Banner Del E. Webb Pre-Construction Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project Title: Month/year:

• 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

Occupational Health documents have been reviewed with contractor

• Contractor will provide evidence of compliance with OSHA regulations regarding the Blood Borne Pathogen Standard, prior to employees coming on site.<br>

  Yes

  No

  N/A

• Contractor will provide evidence of all employees being free of active tuberculosis (e.g. TB skin test or questionnaire).

  Yes

  No

  N/A

Site is free of hazardous materials prior to contractor arrival

• Sharps and other hazardous materials have been properly disposed of prior to start of project

  Yes

  No

  N/A

Plan for construction site containment reviewed.

• Temporary construction partitions will be smoke tight and built of non-combustible material.

  Yes

  No

  N/A

• Windows closed.

  Yes

  No

  N/A

• All penetrations into the construction area must be sealed.

  Yes

  No

  N/A

• Air ducts capped.

  Yes

  No

  N/A

• Construction barricade entrances must have doors that are smoke tight.

  Yes

  No

  N/A

• Self-closing latching hardware.

  Yes

  No

  N/A

Air Quality plan has been reviewed

• Air intake systems will be blocked or redirected.

  Yes

  No

  N/A

• Location of and erection methods for interim dust barriers reviewed.

  Yes

  No

  N/A

• Ventilation and filtration assessed for effectiveness.

  Yes

  No

  N/A

• Equipment will be available for particulate capture (such as HEPA vacuum) and equipment in working order.

  Yes

  No

  N/A

• Negative pressure will be maintained within the project site y use of negative air fan units and vented directly outside.

  Yes

  No

  N/A

• Limitations/restrictions for outdoor construction/demolition activities reviewed.

  Yes

  No

  N/A

Plan for construction traffic is reviewed

• Circulation and traffic control patterns appropriate.

  Yes

  No

  N/A

• Movement of workers between construction and patient care areas is restricted.

  Yes

  No

  N/A

• Employees, patients and visitors able to avoid construction areas.

  Yes

  No

  N/A

• Hand washing and restroom facilities designated for construction workers.

  Yes

  No

  N/A

Plan for debris removal is appropriate for dust reduction

• If debris removal necessary in patient care areas, patients to be in their rooms with the door closed.

  Yes

  No

  N/A

• Debris is transported in covered containers.

  Yes

  No

  N/A

• Dust tracked outside of the barrier will be removed immediately.

  Yes

  No

  N/A

• Cleaning in patient care areas shall be by camp method or with HEPA filtered vacuum cleaners.

  Yes

  No

  N/A

Plan for maintenance of water quality is reviewed.

• No renovations that create/allow for dead end water pipes.

  Yes

  No

  N/A

Construction rounds will be performed frequently to facilitate communication when problems arise

• Representatives attend from:<br> Safety<br> Infection Control<br> Engineering<br> Facilities Services

  Yes

  No

  N/A