South Austin Medical Center

Anonymous

South Austin Medical Center

Risk Assessment

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Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Key:

O-2 Very Low Risk. No extraordinary actions required. Monitor

3-4 Low Risk. Educate. Enforce existing policies. Emphasize during EOC surveys. Monitor

5-9 Moderate Risk. Educate. Enforce existing policies. Emphasize during EOC surveys. Monitor

10> High Risk. Educate. Enforce/ Develop effective policies. Emphasize during EOC surveys. Monitor

To get total multiply: Probability x Risk x Predparedness

Sharps/ Needle Exposure
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
TB Exposure
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Chemical Exposure
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Lasers in use
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Blood and Body Fluid Exposure
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
X-ray Exposure
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Falls
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Ergonomics
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Fire
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
ADA Violations
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Assault
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Theft
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Suicide
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
HIPPA
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media
Utilities
Score.
Probability. 1-10
Risk. 1-10
Preparedness. 1-10
Total
Add media

Comments

Select date
Add signature

Forwarding instructions

Send completed copy to Facility Engineering: Attention Safety

E-Mail completed report to: Michael.huff@stdavids.com Keep a copy for your Department records

South Austin Medical Center

Anonymous

South Austin Medical Center

Risk Assessment

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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