Sample Risk Management Plan Page 3

Plan

Facility Manual

Annual Reviews

KDHE Approval

Confidentiality

Retention of RM Documents

XII

Resource Allocation

RISK MANAGEMENT PROGRAM***Update***

Facility name and address

Committee member names and titles

Risk Manager's name and title

APPROVAL PAGE****Update****

Plan approval signatures: Facility Board Representative, Administrator, Chief of Medical Staff,

Risk Manager

Appendices

A – Organizational Chart, indicating the position of the facility’s review committee

(required)

B – Occurrence/Incident Report Form

C – Log

D – Investigational Tool

E – Grounds for Disciplinary Action/Professional Codes

F – Quarterly Report Form

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Parent category: Business