PUSKESMAS IJEN
FORM ANALISIS INFECTION CONTROL RISK ASSESMENT (ICRA)
Hari/Tgl :
Unit Layanan :
Risk/Impact (Health, Financial,
Potential Probability / Frekuensi Legal, Regulatory) Current Systems/Preparedness
Risks/
Problems 4 3 2 1 0 5 4 3 2 1 5 4 3 2 1
Score
Clinical/ financial
limbFunction/j
Loss of life/
Prolonged
(function/
Serious Loss
Moderate
financial/
Length of
financial
financial
Minimal
Clinical/
Expect it
Maybe
stay
Likely
Never
Solid
Poor
Rare
Good
none
Fair
PUSKESMAS IJEN
Analisis Skala Prioritas Hasil ICRA
No JENIS SKOR PRIORITAS TUJUAN TUJUAN KHUSUS STRATEGI EVALUASi PROGRESS/
KELOM UMUM ANALISIS
POK
RISIKO