Healthcare Facility Security Risk Assessment Form

Facility Information

Facility Name Location/Address Contact Person Date of Assessment

Assessors

Names of Assessors

Facility Security Features

Number of Entry Points Number of Security Personnel Types of Access Controls CCTV Systems Present Not Present Alarm Systems Present Not Present

Identified Risks

Risk	Likelihood	Impact	Mitigation
	Low Medium High	Low Medium High
	Low Medium High	Low Medium High

Recommendations

Approval

Approved By Approval Date