36C25018Q9361-007.pdf

Appendix B Policy Memorandum No. 138-10

Sample Fire/Smoke Barrier Penetration Label

Fire Stop Fire Rated Assembly

Fire Stop Material/Brand: UL System #:

Location/Utility System:

Project #: Purchase Order #:

Installation Information

Company: Technician:

Installation Date: Contact #:

Repenetrated By Date

1.) 1.)

2.) 2.)

3.) 3.)

Penetrations are affixed with a label on or directly adjacent to the repair indicating:

(1) Date repair/penetration sealed.

(2) Name of technician and company, as applicable.

(3) Contact information, including phone number of technician, of the contractor completing the work.

(4) Project number, if applicable.

(5) Purchase order number, if applicable.

(6) Type of utility or system installed, modified or repaired.

(7) Brand of fire stop material used.

(8) Alpha-alpha numeric fire resistant directory number/UL system number of specific fire stop system used for repairs. Numbers are brand specific.

Appendix C Policy Memorandum No. 138-10

Final Fire/Smoke Barrier Inspection Checklist

INSPECTION FORM

Inspection Date: Inspector:

Installer: Project:

Fire Stop Type per Inspection Documents:

Inspected Fire Stops

Location and Inspection Document Reference Deficiency

Repaired Fire Stops

Location and Inspection Form Reference Compliant? Yes. If No, state deficiency.

Fire/Smoke Barrier Permit

Contractor/Department/Service: ___________________________________________

Responsible Party: ______________________________________________________

Location of Penetration(s): ________________________________________________

Purpose: _____________________________________________________________

Prior to issuing a fire/smoke barrier permit, Facilities Management Service, Engineering Section will review the following checklist with the responsible party:

Yes No N/A Did responsible party obtain blueprints from Engineering Service detailing hourly rated walls and identifying the scope of the fire stop work?

Is the manufacturer’s product (fire sealant) application guide containing UL listed fire stop systems available and approved?

Has the responsible party prepared an itemized schedule of fire/smoke barriers to be penetrated?

Materials utilized in repairs:

Fire Stopping __________________________________________________________

Wall board ____________________________________________________________

Other ________________________________________________________________

Approved/Disapproved: _______________________________ Date: _____________ (Approving Official)

After penetrations are sealed, Engineering Section and responsible party will inspect the area to ensure compliance with the required standards.

Inspected By: ________________________________________ Date: ____________

COTR: _____________________________________________ Date: _____________

Note: A copy of this permit must be posted at the work location.

VAF 10-410 (538)

March 2012

VHACLLCROCKK

Typewritten Text EXHIBIT 13 (cont.)

POLICY MEMORANDUM VA Medical Center NO. 138-15 Chillicothe, Ohio September 11, 2012

ELECTRICAL SAFETY

1. PURPOSE: To set forth requirements for employees dealing with specific hazards requiring special means of protection to prevent serious injury, impairment, or jeopardy to themselves and patients in the use of electricity and electrical devices.

2. POLICY: It is the policy of this medical center to provide the safest possible environment. Electrical equipment, appliances, and wiring systems are installed, maintained, and used in accordance with the National Electrical Code, VA directives, and other known electrical safety guides.

3. RESPONSIBILITY:

a. Facilities Management Service, Engineering Section, is responsible for the installation and testing of electrical equipment.

b. Each employee is responsible for adherence to regulations contained in this memorandum regarding use of electrical devices and for ensuring that patients under their direct care are properly supervised when using such devices. Employees are responsible for:

(1) Using equipment for the intended purpose only.

(2) Checking equipment before each use.

(3) Removing unsafe or defective equipment from use.

(4) Identifying defective equipment with a Do Not Use tag.

(5) Reporting defective equipment to the supervisor.

4. PROCEDURES:

a. Areas of patient susceptibility to electricity are:

(1) Non-Patient Areas: Administrative areas and areas where patients have little or no direct contact with electrical and electronic equipment.

(2) Patient Areas: Areas where patients have or may have direct contact with non-invasive therapy and/or electrical or electronic monitoring equipment.

(3) Electrically Susceptible Patient Care Areas (ESPCAs): Areas such as operating rooms and special care units that have patients who are or may be subjected to

VHACLLCROCKK

EXHIBIT 14

2. POLICY MEMORANDUM NO. 138-15

invasive monitoring or therapy using direct pathways to the cardiac musculature.

b. The electrical distribution system is checked annually for deficiencies, such as worn equipment, worn relays, leakage, frayed cables, and loose connections.

Receptacles in the Laboratory are tested for correct polarity, retention force, and Ground Fault Circuit Interrupter (GFCI) function, if provided. Only qualified Engineering Section personnel perform tests, repairs and/or modifications to any electrical equipment or devices.

c. Electrical distribution equipment is cleaned, inspected, tested, and adjusted every three years by a qualified company.

d. Equipment Guidelines:

(1) Prior to the local purchase of any equipment, the requisition is reviewed by Engineering Section to ensure that items such as allowable leakage current and ground lead resistance limits are incorporated into the technical requirements on the requisition.

(2) Upon receipt at the medical center, electrical equipment is inspected by Engineering Section for compliance with manufacturers' specifications and leakage current limits before delivery to the using area. If there are limitations as to use, this is noted on the equipment (restrictions from ESPCAs, anesthetizing location, etc.) before delivery. Information technology equipment is inspected by the Chief Information Office computer technicians for compliance with specifications before delivery to the users.

e. Equipment Testing Program:

(1) Equipment is entered in the VISTA equipment inventory and categorized by Logistics Service.

(2) Engineering Section assesses equipment categories to determine frequency of preventive maintenance and inspections.

(3) Results of the testing program are maintained in Engineering Section.

(4) If equipment is found to be defective, it is tagged and removed from service.

Deficiencies and any actions taken are reported to the person responsible for the operation of the unit inspected.

