Pre-Construction Risk Assessment

For Safety and Infection Control

Date:______Facility:______Location:______

Project Name:______Surveyed By: ______

Yes No N/A

A.  Will construction affect exit routes from occupied areas adjacent
to construction site?
Will a 1-HR fire rated construction barrier be used on this project?
Will Interim Life Safety Measures be enforced during this project?
B. Are any of the following environmental hazards present?
1. Sharps containers
2. Biohazardous waste
3. Asbestos
4. Lead, Mercury, or other heavy metals
5. Radioactive materials or radiation
6. Hazardous chemicals
7. Confined spaces
C. Will any of the following systems be adversely affected?
1. Electrical
2. Domestic water
3. Medical gases
4. Sewage
5. HVAC
6. Fire alarm
7. Paging
8. Sprinkler
9. Nurse Call
10. Code Blue
11. Computer
12. Telephone
13. Intercom
14.  Structural steel
15.  Rated partitions
16.  Pneumatic Tube
17.  Floor/Ceiling assembly

Pre-Construction Assessment

Page 2

Yes No N/A

D. Infection Control
1.  Construction workers have been orientated and trained in the Infection Control plan and system procedures in the event of an emergency?
2.  Dust barriers assessed for efficiency related to ability to prevent airborne particulate escape?
3.  Negative airflow ventilation and/or filtration planned and assessed for effectiveness?
4.  Equipment available and in working order for particulate capture, such as HEPA vacuum?
5.  Circulation and travel control patterns reviewed and evaluated?
6.  Limitations/restrictions for outdoor construction/demolition activities reviewed with contractor?
7.  Negative air fans in place and functioning?
8.  HEPA filtration unit available and in working order for adjacent patient care areas?
9.  Are there times when workers may not be in project area? Specify:______
E.  Are there patients or employees in the area of the project?
1.  If yes, do the patients or employees have any immuno-compromising conditions, pulmonary conditions or both?
2.  If yes, are there patients or employees with sensitivity to dust or mold or have allergies, asthma or both?
3.  If yes, are the patients or employees sensitive to noise or vibration?
4.  If yes, are there procedures, work processes or testing done that are sensitive to noise or vibration?
5.  If yes, are there supplies in areas where dust may be produced?
6.  Has an Infection Control Construction Risk Assessment been done and sent to Epidemiology?

Comments:______

______

______

Infection Control Nurse:______Date:______

Project Manager:______Date:______

Safety Officer:______Date:______

Architectural Manager:______Date:______

Pre-Construction Risk Assessment Form.msw.bk Revised 3/3/05