APPENDIX 2 ENHANCED ENVIRONMENTAL RISK ASSESSMENT (IMPORTANT: Read guidance notes before completing form and refer to Risk – Management Strategy for risk matrix definitions) IDENTIFIED HAZARD ENVIRONMENTAL RISK ASSESSMENT PROFORMA PATIENT NAME: ADDRESS: NHS NO ASSESSMENT DATE: Impact/Consequences Likelihood Risk Rating COMPLETED BY Negligible 1 Rare 1 Form to be Minor 2 Unlikely 2 SIGNED OFF BY completed for risk Moderate 3 Possible 3 ratings 8 and over Major 4 Likely 4 5 Catastrophic Almost Certain 5 EXISTING CONTROLS HAZARD POSSIBLE RISK RATING FURTHER ACTION REVISED RISK EFFECT RATING * e.g. animal Impact/Consequence e.g. patient agreed to restrain/removal e.g. bite, allergic x Likelihood = animal Severity x Likelihood reaction Risk = Risk
APPENDIX 2 – ENHANCED ENVIRONMENTAL RISK ASSESSMENT (IMPORTANT: Read guidance notes before completing form and refer to Risk Management Strategy for risk matrix definitions) IDENTIFIED HAZARD ENVIRONMENTAL RISK ASSESSMENT PROFORMA PATIENT NAME: ADDRESS: NHS NO ASSESSMENT DATE: Impact/Consequences Likelihood Risk Rating Negligible 1 Rare 1 Form to be completed for risk ratings 8 and over Minor 2 Unlikely 2 Moderate 3 Possible 3 Major 4 Likely 4 Catastrophic 5 Almost Certain 5 COMPLETED BY SIGNED OFF BY HAZARD e.g. animal POSSIBLE EFFECT e.g. bite, allergic reaction EXISTING CONTROLS RISK RATING Impact/Consequence x Likelihood = Risk FURTHER ACTION e.g. patient agreed to restrain/removal animal REVISED RISK RATING * Severity x Likelihood = Risk
EnvironmentalRiskAssessment.docx