Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Items

  • Has an ICRA been performed prior to the start of work in all areas?

  • Have all ICRAs been filed, and made accessible to everyone necessary?

  • Have all ICRAs been reviewed by the Owner's Representatives (IC Officer), and Rollins Staff?

  • Have requirements of all active ICRAs been communicated to all Subcontractors performing work in the associated areas?

  • Have all Employees reviewed the Infection Control Video prior to starting work?

Airflow & Monitoring

  • Has a negative airflow been established in all areas of work?

  • Is a negative pressure indicator (ie manometer, etc) in place at each area of work?

  • Is airflow and air quality being monitored on a regular basis?

  • Are airflow and air quality reports being received and filed on a regular basis?

  • Are all Negative Air Machines functioning properly?

  • Have the appropriate Filters been installed and maintained in each Negative Air Machine?

  • Is the leading edge of all Duct sealed?

  • Are all Duct returns capped, terminated, or filtered?

  • Has all stored Duct been sealed appropriately?

Housekeeping

  • Are areas of work being kept clean/swept in order to minimize track-out?

  • Are all corridors and surrounding areas swept and clean (no track-out)?

  • Are all Trash Bins, Gondolas, Carts, etc covered when exiting areas of work?

  • Are the wheels of all Bins, Gondolas, Carts, etc cleaned prior to exiting areas of work?

  • Have walk-off mats (sticky, damp, or other) been installed at the exit to each area of work?

PPE

  • Is appropriate PPE being worn when necessary (gowns, booties, masks, etc)?

Area Isolation & Access Control

  • Have sealed Partitions been installed around each area of work?

  • Do all Temp Doors into areas of work latch appropriately?

  • Have Closures been installed on all Temp Doors?

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.