HAZARD AND VULNERABILITY ASSESSMENT TOOL

NATURALLY OCCURRING EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

DAMPAK DAMPAK DAMPAK RESPON RESPON RISK
PERISTIWA KEMUNGKINAN MANUSIA PROPERTI BISNIS KESIAPAN INTERNAL EKSTERNAL
Time, Community/
Possibility of Physical losses Interuption of
Likelihood this will occur Preplanning effectivness, Mutual Aid staff Relative threat*
death or injury and damages services
resouces and supplies

0 = N/A 1= 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A

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

Gempa bumi 0 0 0 0 0 0 0 0%

Gelombang pasang 0 0 0 0 0 0 0 0%
Suhu Ekstrim 0 0 0 0 0 0 0 0%
Kekeringan 0 0 0 0 0 0 0 0%

Banjir, Eksternal 0 0 0 0 0 0 0 0%

Banjir 0 0 0 0 0 0 0 0%

Tanah longsor 0 0 0 0 0 1 0 0%

Genangan Bendungan 0 0 0 0 0 0 0 0%

Gunung berapi 0 0 0 0 0 0 0 0%

Epidemi 0 0 0 0 0 0 0 0%

0.00 0.00 0.00 0.00 0.00 0.06 0.00 0%

SKOR RATA - RATA
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
1 0.00 0.00 0.00

Natural Hazards : 707783022.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
KEMUNGKINAN DAMPAK DAMPAK DAMPAK RESPON RESPON RISK
PERISTIWA MANUSIA PROPERTI BISNIS KESIAPAN INTERNAL EKSTERNAL
Time, Community/
Possibility of Physical losses Interuption of
Likelihood this will occur Preplanning effectivness, Mutual Aid staff Relative threat*
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%
3 = High Moderate
3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High
Kegagalan Listrik 1 1 1 0 2 3 3 19%
Kegagalan Pembangkit 1 1 1 0 3 3 3 20%
Kegagalan Transportasi 0 0 0 0 0 0 0 0%
Kekurangan Bahan Bakar
1 1 0 0 2 2 2 13%

Kegagalan Gas Alam 0 0 0 0 0 0 0 0%

Kegagalan Air 3 3 0 3 2 2 0 56%
Kegagalan Saluran
3 3 3 3 2 2 2 83%
Pembuangan
Kegagalan Uap 0 0 0 0 0 0 0 0%
Kegagalan Alarm
0 0 0 0 0 0 0 0%
Kebakaran
Kegagalan Komunikasi 3 3 0 3 1 1 1 50%
Kegagalan Gas Medis 1 1 1 3 3 3 3 26%
Kegagalan Vakum Medis
0 0 0 0 0 0 0 0%

Kegagalan HVAC 0 0 0 0 0 0 0 0%
Kegagalan Sistem Informasi 0 0 0 0 0 0 0 0%
Api, Internal 1 1 1 1 3 3 3 22%
Banjir, Internal 0 0 0 0 0 0 0 0%
Paparan Hazmat, Internal
0 0 0 0 0 0 0 0%

Kekurangan Pasokan 0 0 0 0 0 0 0 0%
Kerusakan Struktural 0 0 0 0 0 0 0 0%
SKOR RATA - RATA 0.74 0.74 0.37 0.68 0.95 1.00 0.89 6%

*Threat increases with percentage.

14 RISK = PROBABILITY * SEVERITY
88 0.06 0.25 0.26
Technological Hazards : 707783022.xlsx
 HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS

SEVERITY = (MAGNITUDE - MITIGATION)

RISK
DAMPAK DAMPAK DAMPAK RESPON RESPON
MANUSIA PROPERTI BISNIS KESIAPAN INTERNAL EKSTERNAL
KEMUNGKINAN
Time, Community/
Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff Relative threat*
PERISTIWA death or injury and damages services
resouces and supplies
0 = N/A
0 = N/A 1 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1 = Low
= Low 2 1 = Low 1 = Low 1 = High 1 = High 1 = High
= Moderate 3
2=
2 = Moderate 2 = Moderate 2 = Moderate 3 2 = Moderate 2 = Moderate 0 - 100%
Moderate
= High 3 = High 3 = High = Low or none 3 = Low or none 3 = Low or none
3 = High

