HAZARD AND VULNERABILITY ASSESSMENT TOOL

NATURALLY OCCURRING EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

PROBABILITY Dampak Dampak Dampak respon resiko
( frekuensi Kesiapsiagaan respon internal
KEJADIAN manusia fasilitas pelayanan eksternal
kejadian )
komunitas,
Kemungkinan cedera atau Gangguan sebelum waktu, efektifitas
Hilang atau rusak bantuan umum ancaman relatif
akan terjadi meninggal pelayanan perencanaan dan sumber daya
dan supply

0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A

SCORE 1 = Low 1 = Low 1 = Low 1 = Low 1 = High 1 = High 1 = High
2 = Moderate 2 = Moderate 2 = Moderate 2 = Moderate 2 = Moderate 3 2 = Moderate 2 = Moderate 0 - 100%
3 = High 3 = High 3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none

gempa bumi
suhu extrim
banjir eksternal
kebakaran
tanah longsor
wabah covid

AVERAGE SCORE

*Threat increases with percentage.

0 RISK = PROBABILITY * SEVERITY
0

Natural Hazards : 624130882.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY dampak dampak dampak respon
kesiapsiagaan respon intrnal
manusia fasilitas pelayanan eksternal
Kejadian
kumunitas,
cederah atau gangguan sebelum waktu, efektifitas
kemungkinan terjadi hilang atau rusak bantuan umum
meninggal pelayanan perencanaan dan sumber daya
dan supplay
0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
0 = N/A 1 = Low 1 = Low
1 = Low 1 = Low 1 = High 1 = High 1 = High
SCORE 2 = Moderate 2=
2 = Moderate 2 = Moderate 2 = Moderate 3 2 = Moderate 2 = Moderate
3 = High Moderate
3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High

Kegagaln listrik

kegagalan generator

kegagalan transportasi

kekurangan bahan bakar

kegagalan air

kegagalan saluran pembuangan

kegagalan alaram kebakaran

kegagalan komunikasi

kegagalan gas medis

kegagalan HVAC

kegagalan informasi sistem

kegagalan trasportasi

kegagalan listrik

paparan hazmat intrna

kerusakan alat medis

kerusakan bagunan

AVERAGE SCORE
Technological Hazards : 624130882.xlsx
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
0

Technological Hazards : 624130882.xlsx

 Resiko

Ancaman relatif

0 - 100%

Technological Hazards : 624130882.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

PROBABILITY resiko
dampak dampak dampak respon
kesiapsiagaan respon internal
manusia fasilitas pelayanan eksternal
kejadian
kamunitas,
kemungkinan cederah atau rusak atau gangguan sebelum waktu, efektifitas
bantuan hidup dan ancaman relatif
terjadi meninggal hilang pelayanan perencanaan dan sumber daya
supplay
0 = N/A 0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1 = Low 1 = Low
1 = Low 1 = Low 1 = High 1 = High 1 = High
SCORE 2 = Moderate
2= 2=
2 = Moderate 2 = Moderate 3 2 = Moderate 2 = Moderate 0 - 100%
Moderate Moderate
3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High 3 = High

situasi penyanderaan

penculikan bayi

aksi demonstrasi

acaman bom

kekurangan tenaga

AVERAGE

*Threat increases with percentage.

0 RISK = PROBABILITY * SEVERITY
0

Human Hazards : 624130882.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY dampak dampak dampak
kesiapsiagaan respon internal respon eksternal
kejadian manusia fasilitas pelayanan

kemungkinan cederah atau gangguan sebelum waktu, efektifitas komunitas, bantuan

rusak atau hilang
terjadi meninggal pelayanan perencanaan dan sumber daya hidup dan supplay

0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1 = Low
1 = Low 1 = Low 1 = Low 1 = High 1 = High 1 = High
SCORE 2 = Moderate
2=
2 = Moderate 2 = Moderate 2 = Moderate 3 2 = Moderate 2 = Moderate
Moderate
3 = High 3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High

insiden hazmad korban massal (From historic

events at your MC with >= 5 victims)
insiden hazmad korban kecil (From historic
events at your MC with < 5 victims)

paparan bahan kimia eksternal

tumpahan B3
paparan limbah B3
pencemaran limbah infeksius fakses ke
lingkungan
Radiologic Exposure, Internal
Radiologic Exposure, External

AVERAGE

*Threat increases with percentage.

