36C25219B0004-0001001.pdf

PROJECT RISK ASSESSMENT (SAFETY, INFECTION CONTROL & ISLM)

Project Title: VCS Storage Relocation Project Number: 55617022

Location: B134Bsmt A5, A6, C1, C2 COR Email: craig.marriner@va.gov

Start Date: Design 11/09/17 Const. Est FY19 Phone: 2246103538

55617022 134Bsmt.pdf Adobe Acrobat Document 438 KB File Attachment File Attachment

PRECONSTRUCTION RISK ASSESSMENT YES N/A NO

Off Tour Construction Necessary?

Permit Required Confined Space (PCRS) Entry Necessary?

Cutting, Burning, or Welding Necessary?

Has this project been evaluated for asbestos by an accredited inspector? (IH use only, leave blank until IH review)

NESHAP survey conducted by contractor per Mr. Craig Marriner.

Has this project been evaluated for lead based paint (LBH) by an accredited inspector? (IH use, leave blank until IH review)

Samples collected by contractor for lead analysis per Mr. Craig Marriner.

LOCK OUT/TAG OUT OF THE FOLLOWING CHECKED SYSTEMS WILL BE NECESSARY

Domestic Water Electrical Systems HVAC Systems

Medical Gases Steam Systems Security Alarms

THE FOLLOWING DISCIPLINES/SHOPS WILL BE INVOLVED IN THIS PROJECT

Infection Control Construction Paint Shop Engineering

Biomedical Safety Patient Safety Carpenter

IRM Type Other Type Other Type Other

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ILSM MEASURES ARE REQUIRED FOR THIS PROJECT YES NO

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INFECTION CONTROL RISK ASSESSMENT

STEP 1:

USING THE FOLLOWING TABLE, IDENTIFY TYPE OF CONSTRUCTION

TYPE A Inspection and Non-Invasive Activities.

Includes, but is not limited to:

removal of ceiling tiles for visual inspection only, e.g., limited to 1 tile per 50 square feet painting (but not sanding) wallcovering, 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.

TYPE B Small scale, short duration activities which create minimal dust Includes, but is not limited to:

installation of telephone and computer cabling access to chase spaces cutting of walls or ceiling where dust migration can be controlled

TYPE C Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Includes, but is not limited to:

sanding of walls for painting or wall covering removal of floorcoverings, ceiling tiles and casework new wall construction minor duct work or electrical work above ceilings major cabling activities any activity which cannot be completed within a single work shift

TYPE D Major demolition and construction projects Includes, but is not limited to:

activities which require consecutive work shifts requires heavy demolition or removal of a complete cabling system new construction

CONSTRUCTION TYPE TYPE D

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PATIENT RISK GROUP

IC MATRIX-CLASS OF PRECAUTIONS

STEP 2:

USING THE FOLLOWING TABLE, IDENTIFY THE PATIENT RISK GROUPS AFFECTED.

IF MORE THAN ONE RISK GROUP WILL BE AFFECTED, SELECT THE HIGHER RISK GROUP.

LOW RISK MEDIUM RISK HIGH RISK HIGHEST RISK

Office Areas Cardiology CCU Any area caring for immunocompromised patients

Echocardiography Emergency Room Burn Unit

Endoscopy Labor & Delivery Cardiac Cath Lab

Nuclear Medicine Laboratories (specimen) Central Sterile supply

Physical Therapy Medical Units Intensive Care Units

Radiology/MRI Newborn Nursery Negative Pressure Isolation Rooms

Respiratory Therapy

Outpatient Surgery Oncology

Pediatrics Operating Rooms to include CSection Rooms

Pharmacy

Post Anesthesia Care Unit

Surgical Units

LOW RISK

STEP 3:

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 or Color-Coded Precautions are delineated on the following page

Patient Risk Group TYPE A TYPE B TYPE C TYPE D

LOW RISK GROUP I II II III/IV

MEDIUM RISK GROUP I II III IV

HIGH RISK GROUP I II III/IV IV

HIGHEST RISK GROUP II III/IV III/IV IV

CLASS III/IV

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I

1. Execute work by methods to minimize raising dust from construction operations.

2. Immediately replace a ceiling tile displaced for visual inspection

1. Clean work area upon completion of task.

II

1. Provide active means to prevent airborne dust from dispersing into atmosphere.

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 cleaner/disinfectant.

