Nursing Home and Assisted Living Residence

Hazard and Vulnerability Analysis

_____________________________________

Long Term Care communities are required to conduct and annually review their Hazard
Vulnerability Analysis (HVA). The HVA provides a systematic approach to recognizing hazards
that may affect demand for nursing home or assisted living residences or its ability to provide
those services. The risks associated with each hazard are analyzed to prioritize planning,
mitigation, response and recovery activities. The HVA serves as a needs assessment for the
Emergency Management program. This process should involve your safety or emergency
management committee AND community partners (area emergency managers, fire and police
departments and emergency management services and be communicated to community
emergency response agencies.

This Hazard Vulnerability Analysis Tool is based on the Kaiser Permanente model and has been
re-designed specifically for nursing homes and assisted living residences. Copies of the
templateare included for review, but the template is a downloadable Excel Spreadsheet in which
you record your information and it automatically calculates your HVA scores.

This tool is an adjunct component to your overall emergency operations plan (EOP) and is not a substitute for a co

INSTRUCTIONS:

The purpose of this easy to use HVA Tool is to evaluate potential for

Issues to consider for probability include, but are not limited to:
1 Known risk
2 Historical data
3 Manufacturer/vendor statistic

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 succe

Issues to consider for human impact include, but are not limited to:
1 Potential for staff death or inj
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 interrupti
2 Employees unable to report to work
3 Families unable to reach facility
4 Company in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplie
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 syste
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 MOU partn

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 agenc
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 ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS

KEPARAHAN = (MAGNITUDE-MITIGASI)
KEMUNGKINA DAMPAK THD DAMPAK THD DAMPAK THD RESPON RESPON
N KESIAPAN
PERISTIWA MANUSIA PROPERTI BISNIS INTERNAL EKSTERNAL
Kemungkinan Masyarakat/staff
kemungkinan Kerugian fisik dan Kesiapan Waktu, efektivitas,
kematian atau Interupsi layanan dan pemasok yg
akan terjadi kerusakan sebelumnya sumber daya
luka saling membantu

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

1 = Rendah 1 = Rendah 1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tinggi 1 = Tinggi
SKOR 2= 2= 2= 2= 2 = Sedang 2 = Sedang 2 = Sedang
Sedang 3 Sedang 3 Sedang 3 Sedang 3 3 = Rendah atau 3 = Rendah atau 3 = Rendah atau
= Tinggi = Tinggi = Tinggi = Tinggi tidak ada tidak ada tidak ada

ANGIN TOPAN 0 1 3 2 0 0 0
BADAI 0 1 3 2 0 0 0
BADAI PETIR 0 1 3 2 0 0 0
TANAH LONGSOR 0 2 2 2 0 0 0
GELOMBANG PASANG 0 0 0 0 0 0 0
SUHU EKTREM 0 2 2 1 0 0 0
KEKERINGAN 0 1 0 1 0 0 0
KEBAKARAN 1 3 3 3 1 2 2
DAM JEBOL 0 1 1 0 0 0 0
GEMPA BUMI 1 2 2 1 2 1 2
WABAH PENYAKIT 1 1 0 0 1 1 2
BANJIR 0 1 1 0 0 0 1
ERUPSI GUNUNG MELETUS 0 2 2 1 0 0 0
AVERAGE SCORE

*Threat increases with percentage.

3
0.19 1.13 1.38 0.94 0.25 0.25 0.44
70

RISK = PROBABILITY * SEVERITY

0.02 0.06 0.24

Natural Hazards : 445190633.xlsx

 RESIKO

Ancama relativ

0 - 100%

0%
0%
0%
0%
0%
0%
0%
26%
0%
19%
9%
0%
0%

0%
0%

2%

Natural Hazards : 445190633.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
KEPARAHAN = (MAGNITUDE-MITIGASI)
KEMUNGKINA DAMPAK
DAMPAK THD DAMPAK THD RESPON RESPON
N THD KESIAPAN
PERISTIWA PROPERTI BISNIS INTERNAL EKSTERNAL
MANUSIA

Kemungkinan Masyarakat/staff
kemungkinan Kerugian fisik Kesiapan Waktu, efektivitas,
kematian atau Interupsi layanan dan pemasok yg
akan terjadi dan kerusakan sebelumnya sumber daya
luka saling membantu

0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1=
1 = Rendah 1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tinggi 1 = Tinggi
Rendah
SKOR 2=
2=
2= 2= 2 = Sedang 2 = Sedang 2 = Sedang
Sedang 3 Sedang Sedang 3 3 = Rendah atau 3 = Rendah atau 3 = Rendah atau
Sedang
= Tinggi 3 = Tinggi = Tinggi tidak ada tidak ada tidak ada
3 = Tinggi
GANGGUAN LISTRIK 1 2 2 2 2 2 2
GANGGUAN AC 1 1 1 1 2 2 2
GANGGUAN GENSET 1 2 2 2 2 2 2

GANGGUAN TRANSPORTASI
GANGGUAN GAS LPG
GANGGUAN KOMUNIKASI
GANGGUAN SISTEM INFORMASI
KEBAKARAN
GANGGUAN AIR
GANGGUAN SALURAN PEMBUANGAN
GANGGUAN ALARM KEBAKARAN
GANGGUAN VACUM MEDIS
0 0
1 1
1 1
1 1
2 3
1 2
0 0
2 2
1 2
0 0 0 0 0
3 1 2 2 2
1 2 2 2 3
1 2 2 2 0
3 3 2 2 2
1 1 2 2 2
0 0 0 0 0
2 2 2 2 2
1 2 2 2 2

GANGGUAN PAPARAN B3 (INTERNAL) 2 2 0 2 2 2 2

GANGGUAN SUPLAY 2 1 0 2 2 2 2

KERUSAKAN STRUKTUR BANGUNAN 0 0 0 0 0 0 0

GANGGUAN GAS MEDIS 1 3 1 2 2 2 2
AVERAGE SCORE

*Threat increases with percentage.

