Hospital Security Risk Assessment Form
Use this form to evaluate hospital security risks, document current controls and vulnerabilities, and record recommended mitigation actions.
Assessment Details
Department / Location
*
Please Select
Emergency Department
ICU
Operating Room
Radiology
Pharmacy
Laboratory
Admissions
Patient Ward
Main Entrance
Other
Area or Asset Being Assessed
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name / Role
*
Security Risk Evaluation
Threat Type
*
Unauthorized Access
Theft
Violence
Equipment Tampering
Data Exposure
Fire or Utility Failure
Other
Likelihood Rating
*
Rare
1
2
3
4
5
6
7
8
9
Almost Certain
10
1 is Rare, 10 is Almost Certain
Impact Rating
*
Minor
1
2
3
4
5
6
7
8
9
Severe
10
1 is Minor, 10 is Severe
Current Controls in Place
Badge Access Control
Security Camera Coverage
Alarm System
Security Patrols
Visitor Check-In Procedure
Locked Storage or Restricted Areas
Two-Person Access Control
Staff Training
Other
Identified Vulnerabilities
Recommended Mitigation Actions
Review and Prioritization
Overall Risk Priority
*
Low
Medium
High
Critical
Reviewer Comments / Approval Notes
Owner:
Owner
| Target date:
Target date
Submit
Should be Empty: