ICRA Form v08.07

ICRA Form

8.07
Page 1 of 5

ICRA FORM
Project Name:________________________

Project Number:______________
Project Manager:_____________________
Project Location: _____________
Step 1: Infection Control Risk Assessment Matrix of Precautions for Construction & Renovation
Using the following table, identify the Type of Construction Project (Type A-D)
Inspection and Non-Invasive Activities
TYPE A
Generally less
than 72 hours
TYPE B
Generally
greater than
72 hours
TYPE C
These activities include, but are not limited to:

No cutting of any dry wall
Removal of ceiling tiles for visual inspection.
Painting (but not sanding)
Minor repairs of wall covering, electrical trim work and replacement of facets
No disruption of any building structure other than lifting ceiling tiles
Small scale, short duration (< 72 hours) activities which create minimal dust
Installation of telephone, electrical and computer cabling including within ceiling.
Plumbing work to follow separate Shut down policy.
Access to chase spaces (i.e. a vertical shaft in a building or duct which connects
floor to floor.
Cutting of walls or ceiling if dust migration can be controlled
Long term activity (> 72 hours) or activities that generate a moderate to high level
of dust.
Sanding of walls for painting or wall covering
Removal of floor coverings, ceiling tiles and casework
New wall construction
Duct work
Prolonged activities meaning demolition or removal of fixed building component
or assembly if dust migration cannot be easily controlled
Major demolition and construction projects
TYPE D

Extensive demolition or removal of a complete cabling system
New construction or extensive renovation
ICRA Form
8.07
Page 2 of 5
Step 2: Identify the Area Risk Group
Using the following table, identify the Area Risk Groups that will be affected. If more than one risk
group will be affected, select the higher risk group:
Low Risk Site

No patient care area
No patient occupancy area
(e.g. administrative office)
Medium Risk Site

Outpatient care area
(excluding high risk areas)
Patient occupancy (e.g.
elevator lobby)
Support area (e.g.
Pharmacy, Kitchen)
High Risk Site

High Risk Outpatient Areas,
includes:
Oncology Services
Transplant Services
Lung Clinic
Cystic Fibrosis
Interventional Radiology
Cath Lab
All Inpatient areas
Clean room in Pharmacy
Step 3: Infection Control Construction Matrix

Match the Area Risk Group, Construction Project Type and Class of Precautions:
IC Matrix- Class of Precautions: Construction project by Patient Risk
Area Risk Group
Low Risk
Medium Risk
High Risk
Type A
I
I
II
Construction Project Type

Type B
I
II
III/IV
Type C
II
III
III/IV
Type D
IV
IV
IV
ICRA Form
8.07
Page 3 of 5
Step 4: Risk Mitigation Measures
II SSALC CLASS I
During Construction Project

1.
Environmental Service will conduct cleaning with

Hospital approved disinfectant.
Provide enclosure to control dust migration using portable

tent (control cubes) or sheetrock, plywood, plastic to seal
area from non-work area with a HEPA vacuum continuously
running to create negative pressure (monitoring airflow
direction is not required).
Provide active means as described below to prevent airborne
dust from dispersing:
a. Water mist work surfaces to control dust while cutting.
b. Seal unused doors with tape if high risk site adjacent to
construction site.
c. Place sticky mat at entrance and exit of work area and
change sticky mat when covered with dust.
d. Provide dampen walk off mats at fixed location. If used
must be kept damp.
Contain construction debris prior to removal from site.
Use only designated route/elevator to transport materials or
construction debris.
Review Potable Water System Disruption policy if
applicable.
1.
Disconnect or isolate HVAC system in area in consultation

with the Engineering Department where work is being done
to prevent contamination of duct system.
2. Complete all critical barriers i.e. 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.
3. Place dust mat at entrance and exit of work area and replace
or clean when no longer effective
4. Maintain negative air pressure within work site utilizing
HEPA equipped air filtration units or other methods to
maintain negative pressure.
5. Re-circulating HEPA units may supplement dust control
measures inside the work area.
6. Additional HEPA filtration unit should be placed installed
near all entrance and exit to the work area.
7. Safety will inspect all dust control equipment.
8. Keep work area broom clean and remove debris daily.
9. Contain construction waste before transport in tightly sealed
containers.
10. Use only designated route/elevator to transport materials or
debris and construction personnel.
11. Review Potable Water System Disruption policy if
applicable.
1.
2.
1.
2.
3.
4.
5.
CLASS III
Upon Completion of Project
Execute work by methods to minimize raising dust from

