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Hospital:
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Area Inspected:
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Week Of:
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Rollins Construction Company, LLC
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Inspected By:
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Infection Prevention:
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1. Are all temporary barriers maintained and sealed?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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2. Is work area negative to adjacent spaces?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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3. Are contractor cleaning stations available at each site entry?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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4. Have any special Infection Prevention issues been discussed with staff? If so, explain below:
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Interim Life Safety Measures:
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1. (EP1) Is the area under smoke alarm protection? If so, are all back in service at the end of each shift?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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2. (EP1) Is the area under sprinkler protection? If so, are all back in service at the end of the shift?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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3. (EP2) If required, is signage posted indicating alternative exiting?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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4. (EP4) Are corridors and exit ways clean and free of obstructions?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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5. (EP5) If required, are temporary fire alarm and detection systems in place?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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6. (EP6) Are temporary construction fire extinguishers on site?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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7. (EP7) Are all temporary construction barriers maintained?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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8. (EP8) Surveillance of buildings, grounds, and equipment (job site).
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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9. (EP9) Is jobsite housekeeping and debris removal appropriate?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Any Special Conditions Noted or Special Notes: