• Hospital:

  • Area Inspected:

  • Week Of:

  • Rollins Construction Company, LLC

  • Inspected By:

  • Infection Prevention:

  • 1. Are all temporary barriers maintained and sealed?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 2. Is work area negative to adjacent spaces?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 3. Are contractor cleaning stations available at each site entry?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 4. Have any special Infection Prevention issues been discussed with staff? If so, explain below:

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • Interim Life Safety Measures:

  • 1. (EP1) Is the area under smoke alarm protection? If so, are all back in service at the end of each shift?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 2. (EP1) Is the area under sprinkler protection? If so, are all back in service at the end of the shift?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 3. (EP2) If required, is signage posted indicating alternative exiting?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 4. (EP4) Are corridors and exit ways clean and free of obstructions?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 5. (EP5) If required, are temporary fire alarm and detection systems in place?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 6. (EP6) Are temporary construction fire extinguishers on site?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 7. (EP7) Are all temporary construction barriers maintained?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 8. (EP8) Surveillance of buildings, grounds, and equipment (job site).

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • 9. (EP9) Is jobsite housekeeping and debris removal appropriate?

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • Sunday

  • Any Special Conditions Noted or Special Notes:

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.