Banner Del E. Webb Med. Ctr. Post-Construction Inspection Form

• Document No.

• Project Name - Location

• Client / Site

• Conducted on:

  Date

• Prepared by:

• Inspected by:

ICRA Risk Class: I. II. III. IV.

• Class - I, II, III, or IV

  Risk Class I

  Risk Class II

  Risk Class III

  Risk Class IV

Inspector:

• Inspected by:

Post-Construction, Preoccupancy

• Wet-mop area with disinfectant.

  Yes

  No

  N/A

• Barriers not removed until area thoroughly cleaned.

  Yes

  No

  N/A

• Barriers not removed until area inspected by Safety and Infection Control.

  Yes

  No

  N/A

• Renovation units thoroughly cleaned before admitting patients.

  Safe

  At Risk

  N/A

Utility Services

• Water lines have been flushed thoroughly in newly renovated and adjacent areas before occupancy. This also applies to areas that have been vacant for a period of time and are being put back into service.

  Safe

  At Risk

  N/A

• Provide documentation of correct procedures following re-establishment of interrupted utility services, including but not limited to:

  Safe

  At Risk

  N/A

• Domestic water

• Sewage system

• HVAC System

• Medical Gasses

Air Quality

• If air ducts were not completely sealed, filters were removed & changed.

  Safe

  At Risk

  N/A

• Remove isolation of HVAC system in areas where work is being performed.

  Safe

  At Risk

  N/A

Additional Comments and/or photos

• Photos

  Media

• Comments:

Signatures:

• Development & Construction Rep:

  Sign

• Facilities Services Rep:

  Sign

• Safety Rep:

  Sign

• Infection Prevention Rep:

  Sign

• Contractor/Vendor Rep:

  Sign