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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