National Training on Safe Hospitals - Sri Lanka - Worksheets Module 2 - 14Sept22-24

Worksheets
MODULE 2
Hospital Hazard Identification and
General Risk Analysis
Prioritization of Gaps

Worksheets
Module 2
Instructions:
Pls. accomplish as indicated in the specific instructions.
To promote CLEAR slides, always use BOLD fonts and at least 18 font
size.
Pls. submit to Facilitators right after presentation.
Make a presentation that is ready for submission to your
organization’s leaders.

Executive Report on Safe
Hospital’s Vulnerability
Assessment
Format

Executive Report on Safe Hospital’s
Vulnerability Assessment
Format of Report
Name of Hospital / Health Facility:
Type: Government or Private:
Bed Capacity:
• Confidentiality clause of assessment report:
• Assessment Processes and Scope:
• Date of Assessment:
• Members of Assessment Team:

Format of Report
 Hospital Hazards Identification and Risk Analysis
 List of Gaps per Areas in Each Safe Hospital Component
(Structural, Non-structural, Functional)
 General Descriptive Assessment Statements of Gaps per
Area in Each Safe Hospital Component (Structural, Non-structural,
Functional)

Format of Report
 Prioritization Processes Done and Prioritization Matrix of
Gaps
 Identified 3 Critical Gaps in Each Safe Hospital
Component (Structural, Non-structural, Functional) for
Action Planning

Worksheets

Hospital Hazards Identification and General Risk Analysis
Name of Hospital / Health Facility:
Type: Government or Private:
Bed Capacity:
Name of Assessor Team Leader:
Date of Assessment:
Email Address of Assessor Team Leader:
Pls. accomplish – required!
May place picture of façade of your hospital / health facility.

Hospital Hazards Identification and General Risk Analysis
Hazards
[experienced /
predicted: indicate
– (E) and (P)]
[at least 3]
Vulnerabilities Preparedness /
Capacity /
Readiness
Risks
1.
2.
3.

Worksheets
Collation and Analysis of Safe
Hospital’s Vulnerability Assessment
Data
(after doing a self-assessment
using the WPRO’s tool)

Collation and Analysis of Safe Hospital’s Vulnerability
Assessment Data
List of Gaps per Area in Each Safe
Hospital Component (Structural,
Non-structural, Functional)

Assessment Data
List of Gaps per Area in Each Safe Hospital Component (Structural,
Structural
Compone
nt
Sub-components or Areas Indicators with gaps
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
A. Location
B. Design
C. Structures
D. Permit and Clearance

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
A. Building Documents /
Drawings /Plans
B. Architectural Elements
 Safety of the roofing
 Safety of ceilings
 Safety of doors and
entrances

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
 Safety of windows and
shutters
 Safety of walls, divisions,
partitions
 Safety of exterior elements
(cornices, ornaments,
facade, plastering, etc.)
 Safety of floor coverings
shutters

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
C. Lifeline Facilities
 Electrical System
 Communications System
 Water Supply System
 Medical Gas System

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
 Fire Suppression System
 Emergency Exit System
 Heating, Ventilation and
Air conditioning (HVAC)
Systems in Critical Areas

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
D. Medical and Laboratory
Equipment
 Equipment in Operating
Room and Recovery Room
 Radiological Equipment
and Other Support Devices
 Laboratory Equipment and
Other Support Devices

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
 Medical Equipment in
Emergency Rooms/
Intensive Care Units/
Wards
Pharmacy Departments
Sterilization Units

Assessment Data
Non-
Structural
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
 Equipment and Other
Support Devices in Nuclear
Medicine Department and
Radiation Therapy Units
E. Safety and Security of
People, Equipment and
Supplies
 Safety and Security of
Personnel and Patients
 Safety of Fixtures,
Equipment and Supplies

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
A. Site and Accessibility of
Hospital/ Health Facility
 Site/ Location
 Accessibility

