HIRA.pptx

 What hazards exist in or near by your work
place?
 How frequently do these hazards occur?
 How much damage can they cause?
 Which hazards pose the greatest threat?

 A HIRA is a risk assessment tool that can be
used to assess which hazards pose the
greatest risk in terms of how likely they are to
occur and how great their potential impact
may be. It is not intended to be used as a
prediction tool to determine which hazard
will cause the next emergency.

 Help you to prepare for the worst and/or
most likely hazards.
 Save time by isolating any hazards which can
not affect your community.
 Allows for the creation of emergency plans,
exercises and training based on the most
likely and/or highest risk scenarios.
 Helps your program to become proactive
rather than just reactive.

 GENERAL WORK ENVIRONMENT
 PERSONAL PROTECTIVE EQUIPMENT
 WALKWAYS
 FLOOR AND WALL STAIRWAYS
 STAIRS & STAIRWAYS
 ELEVATED SURFACES
 EXITING OR EGRESS
 EXIT DOORS
 PORTABLE LADDERS
 HAND TOOLS & EQUIPMENT
 PORTABLE (POWER OPERATED) TOOLS
& EQUIPMENT

LIST OF RISK CATEGORY…
Sr.
No.
Risk Categories Definitions
1 Physician Strategy and
Relations
Risks associated with doctor engagement model including attracting and retaining
experienced panel of physicians for hospital operations.
2 Medical Services Risks associated with a multidisciplinary approach to acute care, speciality care,
diagnostic and investigations and wellness program. This includes risks related to
inadequate facilities and inaccurate treatment of an ailment in each of the service
areas.
3 Service Excellence Risks associated with adequate infrastructure to support patient services, patient
satisfaction and care for IP, OP and International Patients
4 Quality and Accreditations Risk associated with infection control, physician licensing and credentialing,
medicare documentation and reporting, clinical standards and practices, emergency
procedures, clinical audits etc.
5 Health & Safety Risks associated with environment pollution, safety of resources and employees’
health and security at health care establishments
6 Nursing Operations Risks related to the adequacy of policies and procedures related to nursing
operations and maintain continuous care.
7 Facilities & Equipments Risks associated with inadequacy or failure of facilities and equipment for
delivery of care.
8 Pharmacy Risks associated with operation of pharmacy and delivery of pharmaceutical
products to hospital units and out patients.
9 Human Resource Risks associated with culture, organisational structure, communication, recruitment,
performance management, remuneration, learning & development, retention,
Occupational Health & Safety and industrial relations, including supporting systems,
processes and procedures.
10 Information Technology The risk that systems are inadequately managed or controlled, data integrity,
reliability may not be ensured, inadequate vendor performance and monitoring,
system or network architecture not supporting medium or long term business
initiatives and strategy, capacity planning not being reviewed on a regular basis

LIST OF RISK CATEGORY…
Sr.
No.
Risk Categories Definitions
11 Marketing/Business
Development
Risks associated with customer sources, competition, brand management &
brand licensing and reputation of the company.
12 Finance Risks related to liquidity /treasury operations, relationship management with
lenders, management of cash, billing and claims processing, customer credit
risks, receivables management inadequacy of controls and lack of adequate
monitoring leading to higher
risks of frauds.
13 Legal and Compliance Risk relating to non-compliance with legislations including direct & indirect
tax law provisions, adequacy of financial reporting & disclosures,
regulations, internal policies and procedures.
14 Supply Chain Risks associated with sourcing and vendor management.
15 Planning and Strategy Risks associated with strategy development, strategic alliances, business
planning, business mix, performance targets, failure to align functional strategies
and objectives with enterprise-wide strategies. Risks related to improper capital
structuring and funding.
16 Corporate Governance The risks associated with board and board procedures including risk oversight,
internal controls, CSR, stakeholder relations including investor relations etc.
17 Corporate/External
communication
Risks associated with appropriateness/adequacy of external communication &
PR
18 Market/Environmental
impact assessment
Risks associated with changing consumer/business trends/technological shifts
affecting all aspects of business and adequacy of assessment of such risks

Type of incident
Falls
Injuries other than falls (e.g. burns, pressure injuries, physical assault, self-harm)
Medication errors (e.g. omission, overdose, underdose, wrong route, wrong medication)
Clinical process problems (e.g. wrong diagnosis, inappropriate treatment, poor care)
Equipment problems (e.g. unavailable, inappropriate, poor design, misuse, failure, malfunction)
Documentation problems (e.g. inadequate, incorrect, not completed, out of date, unclear)
Hazardous environment (e.g. contamination, inadequate cleaning or sterilization)
Inadequate resources (e.g. staff absent, unavailable, inexperienced, poor orientation)
Logistic problems (e.g. problems with admission, treatment, transport, response to emergency)
Administrative problems (e.g. inadequate supervision, lack of resource, poor management decisions)
Infusion problems (e.g. omission, wrong rate)
Infrastructure problems (e.g. power failure, insufficient beds)
Nutrition problems (e.g. fed when fasting, wrong food, food contaminated, problems when ordering)
Colloid or blood product problems (e.g. omission, underdose, overdose, storage problems)
Oxygen problems (e.g. omission, overdose, underdose, premature cessation, failure of supply)

