- Explain procedures for reporting employee injuries, potential hazards and unsafe work practices in the dental office.
- Explain the system for ensuring that employees comply with safe and healthy work practices. Substantial compliance with this requirement includes recognition of employees who follow safe and healthful work practices, training and retraining programs, disciplinary actions or any other such means that ensure employee compliance with safe and healthful work practices.
- Explain the procedure for screening patients with aerosol transmissible disease (ATD) and the policy that aerosol- generating dental procedures are not performed on a patient identified as presenting a possible ATD exposure risk unless a licensed physician determines that the patient does not currently have an ATD.
- Explain the system for communicating with employees on matters relating to occupational safety and health, including the meaning of the accident prevention signs and tags used on-site, provisions designed to encourage employees to inform the employer of hazards at the work site without fear of reprisal. Substantial compliance with this provision includes meetings, training programs, posting, written communications, a system of anonymous notification by employees about hazards, labor/management safety and health committees or any other means that ensure communication with employees.
- Explain procedures for identifying and evaluating workplace hazards including scheduled periodic inspections to identify unsafe conditions and work practices.
Fire Prevention and Emergency Action
- Identify potential fire hazards and ignition sources and review appropriate handling and storage procedures.
- Explain office and building evacuation procedures.
- Explain procedures for communicating an emergency situation to emergency responders.
- Explain procedures to follow during an earthquake.
Repetitive Motion Injury (RMI)
- Requirement to have a plan applies only to those businesses where a work-related repetitive motion injury occurred to more than one employee after July 3, 1997.
- Explain the dental practice’s RMI-prevention program.
- Explain the work exposures that have been associated with RMIs.
- Explain the symptoms and consequences of injuries caused by repetitive motion.
- Explain the importance of reporting symptoms and injuries to the employer.
- Explain methods used at the workplace to minimize RMIs.
Exposure Control (Bloodborne Pathogens)
Provide exposure-control training to an employee upon assignment to duties that potentially expose the employee to bloodborne pathogens, and then annually thereafter, according to Cal/OSHA. The training must include, at a minimum:
- A copy and explanation of the bloodborne pathogens regulation (§ CCR 5193).
- A general explanation of the epidemiology and symptoms of bloodborne diseases.
- An explanation of modes of transmission of bloodborne pathogens.
- An explanation of the employer’s exposure-control plan and the means by which the employee can obtain a copy of the written plan.
- An explanation of appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials (OPIM).
- An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, administrative or work practice controls and personal protective equipment.
- Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment.
- An explanation of the basis for selection of personal protective equipment.
- Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated and that the vaccine and vaccination will be offered free of charge.
- Information on appropriate actions to take and people to contact in an emergency involving blood or OPIM.
- An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident, the medical follow-up that will be made available and the procedure for recording the incident on the Sharps Injury Log.
- Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident.
- An explanation of the signs and labels and/or color-coding required.
- An opportunity for interactive questions and answers with the person conducting the training session.
Sexual Harassment Prevention Training
California employers of five or more employees must provide expanded training on sexual harassment prevention to all of their employees by Jan. 1, 2021. Practically speaking, this means employers will need to complete the mandatory one- or two-hour trainings for employees in 2020 to be compliant by the January 2021 deadline.
- Employers with at least five employees, in order to comply with the new requirements, must provide by Dec. 31, 2020: (1) at least two hours of sexual harassment prevention training to all managerial employees and (2) at least one hour of sexual harassment prevention training to all non-managerial employees.
- Both part-time and full-time employees must be trained.
- After the 2020 compliance requirements are met, employers must provide training every two years at minimum.
- Training must occur within six months of hire to a non-managerial position or promotion to a managerial position (including hiring) as applicable.
- Newly created businesses with five or more employees or contractors must provide training within six months of the business’ establishment and then every two years thereafter.
- Full-time, part-time, temporary employees, unpaid interns, unpaid volunteers, and independent contractors must be included toward the minimum count of five employees.
- The training may be conducted as a group presentation or on an individual basis and may be broken into shorter time segments as long as the two-hour requirement for managerial employees and one-hour requirement for non-managerial employees are met.