17 0.89 1.21 0.95 1.26 1.37 1.37 1.32

142
RISK = PROBABILITY * SEVERITY
0.12 0.30 0.42

Technological Hazards : 445190633.xlsx

 RESIKO

Ancama relativ

0 - 100%

22%
17%
22%

0%
20%
20%
15%
56%
19%
0%
44%
20%

37%

33%

0%
22%
0%
0%
12%

Technological Hazards : 445190633.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS

KEPARAHAN = (MAGNITUDE-MITIGASI)
KEMUNGKINA DAMPAK DAMPAK
DAMPAK THD RESPON RESPON
N THD THD KESIAPAN
BISNIS INTERNAL EKSTERNAL
PERISTIWA MANUSIA PROPERTI

Kemungkinan Masyarakat/staff
kemungkinan Kerugian fisik Kesiapan Waktu, efektivitas,
kematian atau Interupsi layanan dan pemasok yg
akan terjadi dan kerusakan sebelumnya sumber daya
luka saling membantu

0 = N/A 0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A
1= 1=
1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tinggi 1 = Tinggi
Rendah Rendah
SKOR 2=
2= 2=
2= 2 = Sedang 2 = Sedang 2 = Sedang
Sedang 3 Sedang 3 3 = Rendah atau 3 = Rendah atau 3 = Rendah atau
Sedang Sedang
= Tinggi = Tinggi tidak ada tidak ada tidak ada
3 = Tinggi 3 = Tinggi

Musibah Massal (trauma) 1 1 1 1 2 2 2

Musibah Massal (infeksi/medis)) 2 2 1 2 2 2 2

Ancaman gas biologis 0 0 0 0 0 0 1

Penculikan anak 1 2 2 3 2 2 2

Penyanderaan 0 0 0 0 0 0 0

Hura-hura civil 0 0 0 0 0 0 0

Situasi VIP 0 0 0 0 0 0 0

Ancaman Bom 1 3 3 3 2 2 2

AVERAGE

*Threat increases with percentage.

0.50 0.80 0.70 0.90 0.80 0.80 0.90

49

RISK = PROBABILITY * SEVERITY

0.05 0.17 0.30

Human Hazards : 445190633.xlsx

 RESIKO

Ancama relativ

0 - 100%

17%

41%

0%

24%

0%

0%

0%

28%

0%

0%

0%

5%

Human Hazards : 445190633.xlsx

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
KEPARAHAN = (MAGNITUDE-MITIGASI)
KEMUNGKINA DAMPAK RESIKO
DAMPAK THD DAMPAK THD RESPON RESPON
N THD KESIAPAN
PERISTIWA MANUSIA
PROPERTI BISNIS INTERNAL EKSTERNAL
Kemungkinan Masyarakat/staff
kemungkinan Kerugian fisik dan Kesiapan Waktu, efektivitas,
kematian atau Interupsi layanan dan pemasok yg Ancama relativ
akan terjadi kerusakan sebelumnya sumber daya
luka saling membantu
0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A
1= 0 = N/A 0 = N/A 1
1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tinggi
Rendah 1 = Rendah = Tinggi 2=
SKOR 2=
2= 2 = Sedang
2= 2 = Sedang 2 = Sedang
Sedang 3= 0 - 100%
Sedang 3 Sedang 3 3 = Rendah atau 3 = Rendah atau
Sedang 3 = Tinggi Rendah atau tidak ada
= Tinggi = Tinggi tidak ada tidak ada
3 = Tinggi

Mass Casualty
Hazmat Incident 1 1 1 0 1 1 1 9%
(insiden massal
disebabkan bahan
berbahaya, korban >5)

Small Casualty
Hazmat Incident
(insiden massal 1 1 1 0 1 1 1 9%
disebabkan bahan
berbahaya, korban
<5)
Paparan kimia 0 1 0 0 0 0 0 0%
(eksternal)
Tumpahan B3 Kecil 1 1 1 1 1 1 1 11%

Tumpahan B3 Besar
Paparan Radiasi
(eksternal)
Paparan Radiasi
(internal)
Terorisme, radiologi
AVERAGE
1 1
1 2
1 0
0 0
1 1
0 1
1 1
0 0
1 1 1 11%
1 1 1 11%
1 1 1 9%
0 0 0 0%
0%

0.67 0.78 0.56 0.44 0.67 0.67 0.67 5%

*Threat increases with percentage.
6
RESIKO = KEMUNGKINAN * KEPARAHAN
34
0.05 0.22 0.21

Hazardous Materials : 445190633.xlsx

 SUMMARY OF LONG TERM CARE COMMUNITY HAZARDS ANALYSIS

Total for Facility

Technological

Hazmat
Natural

Human
Probability 0.06 0.30 0.17 0.22 0.19

Severity 0.24 0.42 0.30 0.21 0.30

Hazard Specific Relative Risk:
0.02 0.12 0.05 0.05 0.06
R e la tiv e T h re a t to F a c ility

Hazard Specific Relative Risk to Long Term Care Facility

1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Natural Technological Human Hazmat
Relative Im pact on F acility

Probability and Severity of Hazards to Long Term Care Facility

1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Probability Severity

445190633.xlsx Summary