(5) Personnel in ESPCAs inspect equipment before each use for such hazards as broken or damaged plugs, frayed line cords, abnormal operation, obvious chassis damage, overheating, or tingling sensations. If a hazard is suspected, that equipment is not used unless it is life support equipment, in which case, it is tagged by the using personnel and closely monitored until repaired or replaced.

3. POLICY MEMORANDUM NO. 138-15

(6) Electronic equipment that is loaned to or rented by the medical center for medical care or for evaluation purposes is inspected for compliance with VA standards as well as leakage current and grounding resistance limits prior to its use and, thereafter, at a frequency determined by the area of usage. Engineering Section maintains inspection records.

f. Equipment Restrictions:

(1) Extension cords are not used unless authorized and made available by Engineering Section. A ground fault circuit interrupter protects extension cords used outside, in construction, maintenance, or in wet locations. Engineering Section accomplishes any modifications of the electrical distribution system.

(2) Three-to-two wire adapters are not used. Electrical plugs that do not match outlets are referred to Engineering Section for correction.

(3) Patient-owned, electrical line-operated devices are strictly prohibited from ESPCAs. In other areas of the medical center, written permission in the form of an inspection report signed by the Assistant Chief, Engineering Section, or designee, is obtained prior to their use. When permitted, they are inspected prior to use. Personal equipment resulting in nuisance breaker trips is removed by the owner.

(4) Electrical line-operated equipment used in the patient care vicinity is provided with a three-wire power cord and three-pin grounding hospital-grade plug.

(a) Double insulated appliances are permitted to have two conductor cords and plugs. Line-operated devices with two conductor cords and plugs are not used in psychiatric bedrooms. Receptacles in these areas are the safety type requiring grounding plug for operation.

(b) Electrical line-operated items donated or purchased are inspected by Engineering Section prior to use. The using service/care line personnel visually inspect these items for deficiencies, such as damaged cords, cracked housings, and the presence of an attached electrical safety inspection sticker prior to each use. If discrepancies are discovered, the item is removed from service until repairs are made.

(c) Engineering Section inspects non-Nutrition and Food Services coffee makers and microwave ovens and their location to determine the adequacy of electric circuitry and the safety of the coffee makers or microwave ovens prior to use. A request is submitted to Engineering Section for an inspection of newly procured coffee makers or microwave ovens. Once inspected, personal equipment that is authorized for use is labeled with an inspection sticker. Personal electrical equipment is not utilized without an attached electrical safety inspection sticker.

(5) The use of personally owned devices is discouraged. Personally owned

4. POLICY MEMORANDUM NO. 138-15

devices used by medical center employees are inspected for electrical safety prior to use by contacting extension 6172. Personal equipment resulting in nuisance breaker trips is removed by the owner immediately. Once inspected, personal equipment that is authorized for use is labeled with an electrical safety inspection sticker.

(6) Line-operated devices such as televisions, radios, and electrical razors are prohibited in ESPCAs without written permission of the Assistant Chief, Engineering Section, or designee. This permission is requested by memorandum by the physician in charge of that area. If the physician has authorized such a device, it is mounted at such a distance that it cannot be reached by the patient or by an individual at the patient's bedside. Battery-operated radios are permitted at the patient's bedside with physician's authorization.

(7) Electric beds are prohibited from ESPCAs unless specifically suited for such areas. Electric beds placed in ESPCAs are approved for such use by the Assistant Chief, Engineering Section, or designee.

(8) Bedside lamps in ESPCAs are grounded and permanently affixed in the patient's bedside area.

(9) Line-operated devices used in close proximity to a sink or tub are protected with a ground fault circuit interrupter (GFCI).

(10) Portable space heating devices are prohibited in patient treatment and sleeping areas. Portable space heaters with enclosed elements that limit maximum surface temperatures to 212 degrees Fahrenheit are permitted in non-sleeping, employee-only areas, with the exception of nursing stations. A request for inspection is made by contacting extension 6172 prior to equipment use. Once inspected, personal equipment that is authorized for use is labeled with an electrical safety inspection sticker.

Appliances with open heating elements, including toasters and toaster ovens, are prohibited in any building.

g. Employee Education:

(1) For informational purposes, a copy of High Voltage Systems - Methods, Products, and Code Rules is on file in Building T228 for employees working with this system.

(2) Annual training is conducted for medical center employees in equipment and utility use and safety. Training is documented in the Talent Management System

(TMS).

(3) Personnel in ESPCAs receive instructions in electrical safety as applicable to their situation. This may include the grounding system, isolated power system, and dangers of high frequency current. Instruction is accomplished by scheduling safety

5. POLICY MEMORANDUM NO. 138-15

training classes through TMS.

5. REFERENCES: NFPA 70-1996

NFPA 99-1996, Chapter 3 DM&S Supplemental, MP-3, Chapter 2.22 The Joint Commission Comprehensive Accreditation Manual for Hospitals, 2012

6. RESCISSION: Policy Memorandum No. 138-15, Electrical Safety, dated June 11, 2010.

7. RESCISSION DATE: September 11, 2014

//s//

WENDY J. HEPKER, FACHE

Medical Center Director

Distribution: F 161M3 (10)

VHACLLCROCKK

EXHIBIT 15

Engineering Section VA Medical Center Standard Operating Procedure Chillicothe, Ohio Number 20 September 13, 2013

CONFINED SPACE ENTRY

1. PURPOSE: To establish guidelines and procedures for working in confined spaces.

2. POLICY: To provide maximum safety protection for employees and contractors who are performing work in confined spaces.

3. RESPONSIBILITIES:

a. The Chief, Facilities Management Service (FMS), is responsible for ensuring projects, maintenance and repairs in confined spaces utilize only authorized entrants under properly executed Confined Space Entry Permits, Attachment A, and ensures permit spaces are identified.

b. The Safety and Occupational Health (OSH) Manager, Industrial Hygienist, or designee, provides technical guidance to affected employees for entry into a confined space. Additional responsibilities include:

(1) Inspecting the confined space prior to entry for compliance to this policy.

