Nursing Home and Assisted Living Residence

Hazard and Vulnerability Analysis

_____________________________________

Long Term Care communities are required to conduct and annually review their Hazard
Vulnerability Analysis (HVA). The HVA provides a systematic approach to recognizing hazards
that may affect demand for nursing home or assisted living residences or its ability to provide those
services. The risks associated with each hazard are analyzed to prioritize planning, mitigation,
response and recovery activities. The HVA serves as a needs assessment for the Emergency
Management program. This process should involve your safety or emergency management
committee AND community partners (area emergency managers, fire and police departments and
emergency management services and be communicated to community emergency response
agencies.

This Hazard Vulnerability Analysis Tool is based on the Kaiser Permanente model and has been re-
designed specifically for nursing homes and assisted living residences. Copies of the templateare
included for review, but the template is a downloadable Excel Spreadsheet in which you record
your information and it automatically calculates your HVA scores.

This tool is an adjunct component to your overall emergency operations plan (EOP) and is not a substitute for a co

INSTRUCTIONS:

The purpose of this easy to use HVA Tool is to evaluate potential for

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 succes

Issues to consider for human impact include, but are not limited to:
1 Potential for staff death or inj
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 interruptio
2 Employees unable to report to work
3 Families unable to reach facility
4 Company in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplie
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 syste
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 MOU partn

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 agenci
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 ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

PROBABILITY HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL RISK
EVENT IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
Time, Community/
Likelihood this will Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff Relative threat*
occur death or injury and damages services
resouces and supplies

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

Banjir 1 1 2 3 2 2 2 22%
Kebakaran 2 3 3 3 2 2 3 59%
Gempa 2 3 3 3 3 3 3 67%
Puting beliung 1 2 3 2 3 3 3 30%
Wabah 2 3 1 3 3 2 2 52%
Petir 1 2 2 2 3 3 3 28%
AVERAGE SCORE 1.50 2.33 2.33 2.67 2.67 2.50 2.67 8%
106.16666666667
RISK = PROBABILITY * SEVERITY
0.08 0.22 0.37

Natural Hazards : 688817263.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL RISK
EVENT IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
Time, Community/
Likelihood this will Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff Relative threat*
occur death or injury and damages services
resouces and supplies
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 0 - 100%
Moderate
3 = High 3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High

Kegagalan Listrik 3 2 3 3 3 2 2 83%

Kegagalan
2 2 3 3 3 3 2 59%
genset/generator
Kehabisan BBM untuk
2 2 3 3 3 3 2 59%
genset
Kegagalan Gas Non
2 3 3 3 2 2 2 56%
Medis

Kegagalan Informasi 1 1 1 1 1 1 2 13%

Kebakaran Internal 2 3 3 3 2 2 2 56%

Kebakaran Eksternal 1 3 3 3 3 3 3 33%

Paparan limbah medis 3 3 2 1 2 3 3 78%

Kebocoran saluran air 1 1 2 1 2 3 3 22%

AVERAGE SCORE 1.89 2.22 2.56 2.33 2.33 2.44 2.33 11%

*Threat increases with percentage.

RISK = PROBABILITY * SEVERITY
0.11 0.30 0.37

Technological Hazards : 688817263.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

PROBABILITY RISK
HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL
IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
EVENT
Time, Community/
Likelihood this will Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff Relative threat*
occur death or injury and damages services
resouces and supplies
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

Insiden korban massal

1 1 1 1 3 3 3 22%
(Misal kecelakaan)

Insiden korban massal

(Medis/infeksius: Misal 3 3 1 2 2 2 2 67%
Keracunan, dll)

Insiden
kegawatdaruratan 3 3 1 2 3 3 3 83%
hidup

Teroris 1 1 1 3 3 3 3 26%

Tamu dengan
2 1 1 1 2 1 1 26%
protokoler

Penyanderaan 1 2 1 1 3 3 3 24%

Penculikan 1 2 1 1 3 3 3 24%

Pencurian 2 1 3 3 3 3 3 59%

Kehilangan pegawai 1 1 1 1 3 3 3 22%

Bom 1 3 3 3 3 3 3 33%

AVERAGE 1.60 1.80 1.40 1.80 2.80 2.70 2.70 43%

*Threat increases with percentage.

RISK = PROBABILITY * SEVERITY

Human Hazards : 688817263.xlsx

0.43 0.53 0.81

Human Hazards : 688817263.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY HUMAN PROPERTY BUSINESS PREPARED- INTERNAL EXTERNAL RISK
EVENT IMPACT IMPACT IMPACT NESS RESPONSE RESPONSE
Time, Community/
Likelihood this will Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff and Relative threat*
occur death or injury and damages services
resouces supplies
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 0 - 100%
Moderate
3 = High 3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High

Insiden hazmat korban 1 3 3 3 3 3 3 33%

massal (lebih dari 5)

Insiden hazmat korban 1 3 3 3 3 3 3 33%

massal (kurang dari 5)
Paparan bahan kimia 3 3 3 2 2 2 3 83%
internal
Paparan bahan kimia 2 3 2 3 2 2 3 56%
eksternal
Terorisme kimia 1 2 2 3 3 3 3 30%
Paparan radiasi 2 2 1 1 3 3 3 48%

AVERAGE 1.67 2.67 2.33 2.50 2.67 2.67 3.00 22%

*Threat increases with percentage.

RISK = PROBABILITY * SEVERITY

0.22 0.37 0.59

Hazardous Materials : 688817263.xlsx

 SUMMARY OF LONG TERM CARE COMMUNITY HAZARDS ANALYSIS

Total for Facility

Technological

Hazmat
Natural

Human
Probability 0.22 0.30 0.53 0.37 Err:508

Severity 0.37 0.37 0.81 0.59 Err:508

Hazard Specific Relative Risk:
0.08 0.11 0.43 0.22 Err:508

Hazard Specific Relative Risk to Long Term Care Facility

1.00
0.90
Relative Threat to Facility

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 to Long Term Care Facility

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

688817263.xlsx Summary