RISK ASSESSMEN

Department:
Date of the risk assessm
Prepared by:

Key Performance Linkage to overall hospital

Indicators (for
Ref No Department Objectives
monitoring
objectives)

Gross Risk Assessment

Risk
Number Risk Title Risk Root Cause (see key below
Consequences
table)
Likelihood Impact

KEY
Likelihood Impact Overall Control
effectiveness
Rare Insignificant Excellent
Unlikely Minor Low Good
Possible Moderate Medium Moderate
Likely Major High Weak
Almost Catastrophic Extreme Unsatisfactory
certain
1 Risk Response: What response is recommended? For example, cease operation, put controls in place, increase supervision
2 Controls / Risk Mitigation Measures : What measures should be put in place to mitigate this risk
3 Improvement action plan: actions to be undertaken, from where are we now to where we want to be.
 RISK ASSESSMENT FORM 2020
Department:
Date of the risk assessment:
Prepared by:

Linkage to overall hospital strategy and goals

Controls /
Assessment Control
Risk response Risk
(see key below Effectivenes Residual Risk Assessment
(ATAC) Mitigation
table) s
Measures
Overall Likelihood Impact Overall
s in place, increase supervision etc..

want to be.
Improveme
Risk Target
nt action
Owner Date
plan