A Hazard Vulnerability Analysis (HVA) is a systematic way | WriteDen

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								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

EVENT

PROBABILITY SEVERITY = (MAGNITUDE + MITIGATION)

HUMAN IMPACT

PROPERTY IMPACT

BUSINESS IMPACT

PREPARED- NESS

INTERNAL RESPONSE

EXTERNAL RESPONSE

Likelihood this with occur

Possibility of death or injury

Physical losses and damages

Interruption of services

Preplanning Time

effectiveness, resources

Community/ mutual aid staff

and supplier

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 = Low 2 = Moderate 3 = High

0 = N/A 1 = Low 2 = Moderate 3 = High

0 = N/A 1 = Low 2 = Moderate 3 = High

0–100%

Mass Casualty Incident (trauma) Terrorism, Biological Mass Casualty Incident (medical/infectious) Fuel Shortage Natural Gas Failure Water Failure Sewer Failure Steam Failure Fire Alarm Failure Communications Failure Medical Vacuum Failure HVAC Failure Information System Failure Fire, Internal Hazmat Exposure, Internal

AVERAGE SCORE

OSHA (n.d.). Hazard and Vulnerability Assessment Tool: Technological Events. OSHA Best Practices for Hospital-based First Receivers.)

HAZARD AND VULNERABILITY ASSESSMENT TOOL | TECHNOLOGIC EVENTS (example of format used with a complete threat list)

RISK = PROBABILITY + SEVERITY

§Threat increases with percentage.