Mercy Muskegon - ICRA Checklist

• Client / Site

• Conducted on

  Date
• Location
  Address

• Prepared by

Construction Barricades

• Tacky walk-off mats in place & clean?

  Yes

  No

  N/A

• Barricade Doors have self-closers & latching hardware?

  Yes

  No

  N/A

• Doors closed & sealed properly?

  Yes

  No

  N/A

• Adjacent ceiling areas intact?

  Yes

  No

  N/A

• Adjacent floor is clean, no dust tracked out?

  Yes

  No

  N/A

• Barricades sealed, no penetrations (barricades extend from the floor, beyond the ceiling, to underside of the floor slab above)?

  Yes

  No

  N/A

Ventilation

• Ductwork sealed/closed?

  Yes

  No

  N/A

• Negative pressure at entrance to barricade?

  Yes

  No

  N/A

• All windows and doors closed behind barricade?

  Yes

  No

  N/A

• Negative air machines running?

  Yes

  No

  N/A

• Negative air machine filters clean?<br>

  Yes

  No

  N/A

Jobsite

• Project area clean, with debris removed daily?

  Yes

  No

  N/A

• Debris removed in suitable clean containers and covered daily as necessary?

  Yes

  No

  N/A

• Routes cleaned with wet-mop or HEPA vacuum?

  Yes

  No

  N/A

• Established traffic pattern identified and used?

  Yes

  No

  N/A

• Fire Extinguishers present?

  Yes

  No

  N/A

Construction Personnel & Dress Code

• Appropriate attire worn for construction project area (ie hardhat, eyewear, footwear, etc)?

  Yes

  No

  N/A

• Removing dust from clothing, shoes, and hair when entering the building?

  Yes

  No

  N/A

• Wearing Hackley Contractor ID Badges?

  Yes

  No

  N/A

Additional Requirements

• Water lines turned off at area adjacent to occupied Hospital area (is indicated by Project)?

  Yes

  No

  N/A

• Air flow monitoring (as indicated by IC)?

  Yes

  No

  N/A

• Daily temperature monitoring (if requested by IC)?

  Yes

  No

  N/A

• Daily humidity monitoring (if requested by IC)?

  Yes

  No

  N/A

• Air Particle Counts (if requested by IC)?

  Yes

  No

  N/A

Traffic Control

• Restricted to Construction personnel and necessary Staff only?

  Yes

  No

  N/A

• All doors and exits free of debris?

  Yes

  No

  N/A

• Exit routes posted?<br>

  Yes

  No

  N/A

• Construction signs posted?

  Yes

  No

  N/A

• Infection Control Permit posted?

  Yes

  No

  N/A