Hazard Identification
 In this step the hazards that could impact your department / Hospital
are separated.
 This requires a review of all hazards and their causes to determine
whether they may be a threat to your department / Hospital.
 This may require the consultation of historical records and
government bodies

Risk Assessment
 In this step the level of risk for each hazard is examined. This may
involve speaking with hazard experts, researching past occurrences
and possible scenarios.
 The likelihood of the hazard occurring and the potential impacts of
the hazard on people, property, the environment, business and
finance and critical infrastructure should be examined.
 Risk assessment is the combined process of Risk Analysis and
Risk Evaluation.

Risk Analysis
 The information collected in the risk assessment step will be
analyzed in this step.
 The desired outcome of the risk analysis is the ranking of the
hazards.
 This highlights the hazards that should be considered a current
priority for your emergency management program.

 A systematic approach for describing and/or calculating risk.
 Consequence analysis determines the damage to life and property
based on:
 frequency of occurrence
 risk of fatality to employees
 individual risk-risk of fatality to patients/ visitors/ attenders
 Risk analysis involves the identification of undesired events, and the
causes and consequences of these events.
 Risk assessment is a proactive accident prevention technique.
 The process of determining how often specified events may occur
(likelihood) and the magnitude of their consequences (impact).

 The process used to determine Risk Management
priorities by comparing the level of risk against
predetermined standards, target risk levels or other
criteria, to generate a prioritized list of risk for
further monitoring and mitigation.

Monitor and Review
 It is important to remember that a HIRA is an ongoing process and
hazards and their associated risks must be monitored and reviewed.


 The first step in this process is to identify all
possible hazards


Blizzard/Snowstorm
Contamination – Food
Contamination – Water
Earthquake
Extreme Cold
Extreme Heat
Flood – External
Geomagnetic Storm
Hurricane
Ice Storm/Freezing Rain
Infectious Disease – Internal
Pandemic/Epidemic – External
Severe Summer Storm
Severe Winds
Soil Subsidence
Tornado

BombThreat
Child
Abduction
Civil Disorder
Computer
Virus/Cyber
Attack
Hostage
Incident
Labour
Disruption
Mass Casualty
Incident
Missing
Patient
Serious
Adverse Event
Terrorism
Violent Person
– Patient
Violent Person
– Non‐patient
Violent Person
– Active
Shooter
War
Workplace
Injury

Electrical Failure ‐
Primary
Electrical Failure –
Secondary
(Generator)
Electrical Failure –
Total
Fire System Failure
Flood ‐ Internal Fuel Supply Failure HVAC Failure IT Failure
Medical Gas Failure Sewage Failure Steam Failure
Supply Chain
Disruption
Telecommunications
Failure
Water Supply Failure

Natural Hazards Technological Hazards
Agricultural and Food Emergency Building/Structural Collapse
- Farm Animal Disease Critical Infrastructure Failure
- Food Emergency Dam Failure
- Plant Disease and Pest Infestation Energy Emergency (Supply)
Drinking Water Emergency Explosion/Fire
Drought/Low Water Hazardous Materials Incident/Spills
Earthquake - Fixed Site Incident
Erosion - Transportation Incident
Extreme Temperatures Human-Made Space Object Crash
- Heat Wave Mine Emergency
- Cold Wave Nuclear Facility Emergency
Flood Oil/Natural Gas Emergency
- Riverine Flood Radiological Emergency
- Seiche Transportation Emergency
- Storm Surge - Air Emergency
- Urban Flood - Marine Emergency
Fog - Rail Emergency
Forest/Wildland Fire - Road Emergency
Freezing Rain Human-Caused Hazards
Geomagnetic Storm Civil Disorder
Hail Cyber Attack
Human Health Emergency Sabotage
- Epidemic Special Event
- Pandemic Terrorism/CBRNE
Hurricane War and International Emergency
Land Subsidence Other:
Landslide Other:
Lightning Other:
Natural Space Object Crash Other:
Snowstorm/Blizzard Other:
Tornado Other:
Step One:
Hazard
Identification
Worksheet
This is a starting
point in
identifying
hazards

 Risk = [Likelihood] x [Sum of Consequences]

 Second, each hazard was scored based on the
relative risk it posed. The risk score was a
combination of two dimensions: likelihood
and consequence.
 Consequence was further broken down into
the potential impacts on people, property,
finances, and reputation.