(2) Performing atmospheric testing and completing the Confined Space Pre-Entry Checklist, Attachment B.

(3) Providing confined space entry training.

c. The Fire Department provides rescue services and emergency rescue personnel to be utilized as entry attendants for confined spaces that can present special hazards.

Emergency rescue personnel are responsible for completing annual confined space rescue training.

d. The entry supervisor is knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure. Additional responsibilities include:

(1) Determining when responsibility for a permit space entry operation is transferred and, at intervals dictated by the hazards and operations performed within the space, that entry operations remain consistent with terms of the entry permit and that acceptable entry conditions are maintained.

(2) Ensuring that equipment needed for safe entry into any permit required space is available and in proper working order.

(3) Verifying that rescue services are available and that the means for summoning rescue services are operable.

EXHIBIT 16

2. Engineering Section SOP No. 20

(4) Removing unauthorized individuals who enter or attempt to enter the permit space during entry operations.

(5) Verifying, by checking that appropriate entries are made on the permit, that tests specified by the permit are conducted and that procedures and equipment specified by the permit are in place prior to signing and approving the permit and allowing entry to begin.

(6) Terminating the entry and cancelling the permit following task completion.

e. Entry attendants are knowledgeable of permit space hazards, prohibited conditions, the role to remain outside and in communication with entrants, prevention of unauthorized entry, procedures to request rescue and emergency services, and performance of non-entry rescue. The entry attendants’ primary duty is to monitor and protect authorized entrants. Entry attendants are trained on the procedures contained in this policy and are knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure.

f. Authorized entrants are trained on the procedures contained in this policy and are knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure. Additional responsibilities include:

(1) Maintaining proficiency in dealing with the hazards of permit required spaces, proper equipment use, communications systems, acceptable entry and prohibited conditions, immediate evacuation conditions, and safe work task performance.

(2) Alerting the attendant when a prohibited condition is detected or when any warning sign or symptom of exposure to a dangerous situation is recognized.

(3) Exiting the permit space as quickly as possible when:

(a) A prohibited condition is detected.

(b) An order to evacuate is given by the attendant or the entry supervisor.

(c) An evacuation alarm is activated.

(d) Any warning sign or symptom of exposure to a dangerous situation is recognized.

g. Contractors performing work in a confined space at this facility are required to adhere to the requirements of this SOP.

4. DEFINITIONS:

a. Confined Space: An enclosed space that is large enough and so configured that an employee can bodily enter and perform assigned work, has limited or restricted means for entry or exit, and is not designed for continuous employee occupancy. Examples of confined spaces are listed in Attachment C, Confined Spaces, and include storage pits,

3. Engineering Section SOP No. 20 vats, tanks, boilers, ventilation/exhaust ducts, sewers, tunnels, manholes, underground utility vaults or pipelines, and excavations.

b. Permit Required Confined Space:

(1) Contains or has a known potential to contain a hazardous atmosphere.

(2) Contains material with the potential for engulfing of an entrant.

(3) Has internal configurations that could trap or asphyxiate an entrant.

(4) Contains any other recognized serious safety or health hazards.

c. Hazardous Environment/Atmosphere: An atmosphere presenting a potential for death, disablement, injury, or acute illness from one (1) or more of the following causes:

(1) Less than 19.5 percent or more than 23.5 percent oxygen.

(2) A flammable gas or vapor in excess of 10 percent of its lower explosive limit (LEL).

(3) An airborne combustible dust at a concentration that obscures vision at a distance of five (5) feet or less.

(4) An atmospheric concentration that exceeds the listed numerical value of any toxic, corrosive, or asphyxiant substance listed in the Threshold Limit Value (TLV) book by the American Conference of Governmental Industrial Hygienists (ACGIH) or the permissible exposure limit (PEL) that is reasonably expected to be present.

(5) A biological or radiological hazard or one that is otherwise known to present a safety or acute health hazard.

(6) Any condition immediately dangerous to life or health.

d. Entrapment: An area that contains material with the potential to engulf the entrance.

e. Lower Explosive Limit (LEL): The lowest concentration of gas or vapor (percent by volume in air) that will burn or explode if an ignition source is present.

f. Isolation: A process to remove a confined space from service and to completely protected against the inadvertent release of material by the following:

(1) Blanking: The absolute closure of a pipe, line or duct by fastening a solid plate or cap across the pipe, line or duct capable of withstanding the maximum upstream pressure.

(2) Double Block and Bleed: Isolating a confined space from a line, duct or pipe by locking and tagging two (2) closed in-line valves, and locking and tagging open a drain or bleed in the line between the two (2) closed valves to the outside atmosphere.

4. Engineering Section SOP No. 20

(3) Lockout: The placement of a locking device on an energy-isolating device, in accordance with an established procedure, to ensure that the energy-isolating device and the machine or equipment being controlled cannot be operated until the locking device is removed. Lockout devices require a tagging device to be used in conjunction with the locking device unless specifically not required by a documented lockout/tagout procedure.

Refer to Engineering Section SOP No. 30, Control of Hazardous Energy (Lockout/Tagout).

(4) Mechanical Isolation: Isolation achieved by disconnecting linkages or removing drive belts or chains of moving parts. Equipment with moving mechanical parts is also blocked in such a manner that there can be no accidental rotation.

g. Permissible exposure limit (PEL): Regulatory limits on the amount or concentration of a substance in the air, as established by the Occupational Safety and Health Administration (OSHA).

h. Purging and Ventilation Purging: The method by which gases, vapors or other airborne impurities are displaced from a confined space to adjust the atmosphere to acceptable standards. This is accomplished by using fluids or vapors (gas, water steam and/or cleaning solutions) or by forced air ventilation.

i. Ventilation: The movement or circulation of fresh air to keep hazards away after purging. Ventilation is used after entry is made into a space to:

(1) Supply continuous fresh air for entrants inside to breathe.

