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INSPECTION PRIORITY
LEVEL WORKSHEET
Inspection Priority Level Worksheet
Facility Name Data Entry Confirmation
Address
Date of Assessment Licensing Officer Previous Assessment Date Last Routine Inspection Date Hazard Rating at Last Insp Final Priority Rating
Initial
/ / Review / / / / _____ /65
DD MMM YYYY DD MMM YYYY DD MMM YYYY
CCFL GEN 200a (rev Aug 1, 2008) Fraser Health Authority – Community Care Facilities Licensing Program Page 1 of 2
Category Wt Weighted Summary Notes
(circle one number in each category) Rating
(score x wt )
(D) Facility Physical Plant Assessment x2 /10
5. Facility physical plant is extremely hazardous to client health
and safety
OR insufficient information is currently available
4. Facility physical plant is chronically a health and safety hazard
TOTAL: /65
CCFL GEN 200a (rev Aug 1, 2008) Fraser Health Authority – Community Care Facilities Licensing Program Page 2 of 2
VANCOUVER COASTAL
HEALTH
INSPECTION PRIORITY
LEVEL WORKSHEET
( Vancouver Coastal Health inspectors actually enter their assessments directly
into the health authority’s computer system and don’t use a paper worksheet.
However, the comments on the following worksheet are the same ones given to
inspectors when they enter data into their computers. )
The Licensed Community Care Facilities Risk Assessment Worksheet
Facility Name Data Entry Confirmation
Address
Risk Assessment Licensing Officer Last Risk Assessment Last Routine Hazard Rating at Final Risk
Date Initial Date Insp. Date Last Inspection Rating
Review
DD / MMM / YYYY DD / MMM / YYYY DD / MMM / YYYY _____ /65
TOTAL: /65
To ensure the risk assessment tool is providing correct information to others who may view it, licensing officers should include
a brief narrative description of the identified risks for every category that scores 3, 4 or 5. These reports are computer
generated and the scoring is done automatically to assign a risk score, thus a risk rating (low, moderate or high). If a facility
borders these risk rating or it is assessed by the licensing officer that a different risk rating should be assigned, the licensing
officer may collaborate with colleagues, review historical and new information and if deemed necessary override the automatic
category of risk rating given. If this is done it is essential that the licensing officer performing the risk assessment provide a
brief overview as to the reasons for the rating change.