 Likelihood: Likelihood provides a standardized view of how often a
given hazard event may occur, either in the hospital or its community.
The ranking scale is from 1-5, with 1 being the
lowest possible rank and 5 being the highest.
 Consequence is defined as the anticipated impact from a given event in a
worst-case scenario. Consequences can be broken down into four aspects.
They are
 human impact
 physical/infrastructure impact
 financial impact
 damage to reputation.

 Human Impact: The cost of a given event in human terms; li
ves lost and people injured.
 Physical Impact: The cost of a given event in terms of loss
of the use of hospital property or
equipment, whether destroyed, damaged, or requiring clean-up.
 Financial Impact: The cost of the impact of a given event in terms of
dollar cost, whether for repair/replacement or for unbudgeted
incident response costs.
 Reputation Damage: The cost of the impact of a given event in
terms of damage to corporate or facility reputation. While often
overlooked in such exercises, the impacts can affect patient census,
staff recruitment, funding, and fundraising efforts.

Likelihood:
 1 = Unlikely to occur
 2 = May occur once in a 100 year period
 5 = May occur multiple times in a 1 year period
Human Impact:
 1 = Injury or illness to patients/staff unlikely
 2 = Low probability of injuries or illness
 3 = High probability of injuries or illness
 4 = High probability of injuries or illness and low probability of
death
 5 = High probability of injuries or illness and high probability of
death
Physical Impact:
 1 = Property damage or loss of access unlikely
 2 = Minor clean‐up or recovery time
 3 = Minor damage or temporary loss of access
 4 = Major damage or prolonged loss of access
 5 = Indefinite loss of access or rebuild required
Financial Impact:
 1 = Negligible financial impact
 2 = Expenditures or insurance claims under
Rs.50,000
 3 = Expenditures or insurance claims under Rs.
1,00,000
 4 = Expenditures or insurance claims under Rs.
10,00,000
 5 = Expenditures or insurance claims over Rs.
10,00,000 million
Reputation Impact:
 1 = Reputation unlikely to be affected
 2 = Limited negative local media coverage or public
stigma
 3 = Negative regional media coverage and strong
public stigma
 4 = Negative national media coverage, fundraising
or recruitment affected
 5 = Long‐term negative association with hospital,
large fundraising/recruitment impact

Level of Risk Description
< 10 Very Low
11 - 20 Low
21 - 30 Moderate
31 - 40 High
41 - 50 Very High
>50 Extreme
Prioritization Worksheet
Once you have calculated the risk for the hazards, you may wish to group them based on their level of risk using the table below. This is
particularly useful if you have several hazards with the same risk values.
Enter your hazards into the work sheet below according to their risk which you calculated from the Risk Analysis Worksheet.

 The full rankings of each hazard by both
likelihood and consequence are as follows:
 The results shall be summarized in the
following tables according to three different
risk classifications: High, Moderate, and Low
Preparedness Priorities.
 For eg: infrastructure failure is the most likely
hazard while technological hazards pose the
highest consequences.

• High Preparedness Priorities (Top 10; scores 36 – 100): with both a high likelihood of
occurrence and high potential impact on the hospital. High preparedness priorities are
hazards that are candidates for immediate mitigation and preparedness efforts to reduce
the likelihood or consequences of occurrence. Possible risk reduction measures include
physical fortification, redundant pathways, staff training, and acquisition of response
resources.
•
• Moderate Preparedness Priorities (scores 26 – 35): Events with either a high
likelihood of occurrence and low magnitude of impact, or low likelihood but high
consequence. Such potential risk exposures should be addressed in terms of
mitigation and preparedness activities, after high priority events, as time and resources
become available.
•
• Low Preparedness Priorities (scores 4 – 25): Events with a low incidence of occurrence and
low potential impact, or events which have already received substantial mitigation and
preparedness efforts. These events should be monitored for changes in frequency or
consequence, but do not require immediate action otherwise.
•
It should be noted that these results do not necessarily take into account mitigation
and preparedness efforts that are already underway. In some cases, sufficient
measures may already be in place. This should be considered when interpreting results.

NATURAL HAZARDS Likelihood
Score
Consequence Components Total
Risk
Human Physical Financial Reputation
blizzard/snowstorm 4 2 2 2 1 28
contamination – food 3 4 2 3 3 36
contamination – water 3 5 2 3 3 39
earthquake 1 2 3 3 2 10
extreme cold 5 3 1 1 1 30
extreme heat 5 3 1 2 1 35
flood – external 2 2 3 3 3 22
geomagnetic storm 2 1 2 3 2 16
hurricane 2 2 3 3 1 18
ice storm 4 2 3 2 1 32
infectious disease – internal 4 4 1 3 3 44
pandemic/epidemic – external 4 5 2 4 4 60
severe summer storm 4 2 2 2 1 28
severe winds 3 2 3 2 1 24
soil subsidence 1 1 4 4 3 12
tornado 2 4 4 4 2 28

TECHNOLOGICAL HAZARDS Likelihood
Score
Risk
air/space object crash 1 5 5 5 4 19
fire/explosion – external 2 2 3 3 3 22
hazardous materials – external 3 3 3 3 3 36
hazardous materials – internal 3 2 4 2 2 30
nuclear plant fallout 1 3 3 4 3 13
pipeline explosion 2 2 3 3 2 20
fire incident – minor 4 2 2 1 2 28
structural collapse 1 4 4 4 4 16
transportation accident 3 3 3 2 2 30
fire/explosion – internal 2 5 4 4 3 32

HUMAN-CAUSE HAZARDS
Likelihood
Score
Risk
bomb threat 2 2 3 2 3 20
child abduction 3 2 2 2 4 30
civil disorder 2 2 2 2 3 18
computer virus/cyber attack 3 1 3 4 4 36
hostage incident 2 3 3 2 3 22
labour disruption 2 2 2 3 4 22
mass casualty incident 3 4 1 3 2 30
missing patient 5 2 1 1 2 30
serious adverse event 3 3 1 3 4 33
terrorism 1 5 5 5 4 19
violence– patient 5 2 1 2 1 30
violence – non‐patient 3 3 2 1 2 24
violence – active shooter 2 5 2 1 4 24
war 1 2 1 1 1 5
workplace injury 4 2 1 2 2 28

INFRASTRUCTURE
HAZARDS
Likelihood
Score
Risk
electrical failure – primary 5 2 3 2 1 40
electrical failure – secondary 3 2 2 3 1 24
electrical failure – total 2 4 4 3 4 30
fire system failure 4 1 2 2 2 28
flood – internal 3 2 4 3 2 33
fuel supply failure 3 2 3 3 3 33
HVAC failure 4 2 2 2 3 36
IT failure 4 2 3 2 2 36
medical gas failure 3 3 3 2 2 30
sewer failure 2 3 4 3 3 26
steam failure 2 2 3 2 2 18
supply chain disruption 4 2 2 2 2 32
telecommunications failure 3 2 2 2 3 27
water supply disruption 3 3 3 3 3 36

High Preparedness Priorities
Pandemic / Epidemic – External 60 Contamination – Food 36
Infectious Disease – Internal) 44 Hazardous Materials – External 36
Electrical Failure – Primary 40 HVAC Failure 36
Contamination – Water 39 IT Failure 36
Computer Virus / Cyber Attack 36 Water Supply Disruption 36

Moderate Preparedness Priorities
Extreme heat 35 Medical Gas Failure 30
Flood – Internal 33 Missing Patient 30
Fuel Supply Failure 33 Transportation Accident 30
Serious Adverse Event 33 Violent Behaviour – Patient 30
Ice Storm / Freezing Rain 32 Blizzard / Snowstorm 28
Fire / Explosion – Internal 32 Severe Summer Storm 28
Supply Chain Disruption 32 Tornado 28
Child Abduction 30 Workplace Injury 28
Electrical Failure – Total 30 Fire Incident – Minor 28
Extreme Cold 30 Fire System Failure 28
Hazardous Materials – Internal 30 Telecommunications Failure 27
Mass Casualty Incident 30 Sewer Failure 26
Low Preparedness Priorities
Electrical Failure – Secondary 24 Air / Space Object Crash 19
Severe Winds 24 Civil Disorder 18
Violent Person – Non‐Patient 24 Hurricane 18
Violent Person – Active Shooter 24 Steam Failure 18
Fire / Explosion – External 22 Geomagnetic Storm 16
Flood – External 22 Structural Collapse 16
Hostage Incident 22 Nuclear Plant Fallout 13
Labour Disruption 22 Soil Subsidence 12
Bomb Threat 20 Earthquake 10
Pipeline Explosion 20 War 5
Terrorism 19

HAZARDS NO HAZARD HAZARD LEVEL OBSERVATION
LOW AVERAGE HIGH
HUMAN CAUSE HAZARD
BOMB THREAT
CIVIL DISORDER
CHILD ABDUCTION
COMPUTER VIRUS/CYBER ATTACK
HOSTAGE INCIDENT
LABOUR DISRUPTION
MASS CASUALTY INCIDENT
MISSING PATIENT
SERIOUS ADVERSE EVENT
TERRORISM
VIOLENCE– PATIENT & ATTENDER
WORKPLACE INJURY
INFRASTRUCTURE HAZARDS
ELECTRICAL FAILURE
FIRE SYSTEM FAILURE
FLOOD – INTERNAL
FUEL SUPPLY FAILURE
HVAC FAILURE
IT FAILURE
MEDICAL GAS FAILURE
SEWER FAILURE
STEAM FAILURE
SUPPLY CHAIN DISRUPTION
TELECOMMUNICATIONS FAILURE
WATER SUPPLY DISRUPTION
HAZARD IDENTIFICATION & RISK ANALYSIS- CLINICAL AREAS

