KD-HTM-IC-006
Infection Control Risk Assessment and Permit
The infection control risk assessment and permit for building work in an occupied healthcare building: the work and the patients around it, the class of precautions the organisation's IPC matrix gives, the dust, pressure, water, waste and route controls that class requires, the monitoring, and the IPC team's permit with its review triggers.
2 pages · 52 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 2 — click to enlarge
Read all 2 pages first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- HBN 00-09
- HSWA 1974 s.3
- CDM 2015 regs 13 and 15
- MHSWR 1999 reg 3
Guidance and standards relied on
These are not law. HSE guidance carries no statutory force in itself, British Standards and NASC technical guidance are industry documents, and the Joint Code of Practice is an insurers' code. They are what the document is built to — and where a court would look for the standard of the reasonable contractor.
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
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