Insiden Korban Massal 0 0 0 0 0 0 0 0%

(trauma)

Insiden Korban Massal 0 0 0 0 0 0 0 0%

(medis/menular)
0 0 0 0 0 0 0 0%
Terorisme, Biologis
0 0 0 0 0 0 0 0%
Situasi VIP
0 0 0 0 0 0 0 0%
Penculikan Bayi
0 0 0 0 0 0 0 0%
Situasi Penyanderaan
0 0 0 0 0 0 0 0%
Gangguan Sipil
0 0 0 0 0 0 0 0%
Aksi Buruh

0 0 0 0 0 0 0 0%
Penerimaan Forensik
0 0 0 0 0 0 0 0%
Ancaman Bom
SKOR RATA - RATA
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%

*Threat increases with percentage.

0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00

Human Hazards : 707783022.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY RISK
DAMPAK DAMPAK DAMPAK RESPON RESPON
MANUSIA PROPERTI BISNIS KESIAPAN INTERNAL EKSTERNAL
Time, Community/
Likelihood this will Possibility of Physical losses Interuption of
Preplanning effectivness, Mutual Aid staff Relative threat*
PERISTIWA 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 = High
1 = Low 1 = Low 1 = Low 1 = High 1 = High
2 = Moderate
2=
2 = Moderate 2 = Moderate 2 = Moderate 3 2 = Moderate
2 = Moderate 0 - 100%
Moderate 3 = Low or
3 = High 3 = High 3 = High = Low or none 3 = Low or none
3 = High none

Insiden Hazmat 0 0 0 0 0 0 0 0%
Korban Massa
Insiden Hazmat 0 0 0 0 0 0 0 0%
Korban Kecil
Paparan Bahan Kimia, 0 0 0 0 0 0 0 0%
Eksternal
Tumpahan Internal
Berukuran Kecil- 0 0 0 0 0 0 0 0%
Sedang
Tumpahan Internal 0 0 0 0 0 0 0 0%
Besar
Terorisme, Kimia 0 0 0 0 0 0 0 0%
Paparan Radiologi, 0 0 0 0 0 0 0 0%
Internal
Paparan Radiologi, 0 0 0 0 0 0 0 0%
Eksternal
0 0 0 0 0 0 0 0%
Terorisme, Radiologi
AVERAGE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%

*Threat increases with percentage.

RISK = PROBABILITY * SEVERITY
0
0 0.00 0.00 0.00

Hazardous Materials : 707783022.xlsx

 SUMMARY OF HAZARDS ANALYSIS

Total for Facility

Technological

Hazmat
Natural

Human
Probability 0.00 0.25 0.00 0.00 0.09
Severity 0.00 0.26 0.00 0.00 0.09
Hazard Specific Relative Risk:
0.00 0.06 0.00 0.00 0.01

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

707783022.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 Cilincing dalam bermeditasi keselamata
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 Cilinicing adalah gempa bumi, banjir, penculikan

Jakarta, 2 Januari 2018

Dibuat oleh

Dr. Rafael

Ketua
temen di RSUD Cilincing dalam bermeditasi keselamatan pasien dan keamanan, pengunjung dan bekerja selama 2018.
n yang tidak bisa ia dilaksanakan sesuai kondisi yang sebenarnya jadi kita dari tim K3RS permintaan positif saran sebagai evalua
RSUD Cilinicing adalah gempa bumi, banjir, penculikan bayi, dan kebakaran

Diketahui

Director
Dr. Netty Siahaan, M.K.M
NIP 196104241987112001
 bekerja selama 2018.
aan positif saran sebagai evaluasi yang penting dari program dilaksanakan dan membuat referensi untuk melakukan program perb
k melakukan program perbaikan untuk tahun depan.