Hazard And Vulnerability Analysis Template (Page 7 of 7) in pdf

Disaster Preparedness Overview - Assessment Questionnaire

Does the facility have an effective Disaster Manual utilizing ICS/HEICS?

Does the facility have a variety of disaster specific plans in the disaster manual?

Has every department identified potential serious department hazards? (fire, chemicals, workplace violence, equipment/process related, infection control, etc.)

Do departments have supporting department specific plans for each likely hazard?

Does every department have quick access to a cache of appropriate disaster supplies?

Are all staff effectively trained to correctly implement response plans 24/7?

Are Travelers & Temps trained sufficiently to identify hazards and report them correctly? Assigned a buddy to help them to respond correctly?

Incident Commander/Emergency Operations Center preparedness.

Have House Supervisors and Administrators who will likely serve as Incident Commanders been trained to implement and utilize ICS/HEICS effectively?

Is the Emergency Operations Center (and alternate EOC) designed to work effectively with short/no notice incident?

Does the IC and EOC staff have an effective emergency operations manual to help identify critical incident specific responses?

High level response plans, checklists, report forms, wall charts, key vendor & government 24 hour contact numbers?

PIO prepared a series of incident specific media releases preformatted to speed fast and effective releases?

PIO prepared a series of incident specific internal employee releases to speed fast and effective communications?

Alternate communications systems available (ham radio, pay phones, cell phones, fax, data services, etc.)?

Key utility drawings immediately available to House Supervisor, local Fire Department, contractors 24/7?

Have potential in-house disaster locations been identified?

Chemical spill/release areas?

Areas to handle large patient overflow/surge?

Radiological?

Staff Shelter Management?

Hostage?

Alternate EOC location?

Explosion/Blast?

Temporary patient service areas - in case of facility damage

Confined space?

Other?

Has the facility identified likely local industries capable of producing large number of causalities been identified?

Identified by location/industry chemical specific, crush, explosion, release, biological, etc.?

Have extremely hazardous materials in the community been identified by location?

Identified hazards in close proximity that could require Facility Lock Down or Shelter in Place?

Are there staff trained to safely and effectively handle hazardous materials incidents?

Appropriate PPE immediately available?

Decon facilities easily set up 24/7?

MSDS & Decon/Patient care protocols available 24/7?

Staff OSHA HazWoper standard, paragraph (q) trained to protect the facility, themselves and other patients/visitors?

Staff trained in selection/use of respirators?

Staff trained to handle acts of terrorism (biological, chemical, radiological, blast injuries)?

Incident Commanders HazWoper Trained?

House Supervisor, Plant Ops., Security and others trained to implement Facility Lock Down and Shelter in Place 24/7?

Vendors included in disaster response program (critical supplies & services) 24/7?

Facilities repair, off site data centers, commercial hazmat clean up, medical supply vendors, etc.?

Facility cache of critical response materials established outside the facility?

Separate building, 40 ft shipping container, etc.?

Hundred and five hundred year flood plain maps from local flood district have been reviewed?

Local flood inundation (dam failure) flood areas in local community identified (Flood Control District & Corps of Engineers)

Facility Disaster Recovery Plan ready to implement?

Staff trained in evacuation procedures?

When to evacuate vs. when to shelter in place?

How to move patients safely in an emergency evacuation horizontally and vertically?

Establish priorities and techniques for patient evacuation?

Understand Shelter In Place techniques and when to implement?

Understand Fire/Smoke Compartments and how to utilize them effectively?

Understand area bomb search techniques and reporting responsibilities for a bomb threat?

Know how to sign doors/compartments that have been searched?

Understand limits on implementing Search & Rescue without proper training and life support materials?

Other:

Table Math

Average score of each column is sum of the column divided by the total number of events

Probability divisor is 3 times the number of events (each event can be scored up to a 3)

Severity divisor is the number of events times 3 (highest possible score) times 6 (the number of severity ratings per event)

Hazard And Vulnerability Analysis Template Page 7

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