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
B. Internal Circulation and
Interoperability
 Internal Circulation
 Interoperability

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
C. Equipment and Supplies
 Basic equipment and
Supplies
 Equipment and Supplies
for Emergency

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
D. Emergency Management
Policies, Procedures and
Guidelines
 Standard Operations
Procedures (SOP) and
Protocols
 Procedures
 Guidelines

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
E. Logistic System and Utilities
 Logistic System
 Medical Gases Distribution
System

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
F. Safety and Security
Systems
 Safety and Alarm
Systems
 Security Systems

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
G. Communications,
Transportation and
Information Systems
 Communications and
Transportation Systems
 Public Information
Systems
 Information
Management Systems

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
H. Plans for Emergency and
Disaster
 Hospital Emergency
Incident Command System
 Contingency Plan
 Manuals for the Operation,
Preventive Maintenance,
and Restoration of Critical
Services

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
I. Human Resources
 Organization of Hospital
Disaster Committees and
Emergency Operation
Center
 Capability Building of
Personnel
 Drills and Exercises

Assessment Data
Functional
Component
(can use the number
tags in the
assessment tool)
Remarks (may
include
General Descriptive
Assessment
Statements)
J. Monitoring and Evaluation

Assessment Data
General Descriptive Assessment
Statements of Gaps per Area in
Each Safe Hospital Component

Assessment Data
General Descriptive Assessment Statements of Gaps per Area in Each
Safe Hospital Component
Structural
Component
Sub-components or Areas General Descriptive Assessment
Statements
A. Location
B. Design
C. Structures
D. Permit and Clearance

Assessment Data
Non-Structural
Component
Statements
A. Building Documents /
Drawings /Plans
B. Architectural Elements
 Safety of the roofing
 Safety of ceilings
 Safety of doors and
entrances

Assessment Data
Non-Structural
Component
Statements
shutters
 Safety of walls, divisions,
partitions
 Safety of exterior elements
(cornices, ornaments, facade,
plastering, etc.)
 Safety of floor coverings
shutters

Assessment Data
Non-Structural
Component
Statements
C. Lifeline Facilities
 Communications System
 Medical Gas System

Assessment Data
Non-Structural
Component
Statements
 Fire Suppression System
 Emergency Exit System
 Heating, Ventilation and Air
conditioning (HVAC) Systems
in Critical Areas

Assessment Data
Non-Structural
Component
Statements
D. Medical and Laboratory
Equipment
 Equipment in Operating Room
and Recovery Room
 Radiological Equipment and
 Laboratory Equipment and

Assessment Data
Non-Structural
Component
Statements
Emergency Rooms/ Intensive
Care Units/ Wards
Pharmacy Departments
Sterilization Units

Assessment Data
Non-Structural
Component
Statements
 Equipment and Other Support
Devices in Nuclear Medicine
Department and Radiation
Therapy Units
E. Safety and Security of People,
Equipment and Supplies
 Safety and Security of Personnel
and Patients
 Safety of Fixtures, Equipment
and Supplies

Assessment Data
Functional
Component
Statements
A. Site and Accessibility of
Hospital/ Health Facility
 Site/ Location
 Accessibility

Assessment Data
Functional
Component
Statements
B. Internal Circulation and
Interoperability
 Internal Circulation
 Interoperability

Assessment Data
Functional
Component
Statements
C. Equipment and Supplies
 Basic equipment and
Supplies
 Equipment and Supplies for
Emergency

Assessment Data
Functional
Component
Statements
D. Emergency Management
Policies, Procedures and
Guidelines
 Standard Operations
Procedures (SOP) and
Protocols
 Procedures
 Guidelines

Assessment Data
Functional
Component
Statements
E. Logistic System and Utilities
 Logistic System
 Medical Gases Distribution
System

Assessment Data
Functional
Component
Statements
F. Safety and Security Systems
 Safety and Alarm Systems
 Security Systems

