Title Page

  • Conducted on

  • Prepared by

  • Location


  • Project Risk Assessment posted

  • Checklist current


  • Negative pressure maintained

  • HEPA air scrubbers in use

  • Air scrubber filters clean

  • Return vents filtered or sealed per PRA


  • Door closed to construction area

  • Appropriate barrier utilized according to PRA

  • All areas sealed at all seams

  • Barriers that cross through vents are sealed appropriately

  • No holes or tears in barrier


  • Sticky mats in place and functional

  • Patient equipment and supplies removed from area or covered per PRA

  • Area outside construction area remains clean

  • Clean Equipment brought into high risk areas

  • PPE donned and Doffed according to PRA

  • Construction debris removed in cleaned covered containers

  • Daily cleaning of construction area

  • HEPA filter vacuum utilized for cleaning

Quality Measures

  • Air particle count completed

  • Negative air pressure monitored

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.