CLINICAL RISK ASSESSMENT
PARAMETERS PROBABILITY OF RISK PROBABILITY OF EFFECT
LOW MEDIUM HIGH LOW MEDIUM HIGH
Medication errors (e.g. omission,
overdose, under dose, wrong route, wrong
medication)
Patient allergies
Antibiotic Resistance
Injury risk
Risk due to food drug interaction
Risk due to drug-drug interaction
Risk due to Administration error
Lack of patient care
Improper SBAR handover
Equipment breakdown
Injuries other than falls (e.g. burns,
pressure injuries, physical assault, self-
harm)
Clinical process problems (e.g. wrong
diagnosis, inappropriate treatment, poor
care)

CLINICAL RISK ASSESSMENT
PARAMETERS PROBABILITY OF RISK PROBABILITY OF EFFECT
LOW MEDIUM HIGH LOW MEDIUM HIGH
Equipment problems (e.g. unavailable, inappropriate,
poor design, misuse, failure, malfunction)
Documentation problems (e.g. inadequate, incorrect,
not completed, out of date, unclear)
Hazardous environment (e.g. contamination,
inadequate cleaning or sterilization)
Inadequate resources (e.g. staff absent, unavailable,
inexperienced, poor orientation)
Logistic problems (e.g. problems with admission,
treatment, transport, response to emergency)
Administrative problems (e.g. inadequate
supervision, lack of resource, poor management
decisions)
Infusion problems (e.g. omission, wrong rate)
Infrastructure problems (e.g. power failure,
insufficient beds)
Nutrition problems (e.g. fed when fasting, wrong
food, food contaminated, problems when ordering)
Colloid or blood product problems (e.g. omission,
underdose, overdose, storage problems)
Oxygen problems (e.g. omission, overdose,
underdose, premature cessation, failure of supply)

HAZARDS
NO
HAZAR
D
HAZARD LEVEL
OBSERVATION
LOW AVERAG
E
HIGH
GEOLOGICAL PHENOMENA
Earthquakes
Rate the hazard level of the hospital in terms of geotechnical soil
analyses
Volcanic eruptions
Refer to hazard maps of the region to rate the hospital’s exposure to
hazard in terms of its proximity to volcanoes, volcanic activity, routes
of lava flow, pyroclastic flow, and ash fall.
Landslides
Refer to hazard maps to rate the level of hazard for the hospital in
terms of landslides caused by unstable soils (among other causes).
Tsunamis
Refer to hazard maps to rate the level of hazard for the hospital in
terms of previous tsunami events caused by submarine seismic or
volcanic activity.
Others (specify).............................................................Refer to
hazard maps to identify other geological phenomena not listed
above. Specify the hazard and rate the corresponding hazard level
for the hospital.
HYDRO-METEOROLOGICAL PHENOMENA
Hurricanes
Torrential rains
Storm surge or river flooding
Landslides
HIRA- QUALITITATIVE ANALYSIS

SOCIAL PHENOMENA
Population gatherings
Rate the hospital’s exposure to hazard in relation to the type of population it serves, its
proximity to population gatherings and prior events that have affected the hospital.
Displaced populations
Rate the hospital’s exposure to hazard in terms of people who have been displaced as
a result of war, socio-political circumstances, or due to immigration and emigration.
Others (specify) .........................................................................................................
If other social phenomena affect the safety of the hospital, specify them and rate the
level of hazard for the hospital accordingly.
ENVIRONMENTAL PHENOMENA
Epidemics
With reference to any past incidents at the hospital and specific pathogens, rate the
hospital’s exposure to hazards related to epidemics.
Contamination (systems)
With reference to any past incidents involving contamination, rate the hospital’s
exposure to hazards from contamination of its systems.
Infestations
With reference to the location and past incidents at the hospital, rate the hospital’s
exposure to hazards from infestations (flies, fleas, rodents, etc.).
Others (specify):...............................................
Any past incidents at the hospital specify any other environmental phenomena not
included above that might compromise the level of safety of hospital.
CHEMICAL AND/OR TECHNOLOGICAL PHENOMENA
Explosions
With reference to the hospital’s surroundings, rate the hospital’s exposure to
explosions.
Fires:
With reference to the exterior of the hospital building, rate the hospital’s exposure to
external fires.
Hazardous material spills
With reference to the hospital’s surroundings, rate the hospital’s exposure to
hazardous material spills.
Others (specify) .........................................................................................................
Specify and rate other chemical or technological hazards in the area where the

