Work Plan Submission Form.docx

This is a standard Engineering Work Plan submission form template that contractors must complete prior to performing work that impacts building systems. The form requires details about project timing, location, and systems affected including electrical, water, steam, sewage, medical gases, HVAC, fire suppression/alarm, and network infrastructure.

The form calls for documentation of mitigation plans, contingency procedures, detailed work procedures (before/during/after), parts inventory, and various safety-related comments including ILSM, hot work, fire alarm deactivation, confined spaces, crane operations, lockout/tagout procedures, training certifications, infection control risk assessment (ICRA), and PPE requirements. This template appears to be specifically designed for use at medical facilities given the focus on medical gases, infection control, and fire safety systems. The related contract opportunity is for a $500,000-$1,000,000 design-build project to replace sprinkler heads at the C.W. Bill Young VA Medical Center in Bay Pines, FL, which will be solicited around November 30, 2024 as an SDVOSB set-aside.