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An annual self-assessment tool is created to assist each facility with the identification of potential risks and the development of defensive measures for future threats.

Threat Analysis

The Threat Analysis helps identify potential risks to your facility and assist in the development of a comprehensive assessment tool.  Specific threats are identified and analyzed so that security measures can be implemented to eliminate or reduce as much as possible imminent threats as well as potential threats to patients, visitors, staff and physical assets.  Every hospital needs to conduct an initial “Threat Analysis” followed by annual Self-Assessments to meet JCAHO Standards as well as industry norms. To meet JCAHO and industry standards, it is important for hospitals to develop an on-going assessment program with well defined, security protocols, policies, and procedures, reinforced with education and training.

Security Assessments International will be glad to evaluate your existing security practices and offer recommendations to assist you in the protection of patients, visitors, staff and high-value assets within an acceptable time frame and at a reasonable cost.

Hospital Security Risk Factors



1. Sensitive areas not equipped with controlled access or appropriate locking mechanism and maintained in the lock position at all times. 




2.  Open visitation with no visitor control.




3.      Access codes that are not changed periodically or upon termination or resignation of employees.




4.      Emergency Exits / Egresses not equipped with time delay locks and alarms. (Must meet NFPA Requirements)




5.      No video surveillance cameras installed in the nursery and pediatric units which monitor access into and out of  these sensitive areas.




6.      Closed Circuit Television Cameras without record and archive capability as well as cameras not positioned to capture appropriate images.




7.      Electronic Infant Protection Systems not equipped to alarm if a band is cut, falls off, or removed by an unauthorized individual and a system  not UL 294 Listed or with an equivalent listing.




8.      Facilities that have not had a comprehensive security assessment by a qualified healthcare security professional within the past 3 years?




9.    Hospitals that do not have appropriately written protocols, policies, and procedures, re-enforced with education and training, approved by the safety committee, and documented.




10.  Employees and Staff that do not wear a facility photo I.D. badge facing forward, at chest level that displays the hospital logo, individual's name, department, and professional credentials.




11.  Any education and training conducted that is not documented  in the employee’s education and training records.