Attachment 7 671-18-106 Replace Water Softener System IFC Plans R1 - Sheet G005.pdf

This document is a construction permit and risk assessment form for infection control and prevention activities during building renovation or maintenance projects. The form contains three primary sections: a Pre-Construction Risk Assessment (PCRA) Permit for replacing a water softener system, an Infection Prevention and Control Construction/Renovation/Maintenance Permit, and an Infection Control Risk Assessment (ICRA) section.

The PCRA permit identifies the specific project as replacing a water softener system (backwash turntile) at what appears to be a healthcare facility. The document requires detailed information about activity type, anticipated hazards, control measures to be implemented, and sign-off by relevant personnel including the Infection Prevention Officer and Facility Management. The Infection Prevention and Control permit section contains checkboxes for various control measures such as negative or positive pressure requirements, HEPA filtration, dust barriers, and communication protocols. The form mandates specification of work duration, precise location of hazard areas, and identification of all individuals with access to the work area. Additional requirements include documentation of control measures, waste handling procedures, equipment specifications, and post-work inspection verification. Signature lines are provided for the Project Manager, Infection Prevention Officer, Facility Manager, and Safety Officer to confirm compliance with all specified control measures and completion of required inspections before work area closeout.