Banner Del E. Webb Post-Construction Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project Title:

• Project Title:

  Yes

  No

  N/A

Risk Class: I. II. III. IV.

• Risk Class:

  Yes

  No

  N/A

Inspector:

• Inspector: William C. alford, Facilities Operations Supervisor

  Yes

  No

  N/A

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.

  Yes

  No

  N/A

Utility Services

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

  Yes

  No

  N/A

• Drinking water

  Yes

  No

  N/A

• Sewage

  Yes

  No

  N/A

• Ventilation system

  Yes

  No

  N/A

• Medical Gases

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Air Quality

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Signatures:

• Project Manager:

  Yes

  No

  N/A

• Infection Control:

  Yes

  No

  N/A

• Facilities Services:

  Yes

  No

  N/A

• Safety:

  Yes

  No

  N/A