Pre-Construction Risk Assessment (PCRA)

Project Name: Project Location:

Risk Group Involved (from Infection Control Risk Assessment): Class of Infection Control Procedures (from Infection Control Risk Assessment):
Completed By: Date:
Project Description:

Addressed? Factors and Impact on patient care in

Criteria Action taken Responsibility
Yes No N/A affected areas
Disruption of Essential Services and Utilities
Telephone/communications
Electrical
HVAC
Medical gases/vacuum
Water/sewer
Elevators
Steam
Fire Alarm System
Fire Suppression System
Shipping / Receiving / Loading Dock

Emergency Procedures
Fire (Emergency Procedures)
ILSM (assessment performed and
measures discussed)
Utilities (location of emergency shutoffs
identified)
Security (site security, access control)
Traffic flow (alternative routes, signage)

Construction Procedures
Dust (controls for reduction)
Debris (removal and routing)

Control of Odors (controls identified)

Page 1 of 2 Revision Date: May 30, 2019

Pre-Construction Risk Assessment (PCRA)

Hazardous Chemicals (list provided and

hazards discussed)
Asbestos (identified and is abatement
required)
Lead (identified and is abatement
required)
Noise precautions and procedures
(impact, duration, work hours)
Vibration precautions and prevention
(tool use, demolition, distance to sensitive
equipment)

Project Manager: Date: Safety Officer: Date:

Facility Manager: Date: Infection Prevention Officer: Date:

Security Director: Date: Contractor: Date:

Other Representative: Date: Other Representative: Date:

Page 2 of 2 Revision Date: May 30, 2019