SHBRH MM 300.25 Attachment G- Construction/Renovation Inspection Form

• Conducted on

  Date

• Prepared by

PROJECT DEMOGRAPHICS

• Project Name & Location:

INTERIM LIFE SAFETY MEASURES

• All exits and unobstructed and useable, including the construction area<br>OSHA 1926.34

  Yes

  No

  N/A

• All Life Safety Equipment (fire alarms, fire sprinklers, smoke detectors, alarm pull stations, exit lights, emergency lights, door operators, latches and controls, etc.) are NOT impaired and are in proper working order. <br>OSHA 1926.24

  Yes

  No

  N/A

• Temporary construction/renovation partitions are smoke tight, or made on no combustible materials, that will not contribute to the development or spreading of a fire, are in place

  Yes

  No

  N/A

• Air pressure barriers are active (negative pressure maintained, exhaust fans functioning, air quality adequate, no excess fumes/vapors)<br>OSHA 1926.57

  Yes

  No

  N/A

GENERAL CONDITIONS

• All approved permits are posted at each entrance to the construction/renovation area. (Interim Life Safety Plan, Penetration Permits, etc.)<br>OSHA 1926.200

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Facility Support Services has been notified of ANY equipment or systems disabled prior to them being disabled

  Yes

  No

  N/A

• Contractors are following safe work practices (observe for trip/fall hazards, ladder safety, and no smoking)

  Yes

  No

  N/A

• Proper construction garb/ ppe is in use. Including appropriate hospital approved badges. <br>OSHA Subpart E

  Yes

  No

  N/A

• Construction personnel hygiene, appearance, and conduct is appropriate. <br>

  Yes

  No

  N/A

• Is the construction/renovation area clean and orderly<br>OSHA 1926.25

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Compressed gas cylinders are properly stored and secured<br>OSHA 1926 Subpart J

  Yes

  No

  N/A

• Electrical cords and equipment is maintained in good condition. (No frayed cords or damaged equipment)

  Yes

  No

  N/A

• All hazardous materials, including flammable liquids, are properly labeled, store and disposed of when not in use.<br>OSHA 1926.64

  Yes

  No

  N/A

• Ceiling tiles are replaced when the space above the ceiling is not being accessed.

  Yes

  No

  N/A

DUST CONTROL MEASURES

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

  Yes

  No

  N/A

• Walk Off/Tack Mats are clean and adequate

  Yes

  No

  N/A

• Construction personnel and materials are transported on dedicated elevators. (Non-Patient use elevators)

  Yes

  No

  N/A

FINAL INSPECTION INFORMATION

• At Final Inspection: Has housekeeping conducted a terminal/final clean of the space?

  Yes

  No

  N/A

• Please enter date and time of the inspection.

  Date

• Person completing the inspection, please sign below

  Sign

• Email this completed form to: construction@mcmcbr.com