construction operations.
Immediately replace a ceiling tile displaced for visual
inspection.
1.
2.
3.
2.
3.
4.
Vacuum with HEPA filtered vacuum

prior to removing barrier.
Project Manager to notify Environmental
Services to clean after barriers or portable
tent is removed.
Environmental Service will conduct
cleaning with Hospital approved disinfectant.
Do not remove barriers from work area until

completed project is inspected by the PSO
and/or Safety or Infection Control
Department.
Contractor to clean area with HEPA filtered
vacuum or wet mop as appropriate to the
satisfaction of the Project Manager.
Remove isolation of HVAC system in areas
where work is being performed.
Environmental Service will conduct cleaning
with Hospital approved disinfectant before
re-occupation of the area.
ICRA Form
8.07
Page 4 of 5
Upon Completion of Project
CLASS IV
During Construction Project

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Disconnect or isolate HVAC system in area in consultation

with the Engineering Department where work is being done
to prevent contamination of duct system.
Complete all critical barriers i.e. 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.
Place dust mat at entrance and exit of work area and replace
or clean when no longer effective
Maintain negative air pressure within work site utilizing
HEPA equipped air filtration units or other methods to
maintain negative pressure.
Re-circulating HEPA units may supplement dust control
measures inside the work area.
Additional HEPA filtration unit should be placed installed
near all entrance and exit to the work area.
Safety will inspect all dust control equipment.
Keep work area broom clean and remove debris daily.
Contain construction waste before transport in tightly sealed
containers.
Seal holes, pipes, conduits, and punctures appropriately.
Construct anteroom and require all personnel to pass through
this room. Wet mop or HEPA vacuum the anteroom daily.
During demolition, dust producing work, or work in the
ceiling, disposable shoe covers and coveralls are to be worn
and removed in the anteroom when leaving the work area.
Use only designated route/elevator to transport materials or
construction debris.
Review Potable Water System Disruption policy if
applicable.
1.
2.
3.
4.
Do not remove barriers from work area until

completed project is inspected by the PSO
and/or Safety or Infection Control
Department.
Contractor to clean area with HEPA filtered
vacuum or wet mop as appropriate to the
satisfaction of the Project Manager.
Remove isolation of HVAC system in areas
where work is being performed.
Environmental Service will conduct cleaning
with Hospital approved disinfectant before
re-occupation of the area.
ICRA Form
8.07
Page 5 of 5
Step 5:
Identify the areas surrounding the project area, assessing potential impact:
Unit Below
Unit Above
NA
NA
Adjacent
North
NA
Adjacent
South
NA
Adjacent
East
NA
Adjacent
West
NA
Step 6:
1. Review project location e.g. patient rooms, medication room, office, etc.
2. Walk the site with team consisting of safety, Infection Control, project managers, etc.
Step 7:
Issue/systems impacted.
Step 8:
Identify Risk Mitigation Measures, using prior assessment.
Step 9:
1. Is particulate sampling required?
Circle:
If yes, refer to Infection Control Manual and attach specific sampling plan.
2 Is a ICRA reassessment anticipated?
Circle:
YES
NO
YES
NO
YES
NO
Step 10:
Is water sampling required?
Circle:
If yes, refer to the Infection Control Manual Legionella Policy for further steps.
Construction Project Type:____________________________________

Construction Project Team Sign-off:
Project Leader : _________________________________________________Date: ______
Environmental Health & Safety:____________________________________Date:______
Infection Control:__________R. Vogel_______________________________Date:______

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What are the different types of construction projects?

What are the different types of construction projects?

What factors determine the class of precautions required for a construction project?

What factors determine the class of precautions required for a construction project?

ICRA Form

Project Location: _____________

These activities include, but are not limited to:

These activities include, but are not limited to:

Low Risk Site

Medium Risk Site

High Risk Site

Step 3: Infection Control Construction Matrix

Construction Project Type

During Construction Project

Environmental Service will conduct cleaning with

Provide enclosure to control dust migration using portable

Disconnect or isolate HVAC system in area in consultation

Upon Completion of Project

Execute work by methods to minimize raising dust from

Vacuum with HEPA filtered vacuum

Do not remove barriers from work area until

During Construction Project

Disconnect or isolate HVAC system in area in consultation

Do not remove barriers from work area until

Construction Project Type:____________________________________

Project Leader : _________________________________________________Date: ______

Environmental Health & Safety:____________________________________Date:______

Infection Control:__________R. Vogel_______________________________Date:______

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Project Leader : ___________________________________________Date:

Environmental Health & Safety:______________________________Date:

Infection Control:R. Vogel_______________Date: