This customizable document, Risk Assessment - Interim Life Safety Hazard Analysis Worksheet, is taken from MCN Healthcare’s Ambulatory Services Environment of Care Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

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Here is some sample content from Risk Assessment - Interim Life Safety Hazard Analysis Worksheet:

	RISK ASSESSMENT INTERIM LIFE SAFETY HAZARD ANALYSIS WORKSHEET Rate Potential for Compromise on Scale of 5-1 5 being the highest possibility of occurrence or the weakest resources 1 being the least likely to occur or the strongest resources List Type of Construction Activity: New Construction/Renovation/Demolition Potential Compromise to: Potential for Compromise List Patient Care Areas Impacted List Non-Patient Care Areas Impacted List Public Access Areas Impacted List Control Activities Needed Air Requirements 1. 2. 3. Infection Control 1. 2. 3. Utility Failure - Check Effected...
Second excerpt:
	... 2. 3. Infection Control 1. 2. 3. Utility Failure - Check Effected Utility Communications/Telephone Electrical Generator Temperature HVAC Medical/Natural Gas Medical Vacuum Sewer Water Other: 1. 2. 3. 4. 5. 6. 7. 8. 9. Usual Noise Levels 1. 2. 3. 4. Vibration Levels 1. 2. 3. 4. Emergency Procedures Check Effected Procedure Fire Safety Emergency Disaster Management Security Other: 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. RISK ASSESSMENT - INTERIM...