Assessment Data
Functional
Component
Statements
G. Communications,
Transportation and Information
Systems
 Communications and
Transportation Systems
 Public Information Systems
 Information Management
Systems

Assessment Data
Functional
Component
Statements
H. Plans for Emergency and Disaster
 Hospital Emergency Incident
Command System
 Contingency Plan
 Manuals for the Operation,
Preventive Maintenance, and
Restoration of Critical Services

Assessment Data
Functional
Component
Statements
I. Human Resources
 Organization of Hospital
Disaster Committees and
Emergency Operation
Center
 Capability Building of
Personnel
 Drills and Exercises

Assessment Data
Functional
Component
Statements
J. Monitoring and Evaluation

Assessment Data
Prioritization Processes Done and
Prioritization Matrix of Gaps

Assessment Data
Prioritization Processes Done and
(Note: Prioritization means doing first things first after evaluating a
group of gaps and ranking them in their order of importance or
urgency.
Eventually, all gaps will have to be resolved and as soon as possible.)

Assessment Data
Prioritization Processes Done and Prioritization
Matrix of Gaps
Instructions:
Decide on the initial prioritization processes to be done prior to using
prioritization matrix for the identified gaps in the 3 safe hospital
components (structural, non-structural, and functional) to come out
with 9 critical ones (3 per component) – the expected output of
Module 2.

Assessment Data
Matrix of Gaps
Examples of initial prioritization processes:
• Those gaps with “NO - need major improvement” assessments are
given priority across the board over “NO - need slight to moderate
improvement.”
• Those gaps with “UNSURE of status” assessments are given priority
over “NO – need slight to moderate improvement” if the indicators
involved in the former are very critical in making the hospital /
health facility safe from disasters.

Assessment Data
Matrix of Gaps
• Sub-components or areas with the most number of gaps are given
priority over those with lesser number.
• The relative importance of the sub-components or areas with gaps
are considered in the prioritization processes.

Assessment Data
Matrix of Gaps
• An across the board set of criteria, agreed upon by the team, can be
used in initial prioritization particularly in situations where there is
an overwhelming number of gaps to solve.
• An example of an across the board set of criteria includes
magnitude of the gap, urgency to resolve the gap, and impact of the
consequences if the gap is not solved soon.

Assessment Data
Matrix of Gaps
• After the initial prioritization processes have been done, make a list
that contains 6 to 7 gaps per safe hospital component.
• Subject these initially prioritized gaps to a team deliberation using
the prioritization matrix to eventually come out with 3 gaps per safe
hospital component.
• Use the templates shown below.

Assessment Data
STRUCTURAL GAPS
Prioritization Matrix
Criteria [at least 3 with relative weights
1. lowest; 3 - highest)] – see Key
Number of persons giving scores: ___
Total
Scores
(sum)
Rank
1 2 3 4 5
1.
2.
3.
4.
5.
6.
7.

Assessment Data
Criteria Keys
Keys Criteria
1
2
3
4
5
For STRUCTURAL GAPS

Assessment Data
NON-STRUCTURAL
GAPS
Total
Scores
(sum)
Rank
1 2 3 4 5
1.
2.
3.
4.
5.
6.
7.

Assessment Data
Criteria Keys
Keys Criteria
1
2
3
4
5
For NON-STRUCTURAL GAPS

Assessment Data
FUNCTIONAL GAPS
Total
Scores
(sum)
Rank
1 2 3 4 5
1.
2.
3.
4.
5.
6.
7.

Assessment Data
Criteria Keys
Keys Criteria
1
2
3
4
5
For FUNCTIONAL GAPS

Worksheets
MODULE 2
Prioritization of Gaps
The End

National Training on Safe Hospitals - Sri Lanka - Worksheets Module 2 - 14Sept22-24

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National Training on Safe Hospitals - Sri Lanka - Worksheets Module 2 - 14Sept22-24