Risk assessment and intervention plan

Template

Download the DISASTERS & EMERGENCIES:
Pre-incident Assessment and Intervention Plan Template

This template includes:

1. PRE-INCIDENT ASSESSMENT

PART A: Assessment & Situation
PART B: Participant and Environmental Risk Factors
PART C: Mitigation measures and Referral pathways
PART D: Internal rooms & External environment: Photos & other details

2. INTERVENTION PLAN

Use:

  1. This tool should be completed in consultation with the individual (s) concerned i.e. those living and working in the environment
  2. Risks identified and advice on potential  mitigation strategies should be discussed with the individual
  3. The functional profile of the individual (s) in the home (e.g. mental health, physical impairment, cognitive impairment) on the referral will provide some indication of their ability to respond in an emergency situation.

NOTE:

A. This tool is NOT designed to be used in a situation where this is an imminent risk e.g. storm, bushfire etc. In these situations refer to your organisational policies for priority actions.

B. This is not an exhaustive tool. It is an optional supplement to your current Disasters & Emergencies Protocols and Planning.

C. It is a potential starting point for you to build on to meet the specific needs of your Participants and workers.

D. It is a Word document so you can alter it to meet your needs (see the web site for instructions on how to do this i.e. how to edit a Form).