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RUMAH SAKIT UMUM HAJI SURABAYA

KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI


Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

FORMULIR ICRA (Infection Control Risk Assessment)

RESCO
Probabilty / Current systems/
Risk/impact(Health, Finacial, Legal, Regulatory
Frequency Preparedness
Catastropic Serious

Expect it
Potensial Risk/Masalah Loss (life/ Loss Prolonged Moderate Minimal

Maybe
Likely

Never

Good
None

Solid
Poor
Rare

Fair
limb/ (Function/ Length of clinical/ Clinical
function/ financial/ stay financial financial
financial) Legal)
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
                                 
                               

                               

                               

                               

                               

                               

                               
RUMAH SAKIT UMUM HAJI SURABAYA
KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI
Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

FORMULIR INFECTION CONTROL RISK ASSESSMENT (ICRA) PROGRAM

JENIS
POTENSIAL RISK / TUJUAN TUJUAN PROGRE
No KELOMPOK SKOR PRIORITAS STRATEGI EVALUASI
MASALAH UMUM KHUSUS SS/ ANALISIS
RISIKO
RUMAH SAKIT UMUM HAJI SURABAYA
KOMITE PENCEGAHAN DAN PENGENDALIAN INFEKSI
Jl. Manyar Kertoadi Telp. (031) 5924000 Extension 5038 Surabaya 60117

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