Sample Risk Management Plan Template Page 8
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9RISK MANAGEMENT PROGRAM
Facility name and address:
Facility X
800 Main Street
Hometown, Kansas 65432
Risk Management Committee Members:
Jane Doe RN, Risk Manager and Swing Bed Director, Chairperson
Joe Click, Radiology Director
Sue Stick, Lab Director
Robert Pace, Physical Therapy Director
Vickie Streeter, Outpatient Services Director
Clara Barton RN, Director of Nursing
William Right, Quality Assurance Performance Improvement Director
Medical Staff Executive Committee Members:
Dr John Jones, Chief of Medical Staff, Chairperson
Dr Phil Heal, Chief of Surgery
Dr Roberta Gas, Chief of Anesthesiology
Dr Seth Young, Chief of Obstetrics
Dr Theresa Quick, Chief of Emergency Medicine
Non-voting member: Health Information Director and Risk Manager
Risk Manager:
Jane Doe RN, Risk Manager and Swing Bed Director
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