Risk Assessment for the Infection Surveillance, Prevention and Control (ISPC) Program Year: Organization Name: ________________________________ Date of Report: __________________ What is potential impact What is probability of What is organization’s Numerical Event or Condition of event/condition on event/condition preparedness to deal with risk level patients and staff? occurring? this event/condition? High Med Low None High Med Low None None Poor Fair Good Total (3) (2) (1) (0) (3) (2) (1) (0) (3) (2) (1) (0) Community & Populations served: EMERGING INFECTIOUS DISEASE
Risk Assessment for the Infection Surveillance, Prevention and Control (ISPC) Program Year: Organization Name: ________________________________ Date of Report: __________________ Event or Condition What is potential impact of event/condition on patients and staff? What is probability of event/condition occurring? What is organization’s preparedness to deal with this event/condition? Numerical risk level High (3) Med (2) Low (1) None (0) High (3) Med (2) Low (1) None (0) None (3) Poor (2) Fair (1) Good (0) Total Community & Populations served: EMERGING INFECTIOUS DISEASE
ASC_Risk_Assessment_Template.docx