Interim Life Safety Measures and Infection Control Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Interim Life Safety Measures

• 1. All exits are unobstructed and useable, including construction area.

  Yes

  No

  N/A

• 2. Alternate routes are identified if required.

  Yes

  No

  N/A

• 3. All personnel have training if alternate exits have been designated.

  Yes

  No

  N/A

• 4. Construction workers know the means of egress.

  Yes

  No

  N/A

• 5. The means of egress in the construction area are inspected daily.

  Yes

  No

  N/A

• 6. There is free and unobstructed means to access emergency services.

  Yes

  No

  N/A

• 7. The fire alarm detection and suppression systems are not impaired.

  Yes

  No

  N/A

• 8. A temporary, but equivalent, system is provided when fire system is impaired and is inspected, tested and documents monthly.

  Yes

  No

  N/A

• 9. Before the fire alarm systems are taken out of service, steps are taken to compensate, including notification of appropriate authority having jurisdiction (I.e. local fire dept., insurance carrier, etc.)

  Yes

  No

  N/A

• 10. Construction area is clean and orderly.

  Yes

  No

  N/A

• 11. Temporary construction partitions are smoke tight and built of noncombustible or limited combustible material.

  Yes

  No

  N/A

• 12. Construction area is properly restricted from the rest of the facility with appropriate signage.

  Yes

  No

  N/A

• 13. Access to construction area is limited to authorized personnel.

  Yes

  No

  N/A

• 14. Smoking is prohibited in the construction area and adjacent areas.

  Yes

  No

  N/A

• 15. Storage, housekeeping and debris removal practices are enforced to reduce the flammability and combustibility fire load of the building to he minimum necessary to conduct daily operation.

  Yes

  No

  N/A

• 16. Additional firefighting equipment and in-use training is provided to personnel.

  Yes

  No

  N/A

• 17. A minimum of two fire drills per quarter per shift are conducted.

  Yes

  No

  N/A

• 18. Facility-wide safety education programs are conducted to ensure awareness of any fire safety issue deficiencies, construction hazards, and interim life safety measures are in place.

  Yes

  No

  N/A

• 19. Fire watch program is established, and personnel are instructed as to the nature of the job, and the nature of the work in progress.

  Yes

  No

  N/A

Infection Control

• 1. Dust partitions intact.

  Yes

  No

  N/A

• 2. Floors outside work area free of dust.

  Yes

  No

  N/A

• 3. Walk-off mats.

  Yes

  No

  N/A

• 4. Door closed.

  Yes

  No

  N/A

• 5. Signs posted.

  Yes

  No

  N/A

• 6. Appropriate debris transport.

  Yes

  No

  N/A

• 7. Compliance with traffic patterns.

  Yes

  No

  N/A

• 8. HEPA filter unit, filter clean.

  Yes

  No

  N/A

• 9. Appropriate cover attire worn.

  Yes

  No

  N/A

• 10. Area is secure.

  Yes

  No

  N/A

• 11. Area is free of debris.

  Yes

  No

  N/A

• 12. Negative air maintained 24 hours.

  Yes

  No

  N/A

• 13. Other:

  Yes

  No

  N/A