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

3. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

4. Upon completion, restore HVAC system where work was performed.

III

1. Remove or Isolate HVAC system in area where work is being done to prevent contamination of duct system.

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 owner’s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner’s Environmental Services Department.

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 cleaner/disinfectant.

5. Upon completion, restore HVAC system where work was performed.

IV

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

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. Seal holes, pipes, conduits, and punctures.

5. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave work site.

6. All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

1. Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Prevention & Control Department and thoroughly cleaned by the owner’s Environmental Services Dept.

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

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

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

5. Vacuum work area with HEPA filtered vacuums.

6. Wet mop area with cleaner/disinfectant.

7. Upon completion, restore HVAC system where work was performed.

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STEP 5: IDENTIFY SPECIFIC SITE OF ACTIVITY e.g., PATIENT ROOMS, MED ROOM,ETC…

STEP 6: INDENTIFY ISSUES RELATED TO: VENTILATION, PLUMBING, ELECTRICAL IN TERMS OF

OCCURRENCE OF PROBABLE OUTAGES.

STEP 7: IDENTIFY CONTAINMENT MEASURES, USING PRIOR ASSESSMENT. WHAT TYPES OF

BARRIERS? (e.g., SOLIDS WALL BARRIERS) WILL HEPA FILTRATION BE REQUIRED?

(Note: Renovation/construction area shall be isolated from the occupied areas during construction and shall be negative with respect to surrounding areas)

STEP 8: CONSIDER POTENTIAL RISK OF WATER DAMAGE. IS THERE A RISK DUE TO

COMPROMISING STRUCTURAL INTEGRITY? WALL, CEILING OR ROOF

STEP 9: WORK HOURS, CAN OR WILL THE WORK BE DONE DURING NONPATIENT CARE HOURS?

STEP 10: DO PLANS ALLOW FOR ADEQUATE NUMBER OF ISOLATION, NEGATIVE AIRFLOW

ROOMS?

STEP 11: DO PLANS REQUIRE CONTRACTORS TO USE MOUNTABLE MONOMETERS TO MEASURE

AND ASSESS NEGATIVE AIRFLOW IN REAL TIME?

STEP 12: DO PLANS ALLOW FOR THE REQUIRED NUMBER & TYPE OF HANDWASHING SINKS?

STEP 4:

IDENTIFY THE AREAS SURROUNDING THE PROJECT AREA, ASSESSING

POTENTIAL IMPACT:

Insert Phase # if Multiple Unit Below Unit Above Unit Lateral Unit Lateral Unit Behind Unit Front

Unit/Dept. Name Unit/Dept. Name Unit/Dept. Name Unit/Dept. Name Unit/Dept. Name Unit/Dept. Name

None Office ITD Work Out Room Patient Risk Group Patient Risk Group Patient Risk Group Patient Risk Group Patient Risk Group Patient Risk Group

LOW LOW LOW LOW

Current ITD storage areas

Work will occur on all MEP system. Possible scheduled outages likely to occur.

IC controls in accordance with Class III/IV requirements as applicable. IC reviews to occur.

Very low water damage risk.

All design reviews to occur during normal hours, specific construction work may be scheduled for off hours.

Not Applicable

Yes, as required by IC requirements.

Not Applicable

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STEP 13: DOES THE INFECTION PREVENTION & CONTROL STAFF AGREE WITH THE MINIMUM

NUMBER OF SINKS FOR THIS PROJECT?(Verify against FGI design and construction guidelines for types and area)

STEP 14: DOES THE INFECTION PREVENTION & CONTROL STAFF AGREE WITH THE PLANS

RELATIVE TO CLEAN AND SOILED UTILITY ROOMS?

STEP 15: PLAN TO DISCUSS THE FOLLOWING CONTAINMENT ISSUES WITH THE PROJECT TEAM.