(2) Remove potentially hazardous conditions before they become hazardous.

(3) Supply cool air for comfort.

5. PROCEDURES:

a. When entry to a confined space is necessary, the following procedures are followed on a daily basis:

(1) The area is inspected by the work supervisor and the OSH Manager or Industrial Hygienist to determine potential hazards, isolation requirements, types of equipment to be used, number of employees required to enter the space and standby personnel required.

(2) The equipment or area is isolated and allowed to ventilate. Confined entry points are posted with "Danger, Do Not Enter" signage until such time as requirements have been met.

(3) The Assistant Chief, Engineering Section, or designee, issues the Confined Space Entry Permit, Attachment A. The OSH Manager and Fire Department are notified of the proposed entry permit. Emergency standby equipment is available at the location of the confined space.

(4) The OSH Manager or Industrial Hygienist conduct atmospheric testing and inspect the job site for general safety, isolation, and standby equipment. Prior to entry, the OSH

5. Engineering Section SOP No. 20

Manager or Industrial Hygienist completes and signs the Confined Space Pre-Entry Checklist, Attachment B, and documents test results.

(5) Each point of entry must have a completed and signed entry permit posted.

(6) At the conclusion of the workday, the entry permit is removed and "Danger, Do Not Enter" signage is posted.

(7) Entry to a confined space is not permitted until it has been properly prepared, hazards have been identified, standby equipment has been placed on site, and an entry permit has been completed and posted.

(8) The entry permit details the requirements for entry into the confined space.

(9) Prior to entering the confined space, each employee reviews the entry permit for specific requirements, reviews emergency procedures, and inspects the confined space for location of entry and exit points.

(10) Retesting of the atmospheric conditions is completed at lunch break or at four-hour intervals.

(11) Every confined space is considered immediately dangerous to life and health until it is tested and proven otherwise.

(12) No compressed gas cylinders are permitted inside of the confined space.

(13) Portable electrical tools, equipment, and lighting are powered through a ground fault circuit interrupter.

b. Entry attendants assigned to remain outside of the confined space are equipped with radios, harness, and lifeline. Entry attendants:

(1) Maintain visual or verbal contact with those in the confined space at all times.

(2) Maintain safety lines, if in use.

(3) Summon rescue personnel, if necessary.

(4) Summon a supervisor if entry is made in violation of this policy.

(5) Review the conditions for entry into the space as indicated on the Confined Space Entry Permit, Attachment A.

(6) Do not enter or leave the confined space at any time, unless relieved of standby duties.

(7) Continuously maintain an accurate count of authorized entrants in the permit space.

6. Engineering Section SOP No. 20

(8) During an emergency situation, make rescue attempts using lifelines from outside the confined space while awaiting the arrival of rescue personnel.

(9) Remain aware of possible behavioral effects of hazard exposure in authorized entrants.

c. Fire Department personnel accomplish rescue of persons from a confined space.

Emergency rescue personnel are trained in rescue techniques, self-contained breathing apparatus (SCBA) use, use of rescue equipment, and the procedures contained in this policy. Emergency rescue personnel are utilized as entry attendants for confined spaces that can present special hazards, as determined by the supervisor and/or safety representative. Rescue equipment may include:

(1) Harness.

(2) Life line.

(3) SCBA.

(4) Stokes litter.

(5) Tripod retrieval system.

(6) Standard firefighter clothing and personnel protective equipment.

e. Isolating equipment for entry is accomplished by blinding or air gapping lines to and from the equipment. Small screwed lines are disconnected and plugged. Isolation is made as close in proximity as possible to the equipment to be entered.

(1) Double blocks and bleeders are not permitted as a substitute for blinding, except when approved by the OSH Manager or Industrial Hygienist.

(2) Where several pieces of equipment are isolated as a unit, each piece of interconnected equipment is open to the atmosphere and made safe for entry.

(3) Equipment entered is electrically isolated in accordance with Engineering Section SOP No. 30, Control of Hazardous Energy (Lockout/Tagout). Tagging without locking out equipment is not sufficient for confined space entry.

(4) A record is maintained of blinds, plugs and/or other types of isolation for each entry.

Records are used to validate the removal of any type of isolation device. Removing one point of isolation voids the entry permit.

h. Authorized entrants communicate with the attendant, as necessary, to enable the attendant to monitor entrant status and to alert entrants should the need to evacuate the space arise.

6. REFERENCES: Engineering Section SOP No. 30, Control of Hazardous Energy

(Lockout/Tagout)

7. Engineering Section SOP No. 20

7. RESCISSION: Engineering Section SOP No. 20, Confined Space Entry, dated February 29, 2012.

RYAN JETER, PE, PS

Acting Chief, Facilities Management Service

Attachments: 3

Dist: Engineering Section Supervisors (138) Safety and Occupational Health Manager (001S) Industrial Hygienist (001S) Fire Department (07F)

Engineering Section SOP No. 20 Attachment A September 13, 2013

OP-516 (April 2013)

CONFINED SPACE ENTRY PERMIT

RESCUE/FIRE: Ext. 444 SAFETY: Ext. 7952/7153

PERMIT VALIDATION PERIOD: Date Time From To

LOCATION OF WORK

DESCRIPTION OF WORK

REQUIREMENT CHECK LIST: RECORDKEEPING:

ITEM YES NO CONDITION MET

ISOLATION/BLINDING

ELECTRICAL LOCK/TAGOUT

VENTILATION MECHANICAL

RESCUE EQUIPMENT

HOT WORK PERMIT

CONTINUOUS MONITORING

SPECIAL CLOTHING

RESPIRATORS

CLEANING/SLUDGE REMOVAL

MECHANICAL ISOLATION

OTHER

LIFELINES

FULL BODY HARNESS

RETRIEVAL DEVICE

FIRE EXTINGUISHER

COMMUNICATION

SPECIAL LIGHTING

INITIAL EACH TEST COMPLETED AND INDICATE TIME OF TEST (After initial entry, retest is required after lunch or at 4-hour intervals):

