FRANSEN PITTMAN Infection Control Daily Inspection

• Inspection No.:

• Inspection Date:

  Date

• Project Name:

• Client Name:

• Inspection Conducted by:

• Subcontractors onsite:

• Note: Use of this form is not intended to be all encompassing, but is to be used to assist those responsible for implementation of safety procedures, practices , and general compliance with OSHA standards. This form will be used on a daily basis and all items noted for correction are to be monitored until noted as corrected on this form. A copy of this form is to remain onsite in the field office. Copy to main office and to any parties deemed necessary or appropriate.

General Observations:

• Describe contractor activities:

• Using floor plan location identifiers, describe construction traffic pathway. Note any healthcare staff traffic patterns that coincide with construction paths.

Project Observations:

• Is the static pressure greater than -0.02"w.g. (list actual readings in comments, identify manometer by serial number and location)?

  Yes

  No

  N/A

• Is the manometer tubing connected properly?

  Yes

  No

  N/A

• Is the manometer calibration up to date (list last calibration date, identify the manometer by serial number)?

  Yes

  No

  N/A

• Do the negative air machine (NAM) and exhaust ducts have good integrity?

  Yes

  No

  N/A

• Have the NAM pre-filters changed per ICRA requirements?

  Yes

  No

  N/A

• Have the manometers alarm has not been silenced?

  Yes

  No

  N/A

• Has the NAM HEPA filters changed per manufacturers instructions?

  Yes

  No

  N/A

• Are the NAM's on emergency power?

  Yes

  No

  N/A

• Are the manometers on emergency power?

  Yes

  No

  N/A

• Is the anteroom clean, with no dust, or debris?

  Yes

  No

  N/A

• The anteroom and work area doors are not being opened at the same time?

  Yes

  No

  N/A

• The HEPA vacuum is operating properly?

  Yes

  No

  N/A

• The HEPA vacuum is being used by construction personnel when leaving the work area?

  Yes

  No

  N/A

• All contractor's equipment is clean when passing through common pathways (elevators/corridors)?

  Yes

  No

  N/A

• Is the work area is clean and orderly?

  Yes

  No

  N/A

• Are the contractors complying with the traffic patterns?

  Yes

  No

  N/A

• Are the adhesive mats being changed before becoming ineffective?

  Yes

  No

  N/A

• Are the Corredor's free of construction related dust or debris?

  Yes

  No

  N/A

• Do the interior containment walls have good integrity?

  Yes

  No

  N/A

• Do the exterior containment walls have good integrity?

  Yes

  No

  N/A

• Is the Environmental Containment Unit (ECU) being used appropriately?

  Yes

  No

  N/A

• Are the contractors clearly displaying their ID badges (upper torso)?

  Yes

  No

  N/A

• Are the HVAC ducts being stored in a manner that maintains duct cleanliness?

  Yes

  No

  N/A

• Are all installed HVAC ducts being securely covered to protect cleanliness?

  Yes

  No

  N/A

• Is the domestic plumbing being stored in a manner to protect pipe cleanliness?

  Yes

  No

  N/A

• Are all installed domestic plumbing pipes being securely covered to protect cleanliness?

  Yes

  No

  N/A

Inspection Completion and Summary:

• Was the site free of issues? If no, what were the issues?

  Yes

  No

  N/A

• What were the corrective actions taken to eliminate those?

• Closing or Additional Comments?

Inspection Sign-off:

• Signature:

  Sign