Hazard Vulnerability Analysis (HVA) for Your Agency

profileDcook-tulane.edu
kp_hva_template_2014.xls

Instructions

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 summary
section will automatically provide your specific and overall relative threat.
&R&"Arial,Italic"&8&F

Natural Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT PROBABILITY 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%
Hurricane 0%
Tornado 0%
Severe Thunderstorm 0%
Snow Fall 0%
Blizzard 0%
Ice Storm 0%
Earthquake 0%
Tidal Wave 0%
Temperature Extremes 0%
Drought 0%
Flood, External 0%
Wild Fire 0%
Landslide 0%
Dam Inundation
Volcano 0%
Epidemic 0%
AVERAGE SCORE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
&R&"Arial,Italic"&8&A : &F&"Arial,Regular"&10

Technological Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT PROBABILITY 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 0%
Generator Failure 0%
Transportation Failure 0%
Fuel Shortage 0%
Natural Gas Failure 0%
Water Failure 0%
Sewer Failure 0%
Steam Failure 0%
Fire Alarm Failure 0%
Communications Failure 0%
Medical Gas Failure 0%
Medical Vacuum Failure 0%
HVAC Failure 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 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
&R&"Arial,Italic"&8&A : &F

Human Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT PROBABILITY 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) 0%
Mass Casualty Incident (medical/infectious) 0%
Terrorism, Biological 0%
VIP Situation 0%
Infant Abduction 0%
Hostage Situation 0%
Civil Disturbance 0%
Labor Action 0%
Forensic Admission 0%
Bomb Threat 0%
AVERAGE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
&R&"Arial,Italic"&8&A : &F

Hazardous Materials

HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT PROBABILITY 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) 0%
Small Casualty Hazmat Incident (From historic events at your MC with < 5 victims) 0%
Chemical Exposure, External 0%
Small-Medium Sized Internal Spill 0%
Large Internal Spill 0%
Terrorism, Chemical 0%
Radiologic Exposure, Internal 0%
Radiologic Exposure, External 0%
Terrorism, Radiologic 0%
AVERAGE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
&R&"Arial,Italic"&8&A : &F&"Arial,Regular"&10

Summary

SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS
Natural Technological Human Hazmat Total for Facility
Probability 0.00 0.00 0.00 0.00 0.00
Severity 0.00 0.00 0.00 0.00 0.00
Hazard Specific Relative Risk: 0.00 0.00 0.00 0.00 0.00
&R&"Arial,Italic"&8&F &A

Summary

Relative Threat to Facility
Hazard Specific Relative Risk to Medical Center
Relative Impact on Facility
Probability and Severity of Hazards to Medical Center