ICRA JACC Mechanical Upgrade Contract ONLY.pdf

Adapted with permission V Kennedy, B Barnard, St Luke Episcopal Hospital, Houston TX, Forms modified and provided courtesy of Judene Bartley, ECSI Inc Beverly Hills MI 2002 Reviewed 2005

Infection Control Construction Permit-CONTRACT ONLY Project Title: Upgrade Mechanical System Permit No: 520-22-169

Location of Construction: JACC- Eglin- PCY Project Start Date: TBD

Project Coordinator/COTR: Logan Bazo Estimated Duration: TBD

Contractor Performing Work: TBD Permit Expiration Date: TBD

Supervisor: Telephone: 850-912-2150

YES NO CONSTRUCTION ACTIVITY YES NO INFECTION CONTROL RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Low Risk

X TYPE B: Small scale, short duration, moderate to high levels

X GROUP 2: Medium Risk

TYPE C: Activity generates moderate to high levels of dust, requires greater 1 work shift for completion

GROUP 3: Medium/High Risk

TYPE D: Major duration and construction activities

Requiring consecutive work shifts

GROUP 4: Highest Risk

CLASS I 1. Execute work by methods to minimize raising dust from construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

3. Minor Demolition for Remodeling

CLASS II

3/8/2022

TSC

1. Provides active means to prevent air-borne dust from dispersing into atmosphere

2. Water mist work surfaces to control dust while cutting.

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Wipe surfaces with disinfectant.

6. Contain construction waste before transport in tightly covered containers.

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

8. Place dust mat at entrance and exit of work area.

9. Remove or isolate HVAC system in areas where work is being performed.

CLASS III

1. Obtain infection control permit before construction begins.

2. Isolate HVAC system in area where work is being done to prevent contamination of the duct system.

3. Complete all critical barriers or implement control cube method before construction begins.

6. Vacuum work with HEPA filtered vacuums.

7. Wet mop with disinfectant

8. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

9. Contain construction waste before transport in

Date 4. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

5. Do not remove barriers from work area until complete project is thoroughly cleaned by Facilities Management Service.

tightly covered containers.

10. Cover transport receptacles or carts. Tape covering.

11. Remove or isolate HVAC system in areas where work is being performed/

Initial

CLASS IV

1. Obtain infection control permit before construction begins.

2. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

3. Complete all critical barriers or implement control cube method before construction begins.

4. Maintain negative air pressure within work site utilizing

HEPA equipped air filtration units.

5. Seal holes, pipes, conduits, and punctures appropriately.

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

7. All personnel entering work site are required to wear shoe covers

8. Do not remove barriers from work area until completed project is thoroughly cleaned by the Environmental

Service Dept.

9. Vacuum work area with HEPA filtered vacuums.

10. Wet mop with disinfectant.

11. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

12. Contain construction waste before transport in tightly covered containers.

13. Cover transport receptacles or carts. Tape covering.

14. Remove or isolate HVAC system in areas where work is being performed.

Date

Initial

Construction taking place in negative pressure rooms where TB patients are housed or work with exhaust to these rooms? ___Yes _X__No

If yes, the contractor must provide written certification that all employees assigned to the work site have a negative TB screening within 90 days prior to assignment to work area.

Additional Requirements:

Infection Control: Tanya Chandler COTR:

Safety: