Hazard Vulnerability Analysis (HVA) for Your Agency
Dcook-tulane.edukp_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