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Attachment 5:Indoor Air Quality Management Preconstruction Checklist For Minor Renovation

Hospital Safety Center Website, June 22, 2007

Indoor Air Quality Management
Preconstruction Checklist
For Minor Renovation

The following checklist will help inspectors comply with the Joint Commission on Accreditation of Healthcare Organizations' requirement that a preconstruction assessment be conducted to ensure indoor air quality for staff and patients. This form was created by Tim Martin, director of engineering and safety at Trident Medical Center, Charleston, SC; Joshua Smith, loss prevention coordination manager, Centex Rodgers, Inc., Nashville, TN; and Chris McGee, loss prevention manager at Centex Rodgers. They shared these tips during the 2003 ASHE Planning Design and Construction conference and again with the editors of Briefings on Hospital Safety's Regulatory Compliance Manual.

Indoor Air Quality Preconstruction Checklist
for Minor Renovation
Date:  
Project: Location:

Complete the preconstruction checklist for projects with minor renovations prior to the start of work. Confirm that the following precautions have been or will be taken: COMMENTS OR CORRECTIVE ACTION
Yes No Access to affected areas has been authorized by hospital administration. Infection control officer notified before project begins. Date notified:
Yes No Engineering and environmental services notified. Date notified:
Yes No Notified other departments or divisions to coordinate work schedules. Date notified:
Person notified:
Yes No All occupants and patients are vacated within areas of construction.  
Yes No Air vents are blocked and sealed prior to start of work.  
Yes No Dust mats are provided at entrance to work areas.  
Yes No Doors are taped for projects where dust or fumes are anticipated.  
Yes No All through-the-wall penetrations and/or holes are sealed.  
Yes No Proper respiratory masks for workers are available per the Occupational Safety and Health Administration.  
Yes No Provisions are made to water-mist materials to be demolished.  
Yes No A wet mop is available for dust control.  
Yes No A vacuum cleaner is available for dust control.  
Yes No Plastic bags or covered sealed carts are available to remove debris.  
Project manager Date:
Safety officer Date: