UMMS Risk Assessment

• Contact the following for any of these occurrences...Frenkil Security Desk 410-328-8504 (normal hours) 410-328-2200After hours), JLL Bldg. Mgt. 888-808-5562, UMMC Director of Safety and Environmental Health 410-328-6001/443-610-4914

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Key:

• 0-2 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. Enforcen 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 Preparedness

Fire/Smoke/Steam

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Gray Water/Sewer Water Leak

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Chemical Exposure

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Sharps/Needle Exposure

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Blood & Body Fluid Exposure

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

X-ray Exposure

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Falls

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

ADA Violations

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Total:

Theft

• Probability

  High - 3

  Medium - 2

  Low - 1

  N/A - 0

• Risk

  Life Threat - 5

  Health Safety - 4

  High Disruption - 3

  Moderate Disruption - 2

  Low Disruption - 1

• Preparedness

  Poor - 3

  Fair - 2

  Good - 1

• Total:

Comments

• Comments:

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• Phone # 410-328-0000, Fax # 410-328-0000

• Email: UMMS Safety@umm.edu Keep a copy for your records