GEOTECHNICAL PROPERTIES OF THE SOIL
LIQUEFACTION
With reference to the geotechnical soil analysis at the hospital site, rate the level of the
facility’s exposure to hazards from saturated and loose subsoil.
CLAY SOIL
With reference to soil maps, rate the hospital’s exposure to hazards from clay soil.
UNSTABLE SLOPES
Refer to geological maps and specify the hospital’s exposure to hazards from the
presence of slopes
PRIOR EVENTS AFFECTING HOSPITAL SAFETY
SAFETY LEVEL OBSERVATION
LOW AVERAGE HIGH
Has there been prior structural damage to the hospital as a result of natural phenomena?
Determine whether structural reports indicate that the level of safety has been compromised.
Low = Major damage
Average = Moderate damage
High =Minor damage.
Was the hospital built and/or repaired using current safety standards?
Verify whether the building has been repaired, the date of repairs, and whether repairs were
carried out using standards for safe buildings.
Low = Current safety standards not applied;
Average = Current safety standards partially applied;
High = Current safety standards fully applied.
Has remodelling or modification affected structural behavior of the facility? Verify whether
modifications were carried out using standards for safe buildings.
Low = Major remodelling or modifications have been carried out;
Average = Moderate remodelling and/or modifications;
High = Minor remodelling and/or modifications or no modifications
Safety of structural system & type of materials used in building: Condition of the building:
Low = Deterioration caused by weathering; cracks on the first floor and irregular height of
buildings;
Average = Deterioration caused only by weathering;
High = Good; no deterioration or cracks observed.
Construction materials used
Low = Rust with flaking; cracks larger than 3mm;
Average = Cracks between 1 and 3 mm or rust powder present;
High = Cracks less than 1 mm; no rust
ELEMENTS RELATED TO THE STRUCTURAL SAFETY OF THE BUILDING

Interaction of non-structural elements with the structure
Low = Separation of less than 0.5% of the height of partition/joint;
Average = Separation between 0.5 and 1.5% of the height of the partition/joint; High = Separation
above 1.5% of the partition/joint.
Proximity of buildings (hazards of pounding, wind tunnel effects, fires, etc.)
Low = Separation is less than 0.5% of the height of the shorter of two adjacent buildings;
Average= Separation is between 0.5% and 1.5% of the height of the shorter of two adjacent buildings;
High = Separation is more than 1.5% of the height of the shorter of two adjacent buildings.
Structural redundancy
Low = Fewer than three lines of resistance in each direction;
Average = Three lines of resistance in each direction or lines without orthogonal orientation;
High = More than three lines of resistance in each orthogonal direction of the building.
STRUCTURAL DETAILING INCLUDING CONNECTIONS
Low = Built before 1970;
Average = Built between 1970 and 1990;
High = Built after 1990 and according to standards.
Safety of foundations
Low = Information is lacking or foundation depth is less than 1.5 m;
Average = Plans and soil studies are lacking but foundation depth is more than 1.5 m;
High = Plans, soil studies are available and foundation depth is more than 1.5 m.
Irregularities in the plan (rigidity, mass, and resistance)
Low = Shapes are irregular and structure is not uniform;
Average = Shapes are irregular but structure is uniform;
High = Shapes are regular, structure has uniform plan, and there are no elements that would cause
torsion.
Structural resilience to various phenomena (meteorological, geological, among others)
Estimate structural behavior in response to different hazards or dangers, other than Earthquakes
Low = Low structural resilience to natural hazards present at the site fo the hospital;
Average = Satisfactory structural resilience;
High = Excellent structural resilience

You can also do such analysis for the below parameters..
• Electrical system
• Telecommunications system
• Water supply system
• Fuel storage (gas, gasoline, diesel)
• Medical gases (oxygen, nitrogen, etc.)
• Heating, ventilation, and air-conditioning (HVAC) systems in Critical
areas
• Office and storeroom furnishings and equipment (fixed and movable)
including computers, printers, etc
• Medical and laboratory equipment and supplies used for diagnosis and
treatment
• Architectural elements
• Safety based on functional capacity of hospital
• Operational plan for internal or external disasters
• Contingency plans for medical treatment in disasters

Hazard identification and Vulnerability / risk Analysis
DESCRIPTIONS:
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 Hospital in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplies
7 Interruption of product distribution

Hazard identification and Vulnerability / risk Analysis
DESCRIPTIONS:
Evaluate potential for event and response among the following categories using the hazard specific
scale.
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
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

