Medical Center Hazard and Vulnerability Analysis INSTRUCTIONS: Evaluate potential for event and response among the following categories using the hazard specific scale. Issues to consider for probability include, but are not limited to: 1 Known risk 2 Historical data 3 Manufacturer/vendor statistics Issues to consider for response include, but are not limited to: 1 Time to marshal an on-scene response 2 Scope of response capability 3 Historical evaluation of response success Issues to consider for human impact include, but are not limited to: 1 Potential for staff death or injury 2 Potential for patient death or injury Issues to consider for property impact include, but are not limited to: 1 Cost to replace 2 Cost to set up temporary replacement 3 Cost to repair Issues to consider for business impact include, but are not limited to: 1 Business interruption 2 Employees unable to report to work 3 Customers unable to reach facility 4 Company in violation of contractual agreements 5 Imposition of fines and penalties or legal costs 6 Interruption of critical supplies 7 Interruption of product distribution Issues to consider for preparedness include, but are not limited to: 1 Status of current plans 2 Training status 3 Insurance 4 Availability of back-up systems 5 Community resources Issues to consider for internal resources include, but are not limited to: 1 Types of supplies on hand 2 Volume of supplies on hand 3 Staff availability 4 Coordination with MOB's Issues to consider for external resources include, but are not limited to: 1 Types of agreements with community agencies 2 Coordination with local and state agencies 3 Coordination with proximal health care facilities 4 Coordination with treatment specific facilities
Complete all worksheets including Natural, Technological, Human and Hazmat. The summ section will automatically provide your specific and overall relative threat.
365192850.xls
Instruksi : Evaluasi potensi kejadian dan respons dari kategori dibawah
Masalah terkait Probabilitas : 1. Risk yang sdh dikenal 2. Data historis 3. Statistik dari Pabrik/ vendor Masalah terkait respons : 1. Waktu utk respons petugas sampai di lokasi 2. Ruang lingkup kemampuan respons 3. Evaluasi riwayat keberhasilan respons Masalah terkait dampak thd manusia : 1. Potensi terjadi kematian/ cedera petugas 2. Potensi terjadi kematian pasien Masalah terkait dsampak pada harta : 1. Biaya utk mengganti 2. Biaya utk menyiapkan tempat kegiatan sementara 3. Biaya utk memperbaiki Masalah terkait dampak thd usaha : 1. Terhentinya kegiatan 2. Pegawai gak bisa datang ketempat kerja 3. Pelanggan tidak bisa mendatangi tempat usaha 4. Perusahaan melanggar kontrak 5. Biaya hukum atau membayar denda 6. Terganggunya pasokan penting 7. Terganggunya distribusi produk Masalah terkait kesiap siagaan : 1. Kondisi Rencana yang disiapkan 2. Kondisi Pelatihan 3. Asuransi 4. Kesiapan sistem pendukung/ back up 5. Sumber daya lingkungan Masalah terkait sumber daya internal : 1. Jenis Persedian yang ada di RS 2. Jumlah persediaan yang ada di RS 3. Kesiapan/keberadaan staf/petugas 4. Koordinasi penanganan kedaruratan Masalah terkait sumber daya eksternal : 1. Jenis kerjasama dengan badan di masyarakat sekitar 2. Koordinasi dengan badan lokal dan propinsi 3.iKoordinasi dengan fasilitas kesehatan diatas 4. Koordinasi dengan fasilitas kesehatan khusus
