MMH Project Inspection

• Audit Title

• Work Order No.

• Conducted on

  Date

• Prepared by

• Inspections are to be made periodically until project completion.

PROJECT DEMOGRAPHICS

• Project Name:

• Project Location:

• All approved Infection Control Risk Assessment (ICRA) permits are posted at each entrance to the construction/renovation area.

  Yes

  No

  N/A

GENERAL CONDITIONS

• Air pressure barriers are active (negative pressure maintained, exhaust fans functioning, air quality adequate, no excess fumes or vapors).

  Yes

  No

  N/A

• All exits and unobstructed and useable, including the construction area.

  Yes

  No

  N/A

• The means of egress in the construction area are unobstructed and useable.

  Yes

  No

  N/A

• Temporary construction/renovation partitions are dust tight, and sealed.

  Yes

  No

  N/A

• Construction area is secure (barriers are adequate to prevent entry from unauthorized persons, vermin, etc.)

  Yes

  No

  N/A

• Infection Prevention and Facilities has been notified of ANY equipment or systems disabled prior to them being disabled

  Yes

  No

  N/A

• Proper construction garb/ ppe is in use. Including appropriate hospital approved badges.

  Yes

  No

  N/A

• Construction personnel hygiene, appearance, and conduct is appropriate.

  Yes

  No

  N/A

• Is the construction/renovation area clean and orderly.

  Yes

  No

  N/A

• Patient care equipment and items have been removed from the construction area or covered.

  Yes

  No

  N/A

• All waste and scrap has been removed and disposed of properly, in a clean and sealed container.

  Yes

  No

  N/A

• All water utility disruptions will be thoroughly flushed and temperature tested prior to returning to service for routine use.

  Yes

  No

  N/A

DUST CONTROL MEASURES

• Demolition and/or dust producing activities will be conducted OFF/AFTER normal patient hours?

  Yes

  No

  N/A

• Doors and windows shut, and sealed as appropriate?

  Yes

  No

  N/A

• Construction personnel and materials are transported through specific construction traffic paths, non patient paths?

  Yes

  No

  N/A

• Project Barrier Types?

  Select Solid Plastic Containment Cube Zipper wall

  • Solid
  • Plastic
  • Containment Cube
  • Zipper wall

• Project barriers are in place according to ICRA specifications.

  Yes

  No

  N/A

• A zipper wall access will be utilized?

  Yes

  No

  N/A

• A zipper pulled as appropriate?

  Yes

  No

  N/A

• Supply vents sealed where appropriate?

  Yes

  No

  N/A

• Return vents sealed where appropriate?

  Yes

  No

  N/A

• Negative pressure required?

  Yes

  No

  N/A

• Negative air machine is in place, operational, and exhausted appropriately?

  Yes

  No

  N/A

• Negative air machine will have HEPA filter in place.

  Yes

  No

  N/A

• Negative airflow will be maintained continuous throughout project.

  Yes

  No

  N/A

• Negative airflow will be maintained during all dust producing activities?

  Yes

  No

  N/A

• An anteroom will be constructed, maintained, and used appropriately for the duration of project.

  Yes

  No

  N/A

• Minimum pressure requirement?

  >=.03"wc

  >=.01"wc

• Pressure reading?

• Was minimum pressure differential met?

  Yes

  No

  N/A

• Walk Off/Tack Mats are clean and adequate?

  Yes

  No

  N/A

• Walk Off/Tack Mats have been changed with acceptable frequency?

  Yes

  No

  N/A

• Mat #?

• Moist mats are required and appropriately maintained?

  Yes

  No

  N/A

• Construction/renovation areas, adjacent areas, and personnel are free from dust and debris?

  Yes

  No

  N/A

• Ceiling tiles are replaced when the space above the ceiling is not being accessed? (1 per 25 ft. without containment cube)

  Yes

  No

  N/A

• Mist bottle is used for access of individual tiles?

  Yes

  No

  N/A

• Construction personnel will remove dust and debris from their work clothes prior to leaving work site?

  Yes

  No

  N/A

• Construction personnel will clean, vacuum, and mop area as indicated and at the end of each day.

  Yes

  No

  N/A

• Environmental Services in contacted at extension #3333 for terminal site cleaning.

  Yes

  No

  N/A

FINAL INSPECTION INFORMATION

• Person completing the inspection, please sign below

  Sign

• Please enter date and time of the inspection.

  Date

• Email this completed form to: rachel.white@mmhealth.org