INFECTION CONTROL RISK ANALYSIS- INFECTIONS IN THE HOSPITAL
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT
PROBABILITY HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPAREDNE
SS
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
Likelihood
these will be
present in your
patient
population
Severity of this
type infection
Addition
cleaning /
isolation/
staffing needs
due to this
infection
Increased
length of stay/
cost to this
facility due to
this infection
Identification of
the disease/
infection, plan
for caring this
type infections
Staff knowledge /
internal support
of plan for this
particular
disease/
infection
External support
for this type
infectiondisease-
public health,
mutual aid,Govt
agencies etc
Relative threat to this
facility*
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
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 = N/A
1 = High
2 = Moderate
3 = Low or none
0 - 100%
HEPATITIS A 1 2 1 1 2 2 3 20%
MEASLES 1 1 2 1 2 2 3 20%
MUMPS 1 1 2 1 2 2 3 20%
PERTUSSIS 1 2 1 2 2 1 3 20%
HEPATITIS B 1 3 1 2 2 2 3 24%
HEPATATIS C 1 3 1 2 2 2 3 24%
RUBELLA 1 2 2 2 2 2 3 24%
TUBERCULOSIS 1 3 3 3 1 2 2 26%
HIV 1 3 2 3 2 2 3 28%
CHICKENPOX 1 2 3 2 2 3 3 28%
ENTERIC
ORGANISMS
2 2 1 1 1 1 2 30%
Other MDRO'S 2 2 2 2 2 3 2 48%
C DIFFICLE 2 3 3 3 2 2 2 56%
VRE 2 3 3 3 2 2 3 59%
MRSA 2 3 3 3 2 2 3 59%
EPIDEMICS/
PANDEMICS
3 2 3 3 3 3 2 89%
COVID I9 3 3 3 3 3 3 2 94%
AVERAGE SCORE 1.63 2.50 2.25 2.31 2.13 2.25 2.81 43%
*Threat increases with percentage.
26 RISK = PROBABILITY * SEVERITY
228 0.43 0.54 0.79

HAZARD, RISK AND VULNERABILITY ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS
EVENT
PROBABILITY HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPAREDNES
S
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
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*
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
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 = N/A
1 = High
2 = Moderate
3 = Low or none
0 - 100%
Hurricane 0 0 0 0 0 0 0 0%
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 3 3 3 3 2 2 2 83%
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 3 3 2 2 1 1 1 56%
AVERAGE SCORE 0.38 0.38 0.31 0.31 0.19 0.19 0.19 1%
25 0.01 0.13 0.09

TECHNOLOGICAL EVENTS
EVENT
PROBABILIT
Y
HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPARED-
NESS
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
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*
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
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 = N/A
1 = High
2 = Moderate
3 = Low or
none
0 - 100%
Electrical Failure 2 3 1 3 1 1 2 41%
Generator Failure 1 3 1 3 2 1 2 22%
Transportation Failure 1 2 0 2 2 3 2 20%
Fuel Shortage 2 3 1 3 1 2 2 44%
Natural Gas Failure 0 2 1 2 2 3 2 0%
Water Failure 2 3 2 3 1 3 2 52%
Sewer Failure 1 1 0 2 2 3 3 20%
Steam Failure 1 1 0 2 2 3 3 20%
Fire Alarm Failure 1 2 3 2 1 2 3 24%
Communications Failure 2 2 3 3 3 3 3 63%
Medical Gas Failure 2 3 2 3 2 2 2 52%
Medical Vacuum Failure 1 3 2 2 2 2 2 24%
HVAC Failure 1 2 2 2 2 2 2 22%
Information Systems Failure 2 2 3 3 1 2 1 44%
Fire, Internal 1 2 3 2 2 2 1 22%
Flood, Internal 0 0 0 0 0 0 1 0%
Hazmat Exposure, Internal 2 2 2 2 1 3 3 48%
Supply Shortage 2 3 3 3 2 2 3 59%
Structural Damage 1 2 3 3 1 2 1 22%
AVERAGE SCORE 1.32 2.16 1.68 2.37 1.58 2.16 2.11 29%

HUMAN RELATED EVENTS
SEVERITY = (MAGNITUDE -
MITIGATION)
EVENT
PROBABILIT
Y
HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPARED-
NESS
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
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*
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
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 = N/A
1 = High
2 = Moderate
3 = Low or
none
0 - 100%
Mass Casualty Incident
(trauma)
2 3 3 3 2 2 2 56%
Mass Casualty Incident
(medical/infectious)
1 1 1 1 2 2 2 17%
Terrorism, Biological 1 1 1 1 2 2 2 17%
VIP Situation 1 1 1 1 2 2 2 17%
Infant Abduction 1 1 0 1 1 1 2 11%
Hostage Situation 0 0 0 0 0 0 0 0%
Civil Disturbance 1 1 1 1 3 1 2 17%
Labor Action 1 1 1 1 2 1 2 15%
Forensic Admission 1 1 0 1 2 1 1 11%
Bomb Threat 3 3 3 3 2 1 1 72%
AVERAGE 1.20 1.30 1.10 1.30 1.80 1.30 1.60 19%
84 0.19 0.40 0.47