TEST PEL COMPLETION TIME INITIALS RETEST TIME INITIALS

OXYGEN DEFICIENCY (O2) 19.5% - 23%

FLAMMABLE VAPORS (LEL) Any % < 10

CARBON MONOXIDE (CO) 35 PPM

HYDROGEN SULFIDE (H2S) 10 PPM

OTHER TOXINS (specify)

LOCKOUT/TAGOUT

BLINDING/ISOLATION

OTHER

NOTE: STANDBY EQUIPMENT IS REQUIRED AT ALL CONFINED SPACE ENTRIES. STANDBY PERSON IS REQUIRED AT ALL CONFINED SPACE ENTRIES. RESCUE HARNESS MUST BE WORN BY ALL PERSONS ENTERING A CONFINED SPACE.

SIGNATURES:

CHIEF, FACILITIES MANAGEMENT SERVICE (verbal contact after hours)

SUPERVISOR (or designee) IN CHARGE

TESTING OPERATOR

ENTRY CANNOT BE MADE UNTIL ALL CONDITIONS ARE MET AND ALL SIGNATURES OBTAINED.

EMPLOYEES ENTERING AREA:

a.

b.

c.

SUPERVISOR IN CHARGE:

STANDBY PERSON:

HAZARDOUS CONTAMINATES FOUND:

a.

b.

c.

COMMUNICATION PROCEDURES

(to be used by attendants and entrants):

Engineering SOP No. 20 Attachment B September 13, 2013

Confined Space Pre-Entry Checklist

A confined space is either entered through an opening other than a door (such as manhole or side port) or requires the use of a ladder or rungs to reach the working level.

Test results must be satisfactory. This checklist must be completed whenever the job site meets this criteria. See Engineering Section SOP No. 20, Attachment C, Confined Space Listing.

Yes No

1. Did your survey of the surrounding area show it to ( ) ( ) be free of hazards such as drifting vapors from tanks, piping, or sewers?

2. Does your knowledge of industrial or other discharges ( ) ( ) indicate this area is likely to remain free of dangerous air contaminants while occupied?

3. Are you certified in operation of the gas monitor to ( ) ( ) be used?

4. Has a gas monitor functional test (Bump Test) been ( ) ( ) performed this shift on the gas monitor to be used?

5. Did you test the atmosphere of the confined space ( ) ( ) prior to entry?

6. Did the atmosphere check as acceptable (no alarms ( ) ( ) given)?

7. Will the atmosphere be continuously monitored while ( ) ( ) the space is occupied?

Contact the Fire Department (ext. 444) in the event of an emergency.

NOTE: If any of the above questions are answered "no," DO NOT ENTER and contact your immediate supervisor.

Job Location: ___________________________________________________

Signature __________________________________ Date _____________

Industrial Hygienist or Designee

Engineering Section SOP No. 20 Attachment C July 23, 2014

CONFINED SPACES LISTING

1. Manholes:

ELECTRICAL DISTRIBUTION

SYSTEM MANHOLES

1A 8A 20 30 41

1B 8B 21 31 42

1C 9 22 32 43

2A 10 23 33 44

2B 11 24 34 45

2C 12 24A 34A 46

3 13 25 35 47

4 14 26 36 48

5 15 27 37 49

6 16 27A 37A

6A 17 28 38

7 18 29 39

8 19 29A 40

SIGNAL DISTRIBUTION

SYSTEM MANHOLES

1 11 24 35A

2 12 25 36

2B 13 26 37

2C 14 27 38

3 15 27A 39

4 16 29 40

5 17 29A

6 18 30

7 19 31

7A 20 32

8 21 33

9 22 34

10 23 35

STEAM DISTRIBUTION SYSTEM MANHOLES

1 1H PT17 PT81 5A 11

1A 1I PT18 2 6 13

1B 1J PT41 3 6A 13A

1C 1K PT42 3A 7 13B

1D PT9 PT43 3B 8 13C

1E PT12 PT44 4 8A 15

1F PT13 PT45 4D 9 15A

1G PT16 PT46 5 10 D

2. Engineering SOP 20

STORM MANHOLES

1 19 37 53 71 89

2 20 38 54 72 90

3 21 39 55 73 91

4 22 39A 56 74 92

5 23 40 57 75

6 24 41 58 76

7 25 42 59 77

8 26 43 60 78

9 27 43A 61 79

10 28 44 62 80

11 29 45 63 81

12 30 46 64 82

13 31 47 65 83

14 32 48 66 84

15 33 49 67 85

16 34 50 68 86

17 35 51 69 87

18 36 52 70 88

SANITARY SEWER MANHOLES

1 17 33 49 63B 78

2 18 34 50 63C 79

3 19 35 51 64 80

4 20 36 52 65 81

5 21 37 53 66 82

6 22 38 54 67 83

7 23 39 55 68

8 24 40 56 69

9 25 41 57 70

10 26 42 58 71

11 27 43 59 72

12 28 44 60 73

13 29 45 61 74

14 30 46 62 75

15 31 47 63 76

16 32 48 63A 77

3. Engineering SOP 20

2. Miscellaneous Confined Spaces:

a. Four (4) boilers in Building 261, two chambers in each. Boilers and condensate receiver and deaerator, DA tank, wood chip bins, and feed water tank at Building 261.

b. Crawl space under Building 21.

c. Dust collector outside Building 22.

d. Two (2) water storage tanks on top of the hill.

e. Building 27 tunnel crawl space.

f. Elevator hoistways.

g. Two (2) well access vaults located at the well site.