(e.g., TRAFFIC FLOW, HOUSEKEEPING, DEBRIS REMOVAL, HOW AND WHEN)

STEP 16: TUBERCULOSIS RISK ASSESSMENT? YES NO

STEP 17: LEGIONELLA IMPACT: WILL THIS PROJECT INVOLVE DISTURBING OR BREAKING WATER SYSTEMS, OR

RESULT IN STAGNATION OF THE WATER SYSTEMS FOR GREATER THAN 7 DAYS? YES NO

IF LEGIONELLA IMPACT IS YES, COMPLETE THE FOLLOWING 5 STEPS

1. All hot and cold water systems will be flushed until flowing clear and without air in the system.

(NOT LESS THAN 10 MINUTES)

2. All faucets and showerheads will be removed and cleaned.

3. Temperatures will be taken to insure hot water is within limits identified above.

4. Water samples will be taken to verify levels of chlorine and safety of the water for human use.

5. Take a representative sample at affected distal fixtures and send for culture testing.

(NOTE: IT IS NOT NECESSARY TO WAIT FOR SAMPLE PRIOR TO RETURNING THE AREA TO

SERVICE).

Not Applicable, not patient area.

Not Applicable, not patient area

Specific IC requirements and controls to be incorporated into design documents.

PROJECT COORDINATOR CONDUCTED

CONTRACTOR BRIEFINGS & TRAINING

N/A DATE INITIALS

Ensuring free and unobstructed access to emergency department/services and for emergency forces.

Ensuring fire alarm, detection, and suppression systems are not impaired, a temporary, but equivalent system shall be provided when any fire system is impaired.

Contractor will schedule work to minimize time systems are impaired and to notify safety section prior to system being impaired.

Ensuring temporary construction partitions are smoke tight and built of noncombustible or limited combustible materials that will not contribute to the development or spread of fire.

Providing additional fire-fighting equipment and use training for personnel.

Developing and enforcing storage, housekeeping, and debris removal practices that reduce the flammable and combustible fire load of the building to the lowest necessary level for daily operation.

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Final Department Notes: (Required PPE will be listed here)

WHEN INFECTION CONTROL MEASURES ARE IN

PLACE I/C STAFF HAS CONDUCTED

CONTRACTOR BRIEFINGS & TRAINING

N/A DATE INITIALS

Met with Services/Sections surrounding construction site to inform them of impact/precautions to be taken & to instruct them in basic I/C requirements (see attached).

Met with the Construction Manager, Construction Crews, and Sub-Contractors to inform them of impact/precautions to be taken & to instruct them in Basic I/C requirements.

Informed the Project Coordinator that barriers are not to be removed from work area until completed project is inspected by the Safety and Infection Control Sections and thoroughly cleaned by Environmental Management Service.

WHEN ILSM'S ARE IN PLACE SAFETY STAFF HAS

CONDUCTED NOTIFICATIONS & TRAINING

N/A DATE INITIALS

Police/GLFD have been notified to conduct a fire watch at least once per shift during non-business hours whenever any portion of the alarm, detection, or suppression system is impaired for more than four hours within a twenty-four hour period.

1/4/2018 RHH

If exits are obstructed, then personnel in building were trained on alternate routes and exits.

1/4/2018 RHH

Construction areas will have designated and marked exits, maps delineating new exit pathways are in place.

1/4/2018 RHH

Staff In affected area(s) will receive 2 additional fire drills per shift.

1/4/2018 RHH

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Signature Page For Project:

Date: Phone: Signature:

55617022

11/10/2017 8476881900 x83538 Marriner, Craig E. FHCC Lovell

Date: Phone: Signature:

Date: Phone: Signature:

Date: Phone: Signature:

Date: Phone: Signature:

Contractor Name:

Date:_______________ Phone:_________________ Signature:___________________________

NAVFAC:

Date:_______________ Phone:_________________ Signature:___________________________

This Check box to be filled by Project Engineer only after Contractor signed copy is attached above.

Re vision 83116

11/24/2017 8476881900 x89090 Svaldi, Fred E FHCC Lovell

1/4/2018 2246104174 Henne, Robert H. FHCC Lovell

File Attachment

File Attachment

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