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
These activities include, but are not limited to:
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.
These activities include, but are not limited to:
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

These activities include, but are not limited to:

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:______