EVENTS INVOLVING HAZARDOUS MATERIALS
SEVERITY = (MAGNITUDE -
MITIGATION)
EVENT
PROBABILIT
Y
HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPARED-
NESS
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
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*
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
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 = N/A
1 = High
2 = Moderate
3 = Low or none
0 - 100%
Mass Casualty Hazmat Incident
(From historic events at your MC
with >= 5 victims)
2 3 3 3 2 1 2 52%
Small Casualty Hazmat Incident
(From historic events at your MC
with < 5 victims)
1 2 2 2 2 1 2 20%
Chemical Exposure, External 1 1 1 1 2 2 2 17%
Small-Medium Sized Internal Spill 1 1 1 1 2 2 2 17%
Large Internal Spill 1 1 1 1 2 2 2 17%
Terrorism, Chemical 1 1 1 1 2 2 2 17%
Radiologic Exposure, Internal 1 1 1 1 3 3 3 22%
Radiologic Exposure, External 1 1 1 1 3 3 3 22%
Terrorism, Radiologic 1 1 1 1 3 3 3 22%
AVERAGE 1.11 1.33 1.33 1.33 2.33 2.11 2.33 22%
97 0.22 0.37 0.60

0.01
0.29
0.19 0.22
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Natural Technological Human Hazmat
Relative
Threat
to
Facility
Hazard Specific Relative Risk to HCO
0.33
0.45
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Probability Severity
Relative
Impact
on
Facility
Probability and Severity of Hazards to HCO
SUMMARY OF HAZARD IDENTIFICATION AND RISK ANALYSIS
CONTENTS Natural Technological Human Hazmat Total for Facility
Probability 0.13 0.44 0.40 0.37 0.33
Severity 0.09 0.67 0.47 0.60 0.45
Hazard Specific Relative Risk: 0.01 0.29 0.19 0.22 0.15

 Hazards and risks may change over time so it
is important to review your HIRA annually.
Date of Current HIRA:
Date of Next Revision:
Signature:_

 Appropriate documentation of each stage of the risk management
process should be followed.

The documentation will serve following purposes:
 to demonstrate that the risk management process is conducted
properly;
 to provide evidence of a systematic approach to risk identification
and analysis;
 to provide a record of risks to support the development of a
database of the Hospital’s risks
 Provide responsible management with risk treatment plans for
approval and subsequent implementation
 Provide accountability for managing the risks identified;
 Facilitate continuous monitoring and review;
 Share and communicate risk management information across the
Hospital.

 Responsible for identifying risks
 Responsible for reassessing risks on a periodic
basis
 Responsible for preparing risk register and
documenting mitigation plan in risk profile
 Responsible for managing risk by implementing
mitigation plans and reporting on the risk
management activities to the Head of Hospital
through the Risk Coordinator
 Escalate risks to Mgmt through the Risk
Coordinator on a need basis

Periodicity of Activities:
A summary chart displaying the activities to be followed periodically is given below:
Roles Periodicity of
Meeting Half-Yearly Yearly
Risk Owner
Update status of
implementation of mitigation
plan for identified component of
risk
Review and update risk
register and profiles and submit
to Risk Coordinator
-
Risk
Coordinator
Collate updated risk profile
from Risk Owner and submit to
the Management Committee for
their review
Update overall risk register
and report to the Mgmt
Management
Yearly Review the risk register and
profiles submitted
Review consolidated risk register &
risk profile documents for critical
risks
Monitoring and reviewing of the
risk
Review and recommend the Risk
management report

Risk Ref. No:
Risk Category:
Risk Statement:
Risk Owner
Risk Champion
Date of next review: dd/mm/yy
Contributing Factors:
Likelihood Rating (A) -
Impact Rating (B) -
Overall Risk Rating (A*B) -
Description of controls:
Risk Profile
RISK TREATMENT PLAN
Proposed Risk Treatment Actions:
Sr. No. Description Target date Status

RISK PRIORITY NUMBER OR RPN
• One approach to assist in action prioritization has been to use the Risk
Priority Number:
RPN = Severity (S) x Occurrence (O) x Detection (D)
• Within the scope of the individual FMEA, this value can range
between 1 and 1000.

RPN Value before FMEA analysis RPN Value after FMEA analysis & after corrective actions are taken
1518 174

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