36C24818R0093-011.doc

The Occupational Safety and Health Risk Assessment and the Infection Control Risk Assessment will be completed by the VA COTR and the Contractor prior to project commencement.

Construction Safety and infection control risk Assessment VAMC – West Palm Beach

Project Name/Number:

Location:

Start Date:

Contractor/Supervisor Performing Work:

Estimated Duration:

Risk Assessment Review:

CSS Chair

Date

Chief, FMS

Date

Occupational Safety and Health Risk Assessment

Completed by: Date:

1. Does the nature or scope of the project impact potential safety risks for patients, visitors or staff?

2. Does the project create a risk for patients or their environment of care specific to the unique characteristics of the patient? (i.e., age, cognitive ability, mobility challenges, sensory impairments)

3. Does the nature or scope of the project indicate that staff in or adjacent to the area need additional training, protective measures or monitoring?

4. Does the scope or nature of the project create noise or vibration hazards for the surrounding environment of care?

Actions:

Fire Safety and ILSM

1. Does the nature or scope of the project require collaboration with local fire department?

2. Will any exits become blocked or obstructed as a result of the construction? (Include internal, horizontal exits)

If yes, do a,b,c below

3. Will access to any building access point (including emergency department), hydrant or sprinkler connection become blocked or obstructed?

If yes, do d and j

4. Will part of any fire alarm, detection, and/or suppression system be impaired or shut down for more than four hours?

If yes, do g,h,i,,and k

5. Will a temporary fire alarm system be required?

If yes, do c and e

6. Will smoke or fire walls be breached where a temporary seal can not maintain barrier integrity?

If yes, do d, g, i

7. Will it be necessary to erect any temporary construction partitions?

If yes, do f

8. Will the project result in the unacceptable accumulation of debris or construction materials?

If yes, do b and g

9. Will construction effect exterior ground’s safety (pits, storage, equipment, etc.)

If yes, do i

10. Will travel distances to pull stations, fire extinguishers, and exits, remain unchanged?

11. Will protection of hazardous areas remain unchanged?

12. Will hot work permits be required?

13. Will additional fire protection, detection, occupant notification or extinguishment be needed?

14. Will annual/quarterly testing and preventive maintenance of the fire detection, alarm, or extinguishment systems be impacted?

a. Document personnel training for alternative means of egress.

b. Adopt and document daily inspections of construction area by OSH or job foreman.

c. Conduct and document 2 fire drills per shift per quarter.

d. Develop alternate systems, policies (i.e., covering smoke heads during welding operations, uncovering at end of shift)

e. Test and document testing of temporary systems monthly.

f. Document fire resistive rating of partition materials/structure.

g. Excess storage, housekeeping and debris removal so it is maintained at lowest level.

h. Provide and document fire fighting equipment use training.

i. Provide training related to other safety hazards.

j. Meet with ED staff, EMS and/or Fire Department as appropriate to develop plan and document.

k. Notify local fire department and establish fire watch when approved fire alarm or automotive sprinkler system is out of service for > 4 hours.

Actions:

Hazardous Materials Management

1. Are hazardous materials involved?

2. Is hazardous waste created?

3. Will staff in or adjacent to the project require personal monitoring or additional hazard communication training?

4. Are special equipment or monitoring devices needed and appropriately PM’ed and available?

5. Will the project impact Medical Center hazardous waste disposal practices?

6. Will hazardous materials used in the project impact Medical Center compliance with Clean Water, Clean Air, ECRA, SARA Title III, or GEMS compliance?

Actions:

Emergency Management

1. Will the nature or scope of the project impact the Medical Center Emergency Operations Plan?

2. Will the nature or scope of the project impact the emergency call cascade or other emergency notification procedures?

3. Will the nature or scope of the project impact communications or other interactions with local community emergency management?

4. Will the nature or scope of the project impact the Medical Center’s ability to evacuate patients or take incoming patients?

Actions:

INFECTION CONTROL RISK ASSESSMENT

Completed by:

Date:

Type A: Inspection Non-invasive, minor

Low Risk

Type B: Small, short duration, moderate levels

Medium Risk

Type C: Moderate to high-level, generates moderate to high levels of dust.

High Risk

Type D: Major demolition

Highest Risk

Matrix of Precautions for Construction & Renovation

Step One:

Using the following table, identify the Type of Construction Project Activity (Type A-D)

Removal of ceiling tiles for visual inspection limited to 20 Ln Ft tile per 160 sq ft space.

Painting (but not sanding).

· Wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

· Patching walls – not exceeding 8 sq ft

Installation of telephone and computer cabling

· Access to chase spaces Cutting of walls or ceiling where dust migration can be controlled.

· Patching walls – exceeding 8 sq ft

removal of any fixed building components and assemblies or new construction.

Includes, but is not limited to:

Sanding of walls for painting or wall covering exceeding 32 sq ft Removal of floor coverings, ceiling tiles and casework New wall construction

Uncontained duct, HVAC or electrical work above ceilings Major cabling activities

Any other project where high levels of dust are generated.

Activities that require consecutive work shifts Requires heavy demolition or removal of a complete cabling system

New construction.

Step Two:

Using the following table, identify the Patient Risk Groups that will be affected.

If more than one risk group will be affected, select the higher risk group:

· Administrative Offices

· Public Corridors

· Elevators

· Day Rooms

· Canteen Retail Store

· Outpatient, Urgent Care and Primary Care Clinics

· Laboratory

· Cardiology

· Echocardiography

· Endoscopy

· Food Services

· Interim Care and Medical Units

· Nuclear Medicine

· Pharmacy

· Physical Therapy

· Radiology and Nuclear Medicine

· Respiratory Therapy

· CCU

· Emergency Room

· Laboratory

· Outpatient Surgery

· Pharmacy

· Post Anesthesia Care Unit

· Surgical Units

· Any area caring for immuno-compromised patients

· SPD Storage/Sterilization

· Intensive Care Units

· TB Negative Pressure Isolation Rooms

· Operating Room

Step Three: Match the

Patient Risk Group (Low, Medium, High, Highest) with the planned …

Construction Project Type (A, B, C, D) on the following matrix, to find the …

Class of Precautions (I, II, III or IV) or level of infection control activities required.

Class I-IV Precautions are delineated as follows:

Infection Control Matrix Class of Precautions: Construction Project by Patient Risk Construction Project Type

Note:

Infection Control approval will be required when the Construction Activity and Risk Level indicate that Class III or Class IV or control procedures are necessary.

Description of Required Infection Control Precautions by Class

During Construction Project

Upon Completion of Project

2. Immediately replace a ceiling tile displaced for visual inspections

2. Water mist work surfaces to control dust while cutting.

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

5. Place dust mat at entrance and exit of work area.

6. Remove or isolate HVAC system in areas where work is being performed.

1. Wipe work surfaces with disinfectant.

2. Contain construction waste before transport in tightly covered containers.

3. Wipe work surfaces with disinfectant, wet mop and/or vacuum with HEPA vacuum before leaving work area.

4. Remove isolation of HVAC.

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. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.

4. Contain construction waste before transport in tightly covered containers.

5. Cover transport receptacles or carts. Tape covering unless solid lid.

1. Do not remove barriers from work area until completed project is inspected by the Environmental Health and Safety and Infection Control and thoroughly cleaned by Environmental Sanitation Section.

2. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

3. Vacuum work area with HEPA filtered vacuums.

4. Wet mop area with disinfectant.

5. Remove isolation of HVAC system in areas where work is being performed.

Exceptions added to this permit: