Pre-Construction Risk Assessment.docx
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- Solicitation number
- 75H70126R00004
About this file
The document is a Pre-Construction Risk Assessment form for a construction project, specifically designed to evaluate potential risks across multiple operational domains before project initiation. The form covers comprehensive risk assessment categories including fire safety, utilities, confined spaces, environmental/occupational hazards, security, and infection control, with specific focus on classifying project risks into ICRA (Infection Control Risk Assessment) Classes I through IV.
The form requires signatures from multiple stakeholders including the Project Manager, Facility Manager, Safety Officer, IP (Infection Prevention), and Supervisor of the affected area, with sign-offs required at project initiation and closeout. The risk assessment matrix allows project teams to systematically identify potential negative impacts across areas such as fire detection systems, utility disruptions, medical gas systems, chemical hazards, security processes, patient care areas, and potential exposure to infectious agents or environmental risks.
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Text version
Pre-Construction Risk Assessment – Cover Page Project Title:
PRSU Coordinator:
PCRA Submit Date:
| Project Conducted by: |
| ☐ Fac. Mgmt. ☐ I.T. ☐ Telecom ☐ Clin. Eng. |
☐ Contractor:
Proposed Start Date:
Staff/Cont. Name:
Est. Duration:
Supervisor Name:
Est. Complete Date:
Telephone:
Date Project Completed:
Email:
Project Description: (include specific sites and tasks)
| ICRA Classification | |
| Class I | |
| ☐ | Class II |
| ☐ | Class III* |
| ☐ | Class IV* |
| ☐ |
Section 1. Initial Project Impact Review
| Topic |
| Will the project negatively impact or involve…? |
| No |
| Yes |
| Responses (If YES to any) |
Fire Safety Section 2A(1)
| Ceiling tile removal (less than 4 hours total) | ||
| ☐ | ☐ | Complete Above the Ceiling Access Permit (ACAP) |
| Existing fire-stop; minor barrier penetrations | |
| ☐ | ☐ |
Fire Safety Section 2A(2)
| Fire detection/alarm/suppression systems | ||
| ☐ | ☐ | Complete Interim Life Safety Measure (ILSM) evaluation. |
| Exit paths or fire/smoke barriers | |
| ☐ | ☐ |
| Hot work practices | |
| ☐ | ☐ |
| Extra fire load or flammable materials | |
| ☐ | ☐ |
Utilities Section 2B (1)
| Water, sewer, electricity, steam, or HVAC (including outside air intakes) | ||
| ☐ | ☐ | Complete the Utility System Risk Assessment (USRA) |
| Medical gases or vacuum | |
| ☐ | ☐ |
| Call systems, telephones, or IT systems | |
| ☐ | ☐ |
| Confined Space Section 2B (2) | ||
| The area designated as a confined space | ||
| ☐ | ☐ | Confined Space Risk Assessment |
Environmental/ Occupational Section 2C
| Lead or asbestos-containing materials | ||
| ☐ | ☐ | Complete Env./Occ. Risk Assessment (EORA) |
| Chemical hazards (i.e. mercury, volatile organics) | |
| ☐ | ☐ |
| Exposure to infectious agents or mold | |
| ☐ | ☐ |
| Crushing or falling hazard | |
| ☐ | ☐ |
Security Section 2D
| Security systems (badge readers, cameras) | ||
| ☐ | ☐ | Complete Security Risk Assessment (SRA) |
| Security processes (tours, foot/vehicle traffic) | |
| ☐ | ☐ |
Infection Control Section 2E
| Patient care areas or critical utilities | ||
| ☐ | ☐ | Complete an Infection Control Risk Assessment (ICRA) |
| Moderate to high levels of dust, noise, vibration | |
| ☐ | ☐ |
| More than one work shift | |
| ☐ | ☐ |
Project Approval
| Version: September 18th, 2019 | |
| Project Manager Signature |
Date:
Required for: All
Facility Manager Signature
Date:
Required for: All
Safety Officer Signature
Date:
Required for: All
IP Signature
Date:
Required for: USRA and ICRA
Supervisor (affected area)
Date:
Required for: All
Project Close-out Facility Manager Signature
Date:
Required for: All
Safety Officer Signature
Date:
Required for: All
IP Signature
Date:
Required for: ICRA-Class III & IV
Supervisor (affected area)
Date:
Required for: All
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