Lengkapi seluruh lembar diatas termasuk Natural,Teknologi,Human dan Hazmat Ringkasan secara otomatis akan muncul sebagai ancaman menyeluruh
365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
2
3
3
3
3
3
2
63%
2 Banjir
2
3
0
0
1
2
2
30%
3 Kebakaran 4 Angin Badai
1
3
3
3
3
2
2
30%
1
3
2
2
3
3
2
28%
5 Tanah Longsor
1
3
0
0
1
3
2
17%
6 Wabah
1
3
0
0
1
3
2
17%
7 Kekeringan
1
3
0
0
0
0
0
6%
8 Gunung Meletus
0
3
0
0
0
3
2
0%
0
3
0
0
0
0
0
0%
0
0
0
0
0
0
0.44
1.50
0.31
0.31
0.56
1.00
EVENT
SCORE
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
RISK
Relative threat*
0 - 100%
1 Gempa Bumi
9 Tsunami 10 AVERAGE SCORE
0% 0.75
4%
*Threat increases with percentage. 7 RISK = PROBABILITY * SEVERITY 71 0.04 0.15 0.25
Natural Hazards (2) : 365192850.xls
67% 63% 48% 44% 37% 30% 30% 28% 26% 24% 22% 22% 22% 20% 20% 20% 20% 20% 19% 19% 19% 17% 17% 17% 17% 15% 11% 7% 6% 6% 0% 0%
Trauma Gempa Bumi Kegagalan Genset
Infeksi Kegagalan Sistem Informasi
Banjir Kebakaran Angin Badai Kegagalan Alrm Kebakaran Kebakaran Internal Kegagalan Listrik Kekurangan Pasokan
Terorisme Kekuranga Air Kegagalan Gas Medis Ledakan Bahan Berbahaya (B3)
Huru hara Ledakan bahan kimia Kegagalan Komunikasi
Bentrok Antar Golongan Situasi Penyaderaan Tanah Longsor Wabah Kekurangan Bahan Bakar
Penculikan Bayi di RS Kegagalan Transportasi Tumpahan Bahan Berbahaya Skala Besar Paparan Radiasi
Kekeringan Tumpahan Bahan Berbahaya Skala Kecil
Gunung Meletus Tsunami
HAZMAT Human Hazzard Tech Hazzard Natural Hazzard
HUMAN HAZZARD NATURAL HAZZARD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD TECHNOLOGICAL HAZZARAD NATURAL HAZZARD NATURAL HAZZARD NATURAL HAZZARD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD HAZARDOUS MATERIALS TECHNOLOGICAL HAZZARAD HUMAN HAZZARD HUMAN HAZZARD NATURAL HAZZARD NATURAL HAZZARD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD TECHNOLOGICAL HAZZARAD HAZARDOUS MATERIALS HAZARDOUS MATERIALS NATURAL HAZZARD HAZARDOUS MATERIALS NATURAL HAZZARD NATURAL HAZZARD
HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS
SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
Hurricane
0
0
0
0
0
0
0
0%
EVENT
SCORE
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
RISK
Relative threat*
0 - 100%
Tornado
0
0
0
0
0
0
0
0%
Severe Thunderstorm
0
0
0
0
0
0
0
0%
Snow Fall
0
0
0
0
0
0
0
0%
Blizzard
0
0
0
0
0
0
0
0%
Ice Storm
0
0
0
0
0
0
0
0%
Earthquake
0
0
0
0
0
0
0
0%
Tidal Wave
0
0
0
0
0
0
0
0%
Temperature Extremes
0
0
0
0
0
0
0
0%
Drought
0
0
0
0
0
0
0
0%
Flood, External
0
0
0
0
0
0
0
0%
Wild Fire
0
0
0
0
0
0
0
0%
Landslide
0
0
0
0
0
0
0
0%
Dam Inundation
0
0
0
0
0
0
0
0%
Volcano
0
0
0
0
0
0
0
0%
Epidemic
0
0
0
0
0
0
0
0%
AVERAGE SCORE
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0%
*Threat increases with percentage. 0 0
RISK = PROBABILITY * SEVERITY 0.00
0.00
0.00 Natural Hazards : 365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS SEVERITY = (MAGNITUDE - MITIGATION) EVENT
PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
SCORE
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
RISK
Relative threat*
0 - 100%
Kegagalan Genset Kegagalan Sistem Informasi Kegagalan Alrm Kebakaran
2 2 1
3 1 3
1 1 1
3 3 3
2 2 3
2 1 2
2 2 2
48% 37% 26%
Kebakaran Internal
1
3
3
2
2
1
2
24%
Kegagalan Listrik Kekurangan Pasokan
1 1
3 3
1 1
3 3
1 2
2 1
2 2
22% 22%
Kekuranga Air
1
2
1
3
2
1
2
20%
Kegagalan Gas Medis
1
3
1
2
2
1
2
20%
9 10 11
Ledakan Bahan Berbahaya (B3)
1
3
1
2
2
1
2
20%
Kegagalan Komunikasi Kekurangan Bahan Bakar
1 1
1 1
1 1
2 2
2 2
2 1
2 2
19% 17%
12 13
Kegagalan Transportasi
1
1
1
2
1
1
2
15%
1
2 3 4 5 6 7 8
Petir
0% AVERAGE SCORE
*Threat increases with percentage. 12 121
0.63
1.26
0.68
1.42
1.11
0.74
1.16
7%
RISK = PROBABILITY * SEVERITY 0.07 0.21 0.35
Technological Hazards (2) : 365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS SEVERITY = (MAGNITUDE - MITIGATION) EVENT
SCORE
PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
RISK
Relative threat*
0 - 100%
Electrical Failure Generator Failure
0% 0%
Transportation Failure
0%
Fuel Shortage Natural Gas Failure
0% 0%
Water Failure
0%
Sewer Failure
0%
Steam Failure
0%
Fire Alarm Failure Communications Failure
0% 0%
Medical Gas Failure
0%
Medical Vacuum Failure HVAC Failure
0% 0%
Information Systems Failure
0%
Fire, Internal
0%
Flood, Internal
0%
Hazmat Exposure, Internal
0%
Supply Shortage
0%
Structural Damage
0%
AVERAGE SCORE
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0%
*Threat increases with percentage. 0 0
RISK = PROBABILITY * SEVERITY 0.00
0.00
0.00
Technological Hazards : 365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL HUMAN RELATED EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 1 = Low 2= Moderate 3 = High
EVENT
SCORE
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
RISK
Relative threat*
0 - 100%
1 2 3
Trauma Infeksi Terorisme
3 2 1
3 3 2
1 1 2
3 3 1
2 2 3
1 1 2
2 2 2
67% 44% 22%
4
Huru hara
1
2
2
1
2
2
2
20%
1
1
1
1
3
2
2
19%
1
1
1
1
3
2
2
19%
1
2
0
3
1
1
2
17%
1.00
1.40
0.80
1.30
1.60
1.10
1.40
14%
5 6 7
Bentrok Antar Golongan Situasi Penyaderaan Penculikan Bayi di RS
AVERAGE
*Threat increases with percentage. 10
RISK = PROBABILITY * SEVERITY
76
0.14
0.33
0.42
Human Hazards : 365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL EVENTS INVOLVING HAZARDOUS MATERIALS SEVERITY = (MAGNITUDE - MITIGATION) EVENT
SCORE
Ledakan bahan kimia Tumpahan Bahan Berbahaya Skala Besar Paparan Radiasi Tumpahan Bahan Berbahaya Skala Kecil AVERAGE
PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
Relative threat*
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 - 100%
1
3
2
2
3
1
0
20%
1
2
1
1
1
1
0
11%
1
3
0
0
1
0
0
7%
1
1
0
0
1
1
0
6%
0.44
1.00
0.33
0.33
0.67
0.33
0.00
2%
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
RISK
*Threat increases with percentage. 4 24
RISK = PROBABILITY * SEVERITY 0.02
0.15
0.15
Hazardous Materials (2) : 365192850.xls
HAZARD AND VULNERABILITY ASSESSMENT TOOL EVENTS INVOLVING HAZARDOUS MATERIALS SEVERITY = (MAGNITUDE - MITIGATION) EVENT
SCORE
PROBABILITY
HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPAREDNESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
