ICRA MATRIX FOR CONSTRUCTION AND RENNOVATION

Step 1 Step 2
Construction project type activity Patient risk Group
Type Type
Mediu Highes
A B C D Low m High t
Please specify the manner of work: Please Specify :
Step 3
Type Type
Patient risk Group Type A B Type C D

Low risk Group I II II III

Area : Medium Risk Group I II III IV
Date of work expected
to start High Risk group I III IV V

Date of Work Started Highest Risk group III IV V V

Date of work expected

to complete Class of precaution

Reason for the Work

Step 4 Noise & Vibration Mitigation Strategies
If any :
Surrounding area assessment
Behin Fron
Additional Controls: Below Above lateral d t
Noise
Vibration
Dust control
Ventilation
Pressurization
Impact to other
systems, such as:
Data
Mechanical
Med Gases
Water Systems
Step 5
Minimum Required Infection Control Precautions by Class | Before and During Work Activity

Class I II III IV V
I,II and
III III, IV and V
Annexure of

TYPE A, B,C D
MEDIU
PATIENT RISK GROUP LOW M HIGH HIGHEST
CLASS I II III IV V I,II and III III, IV and V

Project Manager Infection Control Nurse

Name: Name:
Sign: Sign:
Date: Date: