Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Project Title:

  • Project Title:

Risk Class: I. II. III. IV.

  • Risk Class:

Inspector:

  • Inspector: William C. alford, Facilities Operations Supervisor

Post-Construction, Preoccupancy

  • Wet-mop area with disinfectant.

  • Barriers not removed until area thoroughly cleaned.

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

  • Renovation units thoroughly cleaned before admitting patients.

Utility Services

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

  • Drinking water

  • Sewage

  • Ventilation system

  • Medical Gases

  • Water lines have been flushed thoroughly in newly renovated and adjacent areas before occupancy.

Air Quality

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

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

Signatures:

  • Project Manager:

  • Infection Control:

  • Facilities Services:

  • Safety:

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