[EVENT NAME], [LOCATION]

Date and version of current assessment:	Choose date, select version	Led by: CO ☐ RO ☐ HQ ☐
Date(s) and version(s) of previous assessment(s):

Overall risk and confidence (based on information available at time of assessment)

Overall risk	Confidence in available information
National	Regional	Global	National	Regional	Global
Choose an item.	Choose an item.	Choose an item.	select	select	select

Risk statement

Risk questions (assess scenario where no further interventions are implemented)

Risk question	Assessment	Risk	Rationale
Likelihood	Consequences
Potential risk for human health?	National	select	select	select
Regional	select	select	select
Global	select	select	select
Risk of event spreading?	National	select	select	select
Regional	select	select	select
Global	select	select	select
Risk of insufficient control capacities with available resources?	National	select	select	select
Regional	select	select	select
Global	select	select	select

Major actions recommended by the risk assessment team

Action	Timeframe
☐	Refer the event for review by IHR Emergency Committee for consideration as a PHEIC by DG (Art 12, IHR)	Choose an item.
☐	Immediate activation of ERF response mechanism (IMS) as urgent public health response is required	Choose an item.
☐	Recommend setting up of grading call (funding can be accessed before grading completed)	Choose an item.
☐	Immediate support to response, but within limit of CFE (no grading recommended at this point in time)	Choose an item.
☐	Rapidly seek further information and repeat RRA (including field risk assessment)	Choose an item.
☐	Support Member State to undertake preparedness measures	Choose an item.
☐	Continue to closely monitor	Choose an item.
☐	No further risk assessment required for this event, return to routine activities	Choose an item.

+If chosen, list actions and identify persons responsible and due dates for each action in section 2 (Supporting information)

Communications

Target audience/ channel	Planned	Done	First date	Last update
Inform DDG and WHE ADG (HQ)	☐	Choose date	Choose date
Inform relevant RD and RED (RO)	☐	Choose date	Choose date
Inform WR (CO)	☐	Choose date	Choose date
Enter event into EMS (RO)	☐	Choose date	Choose date
Inform GOARN Operations Support Team (HQ)	☐	Choose date	Choose date
Share event via Event Information Site (EIS)	☐	☐	Choose date	Choose date
Share event via Disease Outbreak News (DON)	☐	☐	Choose date	Choose date
Public SitRep	☐	☐	Choose date	Choose date
Media talking points (coordinate with Communications)	☐	☐	Choose date	Choose date
Other – specify:	☐	☐	Choose date	Choose date

Supporting information

Hazard assessment

Expand

Exposure assessment

Expand

Context assessment

Brief context summary

Capacities	Vulnerabilities
Expand	Expand

Immediate actions (not a detailed response plan, state if no action required)

List here

Risk assessment team members

List names and roles

CO
RO
HQ

Reference documents used for risk assessment

List here