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Sample of Facility Risk Assessment Findings Report Template

 <Enter Facility Name>
Address of Location:
Participant: Date of Report:

The interview was conducted by <Enter the Name of Person(s) conducting interviews> on <Enter Month, Day, and Year>.

Overview of Facility Business Operations

The <Name of Facility> is responsible for <enter overview of all business operations that are conducted at this site. (Identify if the facility provides patient care.)

Previous Disruption Experiences

  • <Enter any previous disruption experiences and details of incident>
  • <Enter any previous disruption experiences and details of incident>
  • <Enter any previous disruption experiences and details of incident>
  • Risks & Vulnerabilities
Natural Risks

These risks are usually associated with weather related events:  flooding, high winds, severe storms, tornado, hurricane, fire, high winds, snow storms, and ice storms.  In each RA Survey, the facilities manager was asked to identify potential natural risks and rate the severity of each.

<Enter Chart using the template on the Natural Risks tab in the Executive Report Charts located in the appendix.>

Summary of Natural Risks

For the location of this facility and historical weather patterns, it has been stated that <Enter top 3 – 5 Natural Risks> pose the biggest threat. <Add additional comments if necessary.>

How the risk ranking was determined:  Overall Risk = Probability * Severity (Magnitude – Mitigation)

Threat

Probability

Magnitude

Mitigation

Overall Risk

Drought

 

Earthquake

 

Fire

 

Flood / Flash Flooding

 

Hurricane / Tropical Storm

 

Ice Storms

 

Landslides

 

Severe Thunderstorms

 

Tornado

 

Wildfire

To view specific section of this document, please contact us at Bob@training-hipaa.net or call us at (515) 865-4591.