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R I S K AS S E S S M E N T

WORKSHEET

SEVERITY (MAGNITUDE vs MITIGATION)


PROBABILITY

ISSUE

Likelihood this will


occur:
0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

**Device-related infection
- Blood Stream Infection
- Ventilator Associated Infection
- Urinary Tract Infection
- Implant from Surgical Procedure
- Drain or Tube - Temporary
- Ostomy or Related Opening
- Peritoneal Dialysis
- Shunt
- Other
Resistant Microbes
- MRSA
- VRE
- ESBL
- Clostridium difficile
- other
Surgical Site Infection
- Superficial
- Deep
- Organ space
Extrinsic Infection
- Patient-to-Patient Transmission
**- Worker-to-Patient Transmission
- Visitor-to-Patient Transmission
- Foodborne / Waterborne
- Vectorborne / Vermin
- Airborne Environmental Source
- Waterborne / Aerosol Source
**- Surface / Immediate Environment
**- Contaminated Instrument/Equip

RISK

HUMAN
IMPACT

PROPERTY
IMPACT

BUSINESS
IMPACT

PREPAREDNESS

INTERNAL
RESPONSE

EXTERNAL
RESPONSE

Possibility of
Death or Injury:

Physical Losses
and Damages:

Interruption of
services:

Preplanning &
Prevention:

Time,
Effectiveness,
Resources:

Community &
Mutual Aid staff
and supplies:

Relative
Threat * :

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 - 100%

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = None
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

This document is copyrighted material, Washington State Rural Healthcare Quality Network. May be used with permission from RHQN and acknowledgment of copyright.
Adaptation used with permission from Joan Wideman. Author - Sandy Kangas, PhD, RN.

29%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

SEVERITY (MAGNITUDE vs MITIGATION)


PROBABILITY

ISSUE

Likelihood this will


occur:
0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

PROPERTY
IMPACT

BUSINESS
IMPACT

PREPAREDNESS

INTERNAL
RESPONSE

EXTERNAL
RESPONSE

Possibility of
Death or Injury:

Physical Losses
and Damages:

Interruption of
services:

Preplanning &
Prevention:

Time,
Effectiveness,
Resources:

Community &
Mutual Aid staff
and supplies:

Relative
Threat * :

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 - 100%

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = None
1 = Low
2 = Moderate
3 = High
4 = Certain

0 = Never
1 = Low
2 = Moderate
3 = High
4 = Certain

- Contaminated Med / Product


- Other
Special Populations
- Neonates
- Elderly
- Pediatrics
- Transplant
- Chronic Conditions
- HIV
- Other immunocompromised
- Behavioral / IVDA
- Other not specified above
Occupational Health
- Bloodborne Pathogen Exposure
- Tuberculosis Exposure
- Vaccine Preventable Comm Dis
- Non V Preventable Comm Dis
- Other not specified above
Building / Facility
- Water intrusion
- Construction & Renovation
- Utilities loss (refer to facility HVA)
- Surge capacity
- Other not specified above
Community
- Bioterrorism
- Internal cluster/outbreak
- External outbreak
- Epidemic/Pandemic

0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

TOTAL AVERAGE RISK SCORE:


* RISK increases with percentage.

RISK

HUMAN
IMPACT

** Indicates that the issue presents a heightened opportunity for MDRO infection.

This document is copyrighted material, Washington State Rural Healthcare Quality Network. May be used with permission from RHQN and acknowledgment of copyright.
Adaptation used with permission from Joan Wideman. Author - Sandy Kangas, PhD, RN.

29%

Many cells of the Risk Assessment Worksheet have been protected (locked) to prevent changes.
This has been done for the following reasons:
(1) Prevent accidental changes/erasure of formulas and labels when entering data.
(2) User convenience, via automatic skipping of non-data entry cells that saves time.
However, some facilities/users may wish to modify, insert or delete infection risk items (rows) in the worksheet.
To accomplish this, the worksheet must be "un-protected (un-locked) so that editing can take place.
The process of unlocking the worksheet is different between Microsoft Excel 2010, 2007, & 2003.
However, the password for unlocking is the same; it is:

RiskControl

(note: case sensitive)

Unlocking with Excel 2007:


(1) Select the "Risk Assessment Worksheet" by clicking on its tab (bottom of window)
(2) Click on "Review" menu item/tab.
(3) In the "Changes" group, click on "Unprotect Sheet"
(4) When prompted, enter the password (RiskControl)
(5) When done making desired changes to the worksheet, you may Protect (lock) it again by returning
to the same place (steps 1-4 above), except the item in step 2 will say "Protect Sheet".
Unlocking with Excel 2003:
(1) Select the "Risk Assessment Worksheet" by clicking on its tab (bottom of window)
(2) Click on the "Tools" menu item.
(3) In the drop-down list, click on "Protection"
(4) Click on "Unprotect Sheet"
(5) When prompted, enter the password (RiskControl)
(6) When done making desired changes to the worksheet, you may Protect (lock) it again by returning
to the same place (steps 1-5 above), except the item in step 3 will say "Protect Sheet".
Please note:
(1) When adding new row(s) of infection risk control items, be sure to copy the formulas from the cells
directly above the new row into the new row(s) cells.
(2) When adding or removing row(s), check that the formula in the "Total Average Risk" cell,
located in the very bottom right corner, has changed to reflect the new row spans.
Excel should do this automatically, but some errors prevent this; if this error occurs, modify the
formula to reflect the correct row span for Sum and CountIf.
(3) If you wish to lock-protect the formula and label cells of any new row(s) you add, you must select each cell,
locate the "Format" menu item (often available when right-clicking on the cell), choosing "Protection",
and checking the "Lock" item on. The cells will not actually lock until performing the procedure
above where you enter a password, at which time all cells in the worksheet marked as "Lock" will
be Protected.
(4) Excel worksheets (within the same workbook) are Protected separately. Unlocking/unprotecting one sheet
does not automatically unlock others. Both worksheets in this workbook file contain locked cells.

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