RISK = PROBABILITY * SEVERITY
0
0

Hazardous Materials : 624130882.xlsx

 RISK

ancaman relatif

0 - 100%

Hazardous Materials : 624130882.xlsx

 SUMMARY OF HAZARDS ANALYSIS

Total for Facility

Technological

Hazmat
Natural

Human
Probability 0.00 0.00 0.00 0.00 0.00
Severity 0.00 0.00 0.00 0.00 0.00
Hazard Specific Relative Risk:
0.00 0.00 0.00 0.00 0.00

Hazard Specific Relative Risk

1.00
Relative Threat to Facility

0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Natural Technological Human Hazmat

Probability and Severity of Hazards

1.00
0.90
Relative Impact on Facility

0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Probability Severity

624130882.xlsx Summary
 INSTRUCTIONS
Evaluate potential for event and response among the following categories using
the hazard specific scale.
Issues to consider for probability include, but are not limited to:
1 Known risk
2 Historical data
3 Manufacturer/vendor statistics
Issues to consider for response include, but are not limited to:
1 Time to marshal an on-scene response
2 Scope of response capability
3 Historical evaluation of response success
Issues to consider for human impact include, but are not limited to:
1 Potential for staff death or injury
2 Potential for patient death or injury
Issues to consider for property impact include, but are not limited to:
1 Cost to replace
2 Cost to set up temporary replacement
3 Cost to repair
Issues to consider for business impact include, but are not limited to:
1 Business interruption
2 Employees unable to report to work
3 Customers unable to reach facility
4 Company in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplies
7 Interruption of product distribution
Issues to consider for preparedness include, but are not limited to:
1 Status of current plans
2 Training status
3 Insurance
4 Availability of back-up systems
5 Community resources
Issues to consider for internal resources include, but are not limited to:
1 Types of supplies on hand
2 Volume of supplies on hand
3 Staff availability
4 Coordination with MOB's
Issues to consider for external resources include, but are not limited to:
1 Types of agreements with community agencies
2 Coordination with local and state agencies
3 Coordination with proximal health care facilities
4 Coordination with treatment specific facilities
Complete all worksheets including Natural, Technological, Human and Hazmat. The summary
section will automatically provide your specific and overall relative threat.
HAZARD AND VULNERABILITY ANALYSIS
RSUD CILINCING
2018
 BAB IV
CONCLUSION

Identifikasi dikeluarkan sebagai referensi untuk semua departemen di RSUD AHT dalam bermeditasi keselamatan pa
Ketika program implementasi didirikan kendala dan kesulitan yang tidak bisa ia dilaksanakan sesuai kondisi yang seb
Kejadian yang paling besar kemungkinan terjadi bencana di RSUD AHT adalah gempa bumi, banjir, penculikan bayi

WASIOR,
Dibuat oleh

Victor Gusti Wajong

Ketua
temen di RSUD AHT dalam bermeditasi keselamatan pasien dan keamanan, pengunjung dan bekerja selama 2022.
n yang tidak bisa ia dilaksanakan sesuai kondisi yang sebenarnya jadi kita dari tim K3RS permintaan positif saran sebagai evalua
RSUD AHT adalah gempa bumi, banjir, penculikan bayi, dan kebakaran

Diketahui

Direktur

Dr. Yoce Kurniawan

NIP. 197811072006051001
itif saran sebagai evaluasi yang penting dari program dilaksanakan dan membuat referensi untuk melakukan program perbaikan u
kukan program perbaikan untuk tahun depan.