36C24619B0040-0003005.pdf

Project: Date:

No Yes

COR Concurrence

& Signature

Completed by:

Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

Inspection Schedule: per Construction/Safety Committee

Seal holes, pipes, conduits and punctures appropriately. Place dust mat at entrance and exit of work area.

Complete all critical barriers, (sheetrock, plywood, plastic) to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

Contain construction waste in tightly covered container before transporting.

Wipe surfaces with disinfectant.

Place dust mat at entrance and exit of work area.

Isolate HVAC system in areas where work is being performed.

Water mist work surfaces to control dust while cutting.

PATIENT RISK

GROUP

Type D:

Major demolition or construction activities requiring consecutive work shifts

The Project is HIGH RISK for potential transmission of

Tuberculosis to construction workers

Do not remove barriers until area is inspected by CRA Group and thoroughly cleaned by Environmental Services Department.

MEDIUM

CLASS

II

Provide active means to prevent airborne dust from dispersing into atmosphere.

Seal unused doors with tape.

Block off and seal air vents.

LOW

HIGH

Contain construction waste and transport in tightly covered & sealed containers before transporting.

Do not remove barriers until area is inspected by CRA Group and thoroughly cleaned by Environmental Services Department.

Remove barrier materials carefully to minimize spreading of dirt and debris. Transport in tightly covered & sealed containers.

Vacuum work area with HEPA filtered vacuums.

Wet mop area with disinfectant.

Remove isolation of HVAC system.

Construction Project Risk Assessment

2 – Infection Control Risk Assessment (ICRA)

Project Location: ICRA No:

Work Activities:

Contact Person: Phone Number:

CONSTRUCTION ACTIVITY TYPE

1 – General Information

SENSITIVE

CLASS

III

2. Will the project be completed in any acute care areas with potential exposure to tuberculosis patients (ER, ICUs, 4B, 4C, 4D and 2F)?

Vacuum work area with HEPA filtered vacuums.

Wet mop area with disinfectant.

Execute work by methods to minimize raising dust from construction operations.

Immediately replace ceiling tile displaced for visual inspection.

Wet mop and/or vacuum before leaving area.

Remove isolation of HVAC.

Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

Isolate HVAC system in area work is being performed to prevent contamination of duct system.

CLASS

IV

Isolate HVAC system in area where work is being done to prevent contamination of duct system. Seal unused doors with tape.

Complete all critical barriers, (sheetrock, plywood, plastic) to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

Seal holes, pipes, conduits and punctures appropriately.

Construct ante room & require all personnel to pass through so they can be vacuumed using a HEPA vacuum cleaner before leaving work area or they can wear cloth or paper coveralls that are removed each time they leave the work area.

INTERIM INFECTION CONTROL MEASURES (Check all that apply)

CLASS I

Personnel entering work area are required to wear shoe covers. Shoe covers must be changed each time worker exits work area.

Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

Contain construction waste and transport in tightly covered & sealed containers before transporting.

Construction Location Features Actions Needed

1. Will the project breach, alter, or compromise the integrity of any ventilation of negative pressure rooms?

Remove isolation of HVAC system.

Remove barrier material carefully to minimize spreading of dirt and debris. Transport in tightly covered sealed containers.

3 – Risk of Tuberculosis Transmission to Construction Workers Assessment

III/IV

IV

IV

IV

Type A:

Inspection and Non-Invasive

Activity

I

I

I

II

Type B:

Small scale, short duration activities creating minimal dust

II

II

II

III/IV

Type C:

Generates moderate to high levels of dust, requires demolition of building components, or requires greater than 1 work shift for completion

II

III

III/IV

III/IV

Form Date: Feb 2019