- Employees hired after Jan. I, 2021, who received training by a previous employer need only be required to read and acknowledge receipt of the employer’s anti-harassment policy within six months of assuming the new position. The burden of establishing that the prior training was legally compliant with this section is on the current employer.
Seasonal and temporary employee training
Employers should note that the SB 778 extension did not extend the January 1, 2020 training requirement that employers provide training for seasonal, temporary, or other employees hired to work for less than six months.
Beginning January 1, 2020, Employers must provide training to temporary and seasonal employees, or any employee who is hired to work for less than six months. The training must occur within 30 calendar days after the hire date or within 100 hours worked, whichever comes first. In the case of temporary employees employed by an agency (as defined in Section 201.3 of the Labor Code) to perform services for clients, the training must be provided by the agency, not the client.
In lieu of training, employers may obtain a copy of a temporary employee’s current certificate of prior training and track training from that date.
How do I know if my employee is considered a “supervisor” or “manager”?
As defined by Government Code sec. 12926(s)(t), “Supervisor” means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
Types of “effective interactive training”
The harassment prevention training must include information and practical guidance about federal and state sexual harassment laws, including harassment prevention and correction, and remedies that are available to victims. The training must also include a component on the prevention of “abusive conduct,” as well as a component on harassment based on gender identity, gender expression and sexual orientation.
Employers can hire third-party companies that are qualified to conduct training under DFEH regulations for either in-person or online training. Employers can satisfy this training by offering classroom training, e-learning or webinars. Before deciding to utilize a company, the employer should verify that its training meets the following requirements outlined below.
Classroom training: In-person classroom training that features content created by a trainer The employees receive the training from a trainer in a setting that is removed from the employees’ daily duties. California law in CCR sec. 11024(a)(9) specifically defines the credentials that a qualified trainer must possess.
E-learning: Individualized, interactive and computer-based training that was created by a trainer and an instructional designer. Employees must have the opportunity through a link or directions on how to to ask a trainer questions and receive a response within two business days of asking a question.
Webinar: An internet-based seminar that features content created and taught by a trainer and that is transmitted over the internet in real time. Employers who use a webinar for training must document that each employee who is not physically present in the same room as the trainer attended the training. They must also document that the employee actively participated in the training’s interactive content, discussion questions, hypothetical scenarios, polls, quizzes or tests and activities. Webinars must provide employees with the opportunity to ask questions and receive answers to those questions or otherwise seek guidance and assistance.
Large-group webinar: When using this type of training, the employer must comply with documentation procedures, including:
- An employer utilizing a webinar for its managerial or non-managerial employees must document and demonstrate each employee who was not physically present in the same room as the trainer attended the entire training and actively participated with the training’s interactive content, discussion questions, hypothetical scenarios, polls, quizzes or tests, and activities.
- The webinar must provide an opportunity for all employees to ask questions, to have them answered and otherwise to seek guidance and assistance.
- The employer shall maintain a copy of the webinar, all written materials used by the trainer and all written questions submitted during the webinar, and document all written responses or guidance the trainer provided during the webinar for a period of two years after the date of the webinar .
The regulations also authorize other effective, interactive training — including audio, video or other computer technology — but only if used along with, and as a supplement to, classroom, webinar or e-learning training.
A qualified trainer may be any of the following:
- Attorney’s admitted for two or more years to the bar of any state whose practice includes employment law under the FEHA and/or Title VII
- HR Professionals with two or more years of EEO experience (e.g. investigating complaints responding to DFEH/EEOC complains, etc.)
- Professors or instructor with post-graduate degree or teaching credential who are teaching about employment law under FEHA and/or Title VII
- Anyone who does not meet one of the above categories may team teach with another individual who meets the requirements.
The Department of Fair Employment and Housing must develop or obtain two online training courses on the prevention of sexual harassment in the workplace in accordance with the provisions of the law. Both courses must contain an interactive component that requires viewers to periodically answer questions in order for the course to continue to play. The DFEH published a new online resources webpage for California employers and expects to have such trainings available by late 2019.
After initial training, you may not need to retrain newly hired employees who received sexual harassment training from their previous employers within the prior two years. The regulations allow employers to accept an employee’s previous training as valid and to put that employee on a two-year tracking schedule based on his/her prior training date.
However, the new employer must prove that the prior training was sufficient and meets the legal requirements of mandatory training law. In addition, the supervisor must read and acknowledge receiving the current employer’s written anti-harassment policy within six months of being hired or promoted.
Patient Information Privacy
A health care provider that is a HIPAA-covered entity is required to have written policies and procedures to describe how it complies with federal and state information privacy laws. Such policies and procedures should address:
- Uses and disclosures of patient information that may be made with and without authorization.
- Patient rights and how to follow up on patient requests.
- Administrative, physical and technical safeguards for protecting patient information.
- Breach reporting and notification procedures.
At a minimum, a dental office may satisfy the training requirement by providing each employee and any individual considered part of the practice workforce (such as a regional occupational program student or independent contractor dental specialist) with a copy of the office’s written policies and procedures and collecting documentation that the individuals have reviewed the documents. Designated privacy and security officers, however, should be trained on what federal and state information privacy laws require since they are charged with developing and implementing the policies and procedures employees must follow.
A workforce member should be trained on the entity’s policies and procedures prior to handling patient information.
The frequency of privacy training thereafter is not mandated, however, it is recommended that training occur as often as necessary to ensure employees understand what they are required to do. Retraining is required if an employee is found to have violated a policy or failed to follow procedure.
There are two separate sets of laws for medical waste and for hazardous waste and, in many areas, two different regulatory agencies. Document employee training on the management of both waste streams. All employees in a dental office should receive training to ensure regulated waste is properly disposed. Training can be as simple as having employees review written documents that describe proper waste disposal. A local enforcement agency may require annual training.
A federal rule requiring the use of amalgam separators in most dental practices became effective in 2017. Local sanitation agencies enforce the federal rule and some of them may require dental practices to train employees on the proper operation of the separator and on proper waste disposal. Training frequency is specified in respective local wastewater discharge permits.
No agency requires a specific form to document employee training. Training documentation should include:
- Title and content summary.
- Date and location of training.
- Trainer and/or training documents.
- Printed name and signature of individual trained.
In addition to the above, specific documentation requirements for both trainers and employers are mandated for sexual harassment prevention e-learning and webinar training:
- E-learning: The trainer must maintain all written questions received and all written responses or guidance provided for a period of two years after the date of the response.
- Webinars: The employer must maintain a copy of the webinar, all written materials used by the trainer and all written questions submitted during the webinar. The employer must also document all written responses or guidance the trainer provided during the webinar.
Required retention period of training records does vary.
- Injury and illness prevention – one year, except for employees who worked less than one year.
- Bloodborne pathogens/exposure control – three years from the date of training.
- HIPAA – six years from the date of training.
- Sexual harassment – two years from the date of training.
- Waste management and amalgam separator – follow applicable local rule.
Dental Board-Required Infection-Control C.E. vs. Cal/OSHA Bloodborne Pathogens Training
Both Cal/OSHA and the Dental Board of California have regulations governing infection-control practices in dental settings. The dental board requires licensed professionals to take two hours of infection-control training every license-renewal period. The training should include at a minimum a discussion of the dental board’s infection-control regulations. A dental board- registered continuing-education provider must provide training. The training course must be approved by the dental board.
Cal/OSHA requires employers to provide bloodborne pathogens training to occupationally exposed employees upon hire and at least annually thereafter. (Refer to your Exposure Control Plan to identify occupationally exposed employees.) Although there is no minimum time requirement, the training must include the 14 elements listed above. A person knowledgeable in the subject as it relates to the workplace must provide the training.
The dental board infection-control course and the Cal/OSHA bloodborne pathogens training are typically provided as separate programs. It is possible to combine the two programs into one educational offering because they cover similar subjects. A combined training program must be at least two hours in length, be approved by the dental board and be provided by a dental board-registered continuing-education provider who is knowledgeable in bloodborne pathogens and infection control as they relate to a dental-practice setting. (You can check registered providers on the Department of Consumer Affairs License Search website. If employees get infection-control training outside the office, specific office infection-control policies and procedures should be reviewed in the office. The combined course must review the dental board infection-control regulations and include the elements mandated by Cal/OSHA and listed above.