Risk Assessment Template.

Risk Assessment Template
Risk Owner Assessment Conducted By
Establish the Context Risk Description Effectiveness of Controls Analysis
Evaluation
Objective Context Risk Source Description Current Control(s) Control Rating Risk Rating
Clinical
To prevent
medication
administration error
Internal factors –
Behavioral and
knowledge factors
External factors –
Workplace
disruption
Medication
administration error
Something might occur which
{Cause(s)} the {Event} that leads to
an {Impact/Consequence(s)}
Cause – lack of knowledge or
confidence issues
Event – medication administration
error
Impact – aggravation of patient’s
health, can be fatal
Supervision, policy,
audits and training
Medication
administration
efficiency scales
Use likelihood and
consequence table
and risk matrix.
Patient B suffered from a severe
systematic symptoms after
being administered with the
wrong medication diazepam
instead of Beta blocker.
Business objective:
Increase service
productivity to core
clients by 10 % in 1
year
Obsolete
technology;
budgetary
constraints; change
in management
Change in
management; change
in government funding;
changes in legislation
Cause
E.g. Failure
to maintain
client service
managemen
t system
Event
E.g.
Leads to
delays in
service
delivery
Impact
E.g. Results
in poor
service level
to core
clients
Governance
committee; policies
and procedures;
quality improvement
plans
High, Medium or
Low
Rating = Likelihood x
Consequence
Risk evaluation involves
comparing the level of risk found
during the analysis process with
risk criteria established when the
context was considered. Based on
this comparison, the need for
treatment can be considered.
Options for treatment may include:
 Avoidance of risk
 Pursuing risk
 Removing risk source
 Changing likelihood
 Changing consequence
 Sharing risk with another
party
 Retaining the risk
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