Preplanning
Time, effectivness, resouces
Community/ Mutual Aid staff and supplies
Relative threat*
0 = N/A 1 = Low 2= Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 = N/A 1 = High 2 = Moderate 3 = Low or none
0 - 100%
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 0 = N/A 1 = Low 1 = High 2 = Moderate 2 = Moderate 3 = High 3 = Low or none
RISK
Mass Casualty Hazmat Incident (From
0
0
0
0
0
0
0
0%
Small Casualty Hazmat Incident (From
0
0
0
0
0
0
0
0%
Chemical Exposure, External
0
0
0
0
0
0
0
0%
0
0
0
0
0
0
0
0%
0
0
0
0
0
0
0
0%
0
0
0
0
0
0
0
0%
Radiologic Exposure, Internal
0
0
0
0
0
0
0
0%
Radiologic Exposure, External
0
0
0
0
0
0
0
0%
0
0
0
0
0
0
0
0%
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0%
historic events at your MC with >= 5 victims)
historic events at your MC with < 5 victims)
Small-Medium Sized Internal Spill Large Internal Spill Terrorism, Chemical
Terrorism, Radiologic AVERAGE
*Threat increases with percentage. 0 0
RISK = PROBABILITY * SEVERITY 0.00
0.00
0.00
Hazardous Materials : 365192850.xls
Natural
Technological
Human
Hazmat
Total for Facility
SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS
Probability
0.15
0.21
0.33
0.15
0.06
Severity
0.25
0.35
0.42
0.15
0.08
0.04
0.07
0.14
0.02
0.00
Relative T h reat to F acility
Hazard Specific Relative Risk:
Hazard Specific Relative Risk to Medical Center 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00
Relative Impact on Facility
Natural
Technological
Human
Hazmat
Probability and Severity of Hazards to Medical Center 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Probability
Severity
365192850.xls Summary
TIM KESELAMATAN & KESEHATAN KERJA ( K3 ) RUMAH SAKIT ………………..
HVA - PRIORITAS MASALAH No Kejadian 1 Trauma 2 Gempa Bumi Kegagalan Genset 3 4 Infeksi 5 6 7 8 9 10 11 12 13 14 15 16
Kegagalan Sistem Informasi
Banjir Kebakaran Angin Badai Kegagalan Alrm Kebakaran Kebakaran Internal Kegagalan Listrik Kekurangan Pasokan
Terorisme Kekuranga Air Kegagalan Gas Medis Ledakan Bahan Berbahaya (B3)
17 18 19
Huru hara
20
Bentrok Antar Golongan
Ledakan bahan kimia Kegagalan Komunikasi
21 Situasi Penyaderaan 22 Tanah Longsor 23 Wabah 24
Kekurangan Bahan Bakar
25 26
Penculikan Bayi di RS
27
Kegagalan Transportasi Tumpahan Bahan Berbahaya Skala Besar Paparan Radiasi
28 29 Kekeringan 30
Tumpahan Bahan Berbahaya Skala Kecil
31 Gunung Meletus 32 Tsunami
% Rencana Tindak Lanjut 67% 63% 48% 44%
KETERANGAN HUMAN HAZZARD NATURAL HAZZARD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD
37% 30% 30% 28%
TECHNOLOGICAL HAZZARAD NATURAL HAZZARD NATURAL HAZZARD NATURAL HAZZARD
26% 24% 22% 22% 22% 20% 20%
TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD HUMAN HAZZARD TECHNOLOGICAL HAZZARAD TECHNOLOGICAL HAZZARAD
20% 20% 20% 19%
TECHNOLOGICAL HAZZARAD HUMAN HAZZARD HAZARDOUS MATERIALS TECHNOLOGICAL HAZZARAD
19% 19% 17% 17%
HUMAN HAZZARD HUMAN HAZZARD NATURAL HAZZARD NATURAL HAZZARD
17% 17% 15%
TECHNOLOGICAL HAZZARAD HUMAN HAZZARD TECHNOLOGICAL HAZZARAD
11% 7% 6%
HAZARDOUS MATERIALS HAZARDOUS MATERIALS NATURAL HAZZARD
6% 0% 0%
HAZARDOUS MATERIALS NATURAL HAZZARD NATURAL HAZZARD