3. Biomass Boiler Plant Confined Space Inventory:

a. Condensate outside pit – Outside east side, conventional side.

b. DA tank – East side, conventional side.

c. Treated water tank – East side, conventional side.

d. Boiler #1 – Conventional side, front and back.

e. Boiler #2 – Conventional side, front and back.

f. Boiler #3 – Conventional side, front and back.

g. Small brine tank – West wall, conventional side.

h. Large outside brine tank – Outside west side, conventional side.

i. Water softener #A – West wall, conventional side.

j. Water softener #B – West wall, conventional side.

k. Biomass furnace doors – Biomass side.

l. Under grate ash doors – Biomass side.

m. Under grate ash doors – Biomass side.

n. Biomass boiler economizer door – Biomass side.

o. Biomass boiler cyclone #1 door – Biomass side.

4. Engineering SOP 20

p. Biomass boiler cyclone #2 door – Biomass side.

q. East fuel bunker – Biomass bunker room.

r. West fuel bunker – Biomass bunker room.

s. Vibrating conveyor doors – Biomass side.

t. Ash dumpster – Outside east biomass side.

u. ESP north ash conveyor – Outside east biomass side.

v. ESP south ash conveyor – Outside east biomass side.

w. Fuel oil tank #1 – Outside east biomass side.

x. Fuel oil tank #2 – Outside east biomass side.

4. Elevator Pits

Building Number

1 P1 1 P2 7 F1 7 F2 9 P1 23 F1 24 P1 24 P2 26 P1 26 P2 27 P1 27 P2 30 P1 30 P2 31 P1 31 P2 31 P3 31 P4 210 P1 210 P2 211 P1 211 P2 212 P1 35 P1 35 P2 28 P1

Engineering Section VA Medical Center Standard Operating Procedure Chillicothe, Ohio Number 31 February 25, 2015

HOT WORK OPERATIONS

1. PURPOSE: To establish procedures for hot work operations under the responsibility of Facilities Management Service (FMS), Engineering Section.

2. POLICY: Engineering employees and contractors perform hot work operations in compliance with the hot work permit system. Hot work operations include cutting, welding, Thermite welding, brazing, soldering, thermal spraying, thawing pipe or any similar operation. Minor repairs, such as soldering electronic equipment, are exempt from the scope of this procedure.

3. RESPONSIBILITIES:

a. The Chief, Facilities Management Service (FMS) is responsible for assuring that hot work procedures are followed and employees are trained in the use of this procedure.

b. The Fire Chief or Crew Chief is responsible for conducting weekly safety rounds of construction sites. Additionally, the Fire Chief is responsible for maintaining a fire response crew to mitigate risk from hot work operations during construction and maintenance activities. When requested, the Fire Chief is responsible for examining the precautions taken prior to hot work commencing and making recommendations for improvement, if required.

c. For hot work conducted by Engineering employees:

(1) Engineering employees conducting the hot work are responsible for:

(a) Filling out the hot work permit, signing the permit as the competent person conducting the work, obtaining the Engineering supervisor’s signature for approval of the permit, and meeting the requirements of the permit, this Standard Operating Procedure, and National Fire Protection Association (NFPA) 51B.

(b) Turning a copy of the permit in to the Engineering office in Building 21.

(c) Prior to work commencing:

1. Posting the hot work permit on the wall in a visible location near the work site so that personnel passing by know that a permit has been approved. Do not post the permit in a location that would cause a fire hazard. Do not post the permit in a manner

VHACLLCROCKK

EXHIBIT 17

2. Engineering Section SOP No. 31 that would damage finishes. If the permit cannot be posted, ensure that the fire watch has a copy of it available.

2. Ensuring precautions are in place for hot work, as required by NFPA 51B.

3. Making sure appropriate fire extinguisher(s) are readily available.

4. Ensuring a fire watch is appointed and in place.

(d) Stopping hot work at the end of the work shift in the appropriate time frame for final inspection:

1. For torch applied roofing, two (2) hours prior to the end of the shift, according to

NFPA 241.

2. For all other hot work, 30 minutes prior to the end of the shift.

(e) Removing the posted permit once the work is completed.

(2) Engineering Supervisors of employees conducting the hot work are responsible for:

(a) Discussing the work plan with the employee, including the precautions the employee has put in place for hot work operations.

(b) Appointing a fire watch for the employee.

(c) Ensuring the fire watch appointed is trained to understand the inherent hazards of the work site and of the hot work.

(d) Ensuring hot work permits are only issued to employees who are competent in hot work operations.

(e) Signing the hot work permit, giving approval to the employee to commence hot work operations.

(3) The Engineering office is responsible for filing a copy of the approved hot work permit in an organized systematic manner.

d. For hot work conducted by Contractors:

(1) The General Contractor’s Superintendent or Competent Person is responsible for:

3. Engineering Section SOP No. 31

(a) Ensuring hot work permits are filled out, ensuring the person conducting the hot work is a competent person as defined by OSHA, having the person conducting the work sign the permit, designating a fire watch person on the permit, signing the permit, discussing the hot work operations plan and precautions with the Contracting Officer’s Representative (COR), obtaining the COR’s signature on the hot work permit prior to commencing hot work operations, and meeting the requirements of the permit, this Standard Operating Procedure, and NFPA 51B.

(b) Ensuring the fire watch appointed is trained to understand the inherent hazards of the work site and of the hot work.

(c) Prior to work commencing:

1. Posting the hot work permit on the wall in a visible location near the work site so that personnel passing by know that a permit has been approved. Do not post the permit in a location that would cause a fire hazard. Do not post the permit in a manner that would damage finishes. If the permit cannot be posted, ensure that the fire watch has a copy of it available.

