INCIDENT E

INCIDENT PROBABILITY HUMAN IMPACT PROPERTY IMPACT

Possibility of death or Amount of property

Likelihood this will occur injury severly damaged

4 = Highly Likely (probable within 4 = Multiple deaths 4 = >50 %

this year)
3 = Likely (probable within 3 3 = Injuries result in 3 = 25-50 %
years) permanent disability
2 = Injuries do not
2 = Possible (probable within 5 result in permanent 2 = 10-25 %
years) disability

1= Unlikely (probable within 10 1= Injuries treatable 1 = <10 %

years) with first aid

Bomb Threat 3 1 3
Workplace Violence 3 2 1
Earthquake 3 3 4
Fire 2 3 4
Flood 2 1 1
Disease Outbreak 1 2 1
Water Service Failure 2 1 1
Phone Service Failure 3 1 1

2.38 1.75 2.00

INCIDENT EFFECT PREPAREDNESS

FACILITY IMPACT WARNING TIME DURATION PLANNING

Emergency
Complete interruption/ Incident anticipation Time incident Management/
shutdown of facility or services time may continue Operations Plan

4 = >30 days 4 = <6 hours 4 = >1 week 4 = No EMP or EOP

3 = EMP/ EOP partially

3 = >2 weeks 3 = 6-12 hours 3 = <1 week complete

2 = >1 week 2 = 12-24 hours 2 = <1 day 2 = EMP/EOP complete

1 = EMP/ EOP exercised

1 = 24 hours or less 1 = 24+ hours 1 = <6 hours and/or evaluated

2 4
2 4
3 3
4 3
1 1
1 2
1 3
1 2
2 2
2 2
3 3
1 2
2 3
3 3
1 4
2 3

1.88 2.75 2.00 2.75

PREPAREDNESS
RISK
TRAINING EQUIPMENT

Staff trained and equipped Relative Threat

4 = staff not trained on EOP 7.00 - 7.40 =

Very High
3 = some staff trained, no 5.27 - 7.00 =
equipment High

2 = most staff trained, some 3.56 - 5.27 =

equipment Moderate

1 = Anticipated staff trained 1.85 - 3.56 = Low

and properly equipped

2
4.45
2 4.15
2 5.75
2 5.25
4 3.00
2 2.90
4 3.35
2 3.40
-
-
-
-
-
-
-
-

2.50
 INCIDENT EFFECT

PROPERTY
PROBABILITY HUMAN IMPACT FACILITY IMPACT WARNING TIME DURATION
INCIDENT IMPACT

Possibility of death or Amount of property Complete interruption/ Incident Time incident

Likelihood this will occur shutdown of facility or
injury severly damaged anticipation time may continue
services

4 = Highly Likely (probable within 4 = Multiple deaths 4 = >50 % 4 = >30 days 4 = <6 hours 4 = >1 week
this year)

3 = Likely (probable within 3 3 = Injuries result in 3 = 25-50 % 3 = >2 weeks 3 = 6-12 hours 3 = <1 week
years) permanent disability

2 = Injuries do not
2 = Possible (probable within 5 result in permanent 2 = 10-25 % 2 = >1 week 2 = 12-24 hours 2 = <1 day
years) disability

1= Unlikely (probable within 10 1= Injuries treatable 1 = <10 % 1 = 24 hours or less 1 = 24+ hours 1 = <6 hours
years) with first aid

Bomb
Threat 3 1 3 2 4 2

Workplace
Violence 3 2 1 2 4 2

Earthquake
3 3 4 3 3 3

Fire
2 3 4 4 3 1

Flood
2 1 1 1 1 2

Disease
Outbreak 1 2 1 1 2 3

Water
Service 2 1 1 1 3 1
Failure
Phone
Service 3 1 1 1 2 2
Failure

2.38 1.75 2.00 1.88 2.75 2.00

Dibuat oleh

K3 RS
 PREPAREDNESS
RISK
PLANNING TRAINING EQUIPMENT

Emergency Staff trained and

Management/ Relative Threat
equipped
Operations Plan

4 = staff not trained on 7.00 - 7.40 =

4 = No EMP or EOP EOP Very High

3 = EMP/ EOP partially 3 = some staff trained, no 5.27 - 7.00 =

complete equipment High

2 = EMP/EOP complete 2 = most staff trained, 3.56 - 5.27 =

some equipment Moderate

1 = EMP/ EOP exercised 1 = Anticipated staff 1.85 - 3.56 =

trained and properly
and/or evaluated Low
equipped

2 2
4.45
2 2
4.15

3 2
5.75
2 2
5.25
3 4
3.00

3 2
2.90

4 4
3.35
3 2
3.40
-
-
-
2.75 2.50

Mengetahui

CEO
 RS.BELLA HVA Gap Analsis

Event Risk Score Vulnerability Improvement Action

Earthquake 5.75 RS.BELLA belum mempunyai RS.BELLA harus memperbarui prosedur memindahkan pasien secara aman dan
peralatan yang mendukung cepat dari lantai yang tinggi.
untuk evakuasi secara cepat
pasien di lantai atas.

Fire 5.25 Peralatan untuk RS.BELLA perlu memeriksa kelayakan peralatan pemadam api dan melakukan
memadamkan api sebagian latihan pemadaman kebakaran dan evakuasi.
besar tidak berfungsi ;
Pelatihan pemadaman api
dilakukan 3 tahun yang lalu.

Bomb Threat 4.45 Belum pernah melakukan RS.BELLA perlu mengadakan simulasi ancaman bom.
simulasi penanganan
ancaman bom.

Dibuat oleh

K3 RS
Responsible
Individual
K3

K3

K3

Mengetahui

DIREKTUR