Business Impact Analysis



Business Impact Analysis Questionnaire

Unit/Department Name:

Description of Unit/Department’s Purpose in the Organization:

Name of Unit/Department’s Manager/Director:

In the followings table, list the functions/processes performed by the Unit/Department

(See document attached called “Health Care Processes Sample List” for ideas)

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For each function/process listed above, fill out a questionnaire sheet.

Completed by: Date:

Business Impact Analysis Questionnaire

1) Unit/Department Name:

2) Process Name:

3) Process Type:

5 Direct Patient Care

5 Ancillary Services

5 Financial Services

5 Decision Support

5 Executive Services/Support

5 Administrative/ Operations Support

5 Human Resources

5 Information Systems

5 Data Collection

4) Is the process critical to providing services to the Department/process type above? 5 Yes 5 No

5) Process Description (Describe the process and user workflow):

6) Process Dependencies:

a. Does this function depend on other departments within the organization? [pic][pic]

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b. Does this function depend on external organizations, partners, services, or products? [pic][pic]

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c. Are there compliance or accreditation requirements related to this function? [pic][pic]

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d. Is this function dependent on any hardware or software applications? [pic][pic]

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7) Type and number of resources required for resumption and recovery

|Resource |Description |Amount |

|Personnel | | |

|Vendor(s)/outside providers | | |

|IT hardware and software | | |

|Vital records (electronic or paper) | | |

|Medical equipment/supplies | | |

|Non-medical equipment/supplies | | |

|Facility/office space | | |

|Other | | |

8) Specify your estimated amount of exposure during each time period below (1-30 days), using the Impact Categories to classify the type of loss incurred and the loss ranges (see attached loss range rubric):

| | |Cumulative Impact after Day(s): |

|Impact Category |

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Completed by: Date:

Loss Range Rubric

The following number scores have been established to provide firm tangible and intangible exposure categories for cross-organizational comparison.

Tangible (financial) - Loss of revenue, additional expenses (e.g. overtime, equipment, services), regulatory/legal exposures

|Score |Loss Range |

|0 |Not applicable |

|1 |< $1,000 |

|2 |≥ $1,000 < $5,000 |

|3 |≥ $5,000 < $10,000 |

|4 |≥ $10,000 < $25,000 |

|5 |≥ $25,000 < $50,000 |

|6 |≥ $50,000 < $100,000 |

|7 |≥ $100, 000 < $150,000 |

|8 |≥ $150,000 < $250,000 |

|9 |≥ $250,000 < $500,000 |

|10 |≥ $500,000 |

Intangible – Patient safety, public image, market share, stakeholder relations

|Score |Effect |

|0 |None |

|2 |Minimal |

|4 |Moderate |

|6 |Moderately Heavy |

|8 |Heavy |

|10 |Severe |

Operations impact (indication of recovery time objective)

Score Effect

0. Not applicable

1. No impact

2. >72 hours

3. ................
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