2. Ensuring precautions are in place for hot work, as required by NFPA 51B.

3. Making sure appropriate fire extinguisher(s) are readily available.

4. Ensuring a fire watch is appointed and in place.

(d) Stopping hot work at the end of the work shift in the appropriate time frame for final inspection:

1. For torch applied roofing, two (2) hours prior to the end of the shift, according to

NFPA 241.

2. For all other hot work, 30 minutes prior to the end of the shift.

(e) Removing the posted permit once the work is completed.

(2) Contracting Officer’s Representatives (CORs) are responsible for:

(a) Discussing the work plan with the Contractor’s Superintendent or Competent Person, to include discussing the precautions the Contractor has put in place for hot work operations. This discussion is for the situational awareness of the COR to understand the precautions the contractor has put in place for hot work operations.

(b) Signing the hot work permit, giving approval to the contractor to commence hot work operations. This signature in no way removes responsibility from the Contractor as the responsible person for all hot work operations on their project.

4. Engineering Section SOP No. 31

(c) Obtaining a copy of the signed hot work permit to file with the project documents, either in paper or electronic format.

4. PROCEDURES:

a. The Assistant Chief, Engineering Section and Maintenance and Operations (M&O) Supervisor assure that annual training on the use of this procedure is provided to employees involved with hot work.

b. CORs assure contractors are provided a copy of this procedure.

c. There are separate hot work permits approved for each day hot work operations are performed. Each hot work permit is specific to the hot work task being performed.

For example, construction work with hot work operations being performed by different trades and/or different locations have a hot work permit for each individual activity. Hot work operations may be planned and scheduled up to a week in advance. For example, up to one (1) weeks’ worth of hot work operations daily permits may be approved at one time. Hot work permits approved in advance must be reapplied for if conditions change prior to the hot work commencing. The ability to apply for hot work permits in advance may be revoked at any time by CORs or Engineering Supervisors. The intent of allowing hot work permits to be applied for up to one (1) week in advance is to allow for thoughtful, safe, well-planned hot work operations.

d. CORs may approve hot work permits for other CORs’ projects. For example, if a COR is on vacation or works a shift that does not align with the contractor’s shift, another COR may approve the hot work permits for that project. In doing so, the COR who approves the hot work permit for the COR that is unavailable makes a copy of the hot work permit for the COR responsible for the project. CORs responsible for a project may revoke this privilege at their discretion.

e. For Engineering employees conducting hot work operations after normal duty hours, the senior Engineering mechanic on duty acts as the supervisor and signs and approves the permit.

f. Engineering employees and contractors performing hot work operations are responsible for following the following procedures:

(1) Performing hot work operations only when conditions are safe.

(2) Obtaining a daily hot work permit.

(3) Continuing work only so long as conditions remain unchanged.

5. Engineering Section SOP No. 31

(4) Assuring that combustible materials are located at least 35 feet from the hot work site or covered to prevent the passage of sparks.

(5) Securing or covering cracks or openings in walls, floors, doors and windows within 35 feet from the hot work site to prevent the passage of sparks.

(6) Assuring that fire resistant guards are provided for floors, walls, and partitions of combustible construction.

(7) Assuring that hot work is not conducted on pipes or other metal in contact with combustible material if it is close enough to cause ignition by conduction.

(8) Assuring that fully-charged, operational fire extinguisher(s) are in the immediate work area.

(9) Assuring that sprinkler heads are covered with wet rags.

(10) Assuring that personnel are protected against heat and sparks.

(11) Assuring the fire watch designee is posted as fire watch.

(12) Assuring pipes or other enclosures are isolated, open to the atmosphere, and for verifying that combustible vapors/materials are not present in internal spaces.

(13) Assuring that hot work is not conducted on any piece of equipment under pressure.

g. Engineering employees and contractors performing fire watch for hot work operations:

(1) Ensure that safe conditions are maintained during hot work operations

(2) Have fire extinguisher(s) readily available and are trained in its use.

(3) Are familiar with facilities and procedures for sounding alarms.

(4) Watch for hot fires during the hot work and for 30 minutes thereafter, or 2 hours after for torch applied roofing.

(5) Have the authority to stop the hot work operations if unsafe conditions develop.

(6) Watch for fire in all exposed areas and try to extinguish them only when the fires are obviously within the capacity of the equipment available. If the fire watch determines that the fire is not within the capacity of the equipment, the fire watch will sound the alarm immediately.

6. Engineering Section SOP No. 31

(7) Are permitted to perform additional tasks, but those tasks must not distract him or her from the fire watch responsibilities.

i. Hot work permits include the front and back page when submitted for approval, preferably printed double sided, but may be stapled.

j. Engineering supervisors may implement task specific safety precautions.

5. REFERENCES: NFPA 241 and 51B VA Office of Facilities Information Letter, IL 08-89-01

6. RESCISSION: Engineering Section SOP Number 31, Hot Work Operations, dated September 15, 2014.

es/Steven Benson

Steven Benson, PE, PS, CHFM, CHESP Chief, Facilities Management Service

Attachment

Dist: Engineering Section Supervisors Fire Department (07F) Safety and Occupational Health Manager (138S)

Appendix A VA Medical Center Engineering Section SOP 31 Chillicothe, Ohio

February 25, 2015

ENGINEERING EMPLOYEE HOT WORK PERMIT

Seek an alternative/safer method if possible!

Before initiating hot work, ensure precautions are in place as required by NFPA 51B and Engineering Section Standard Operation Procedure (SOP) 31

Make sure an appropriate fire extinguisher is readily available.

This Hot Work Permit is required for any operation involving open flame or producing heat and/or sparks. This work includes, but is not limited to, welding, brazing, cutting, grinding, soldering, thawing pipe, torch-applied roofing, or chemical welding.

FOR EMERGENCIES, CALL CHILLICOTHE VAMC FIRE DEPARTMENT AT 740-773-1141, EXT. 444

OR CALL 444 FROM ANY VA PHONE LINE.

