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designsafe Report
Application:
Analyst Name(s):
Description:
Company:
Facility Location:
Product Identifier:
Assessment Type:
Detailed
Limits:
Sources:
Risk Scoring System:
Guide sentence: When doing [task], the [user] could be injured by the [hazard] due to the [failure mode].
Initial Assessment
Severity
Probability
Risk Level
Final Assessment
Severity
Probability
Risk Level
Status /
Responsible
/Comments
/Reference
User /
Task
Hazard /
Failure Mode
1-1-1
Anesthesiologist
move / lift / reposition
patients
Moderate
Unlikely
Low
Minor
Unlikely
Negligible
On-going [Daily]
Maurice Reynolds
1-2-1
Anesthesiologist
calibrate / test medical
monitoring equipment
electrical / electronic :
improper wiring
pH, temp, and DO probe
wires can be connected to
wrong input during
calibration.
Minor
Likely
Low
warning label(s)
Minor
Unlikely
Negligible
On-going [Daily]
Eric Hsu and Andrew Ng
1-2-2
Anesthesiologist
calibrate / test medical
monitoring equipment
Moderate
Unlikely
Low
Minor
Unlikely
Negligible
On-going [Daily]
Maurice Reynolds
1-3-1
Anesthesiologist
monitor patients
2-1-1
Surgical Technician
setup supplies / equipment /
instruments for operation
Serious
Unlikely
Medium
Moderate
Unlikely
Low
On-going [Daily]
Maurice Reynolds
Item Id
Page 1
11/30/2014
Initial Assessment
Severity
Probability
Risk Level
Final Assessment
Severity
Probability
Risk Level
Status /
Responsible
/Comments
/Reference
User /
Task
Hazard /
Failure Mode
2-1-2
Surgical Technician
setup supplies / equipment /
instruments for operation
electrical / electronic :
improper wiring
pH, temp, and DO probe
wires can be connected to
wrong input during
calibration.
Minor
Likely
Low
warning label(s)
Minor
Unlikely
Negligible
On-going [Daily]
Eric Hsu and Andrew Ng
2-1-3
Surgical Technician
setup supplies / equipment /
instruments for operation
Moderate
Unlikely
Low
Minor
Unlikely
Negligible
On-going [Daily]
Maurice Reynolds
2-1-4
Surgical Technician
setup supplies / equipment /
instruments for operation
material handling :
movement to / from storage
Minor
Likely
Low
Minor
Unlikely
Negligible
On-going [Daily]
Zoo Technicians
2-2-1
Surgical Technician
monitor machines
2-3-1
Surgical Technician
trouble shooting / problem
solving
electrical / electronic :
improper wiring
pH, temp, and DO probe
wires can be connected to
wrong input during
calibration.
Minor
Likely
Low
warning label(s)
Minor
Unlikely
Negligible
On-going [Daily]
Eric Hsu and Andrew Ng
2-3-2
Surgical Technician
trouble shooting / problem
solving
Moderate
Unlikely
Low
Minor
Unlikely
Negligible
On-going [Daily]
Maurice Reynolds
Item Id
Page 2