FOR NON-EMERGENCIES, CHILLICOTHE VAMC FIRE DEPARTMENT CAN BE REACHED AT EXT. 7161

Date: Building/Floor:

Service: Time Started: Time to be completed:

Work Required:

See back page for additional requirements

Name (print) of person designated to perform Fire Watch:

The work location has been examined. Necessary precautions have been taken and permission is requested to proceed with the work.

Name (print) and signature of competent person doing hot work:

The work plan and precautions have been discussed. Permission is granted for this work:

Name (print) and signature of Engineering or M&O Supervisor or

FOR AFTER HOURS WORK OR IF THE ENGINEERING SUPERVISOR OR M&O SUPERVISOR IS UNAVAILABLE, IN LIEU OF THEIR

SIGNATURE, THE FOLOWING WILL SIGN WITH SUPERVISORY AUTHORITY TO GRANT PERMISSION FOR THIS WORK.

Name (print) and signature of senior Engineering Mechanic on duty:

FINAL INSPECTION

TO BE CONDUCTED BY THE ENGINEERING EMPLOYEE DOING HOT WORK AND THE DESIGNATED

FIRE WATCH

Fire watch and monitoring of the hot work area and areas adjacent to which sparks and heat may have spread, including floors above and below and opposite sides of walls, are inspected 30 minutes after the completion of work and found to be fire safe. For torch-applied roofing, this is required for 2 hours after the completion of work.

THIS PERMIT IS GOOD FOR ONE DAY ONLY

PERMIT MUST BE POSTED IN A SAFE LOCATION OR ON THE FIRE WATCH’S PERSON

AND SHOWN TO ENGINEERING EMPLOYEES UPON REQUEST

Appendix A VA Medical Center

ATTENTION: Prior to requesting any hot work permit, the Engineering employee and designated fire watch inspects the work area and confirms that precautions are taken to prevent fire in accordance with NFPA 51B.

PRECAUTIONS:

Hot work equipment is in good working condition in accordance with manufacturer’s specifications.

Extinguishers are in service and operable.

Sprinklers are in service. If not, special permission of the VAMC Fire Department is required.

Requirements within 35 feet (11m) of hot work:

Flammable liquid, dust, lint, and oily deposits are removed.

Explosive atmosphere in area is eliminated.

Floors are swept clean and trash is removed.

Combustible floors are wet down or covered with damp sand or fire-resistive/noncombustible materials or equivalent.

Personnel are protected from electrical shock when floors are wet.

Other combustible storage materials are removed or covered with listed or approved materials (welding pads, blankets, or curtains, or fire-resistive tarpaulins), metal shields, or noncombustible materials.

All wall and floor openings are covered.

Ducts and conveyors that might carry sparks to distant combustible material are covered, protected or shut down.

Requirements for hot work on walls, ceilings, or roofs:

Construction is noncombustible and without combustible coverings or insulation.

Combustible material on other side of walls, ceilings, or roofs is moved away.

Requirements for hot work on enclosed equipment:

Enclosed equipment is cleaned of all combustibles.

Containers are purged of flammable liquid/vapor.

Pressurized vessels, piping, and equipment is removed from service, isolated, and vented.

Requirements for hot work fire watch and fire monitoring:

Fire watch is provided during, and for a minimum of, 30 minutes after hot work, including any break activity, or 2 hours for torch-applied roofing.

Fire watch is provided with suitable extinguishers and, where practical, a charged small hose.

Fire watch is trained in the use of equipment and in sounding alarms.

Fire watch is required in adjoining areas, above and below.

END OF VA EMPLOYEE HOT WORK PERMIT

Appendix B VA Medical Center

CONTRACTOR HOT WORK PERMIT

Seek an alternative/safer method if possible!

Before initiating hot work, ensure precautions are in place as required by NFPA 51B and Engineering Section Standard Operation Procedure (SOP) 31

Make sure an appropriate fire extinguisher is readily available.

This Hot Work Permit is required for any operation involving open flame or producing heat and/or sparks. This work includes, but is not limited to, welding, brazing, cutting, grinding, soldering, thawing pipe, torch-applied roofing, or chemical welding.

FOR EMERGENCIES, CALL CHILLICOTHE VAMC FIRE DEPARTMENT AT 740-773-1141, EXT. 444

OR CALL 444 FROM ANY VA PHONE LINE.

FOR NON-EMERGENCIES, CHILLICOTHE VAMC FIRE DEPARTMENT CAN BE REACHED AT EXT. 7161

Date: Building/Floor:

Contractor: Time Started: Time to be completed:

Work Required:

See back page for additional requirements

Name (print) of person designated to perform Fire Watch:

The work location has been examined. Necessary precautions have been taken and permission is requested

Name (print) and signature of competent person doing hot work:

The work location has been examined. Necessary precautions have been taken and permission is requested

Name (print) and signature of General Contractor’s Superintendent or Competent Person:

Name (print) and signature of Contracting Officer Representative (COR):

FINAL INSPECTION

TO BE CONDUCTED BY THE CONTRACTOR’S SUPERINTENDENT OR COMPETENT PERSON AND THE

DESIGNATED FIRE WATCH

Fire watch and monitoring of the hot work area and areas adjacent to which sparks and heat may have spread, including floors above and below and opposite sides of walls, are inspected 30 minutes after the completion of work and found to be fire safe. For torch-applied roofing, this is required for 2 hours after the completion of work.

THIS PERMIT IS GOOD FOR ONE DAY ONLY

PERMIT MUST BE POSTED IN A SAFE LOCATION OR ON THE FIRE WATCH’S PERSON

AND SHOWN TO ENGINEERING EMPLOYEES UPON REQUEST

Appendix B VA Medical Center

ATTENTION: Prior to requesting any hot work permit, the Contractor’s Superintendent or Competent Person inspects the work area and confirms that precautions are taken to prevent fire in accordance with NFPA 51B.

PRECAUTIONS:

Hot…