36C25219B0055-0002001.pdf

Tomah VA Medical Center Project Engineering

SCOPE OF WORK MEMORANDUM AMENDMENT 1

1. Project Data:

A. Title: Repair Campus Life Safety Findings B. Location: VA Medical Center, Tomah, Wisconsin B-400 C. Project #: 676-19-116 D. COR: David M. Martin E. Contractor:

F. Time requirement: 90 days from Notice to Proceed

Provide work as per Scope of Work: See Attached SOW

Provide work in accordance with federal, state, and local authorities. Project conditions:

The intent of this project is to repair the sixty (60) remaining Life Safety findings from our recent Life Safety Surveyor visit.

Guarantee Period Services will NOT be required for this project.

AMENDMENT 1

SCOPE OF WORK AMENDMENT 1

676-19-116

Repair Campus Life Safety Findings Tomah VAMC, Tomah WI 54660

20190718

A. INSPECTION OF SITE OF PROPOSED WORK:

Due to questions generated during the site visit 11 July 2019 Amendment 1 has been created to eliminate confusion and numerous Requests for information by those in attendance,

a) The deletion of VA completed work, the text has been highlighted yellow with strikethrough to represent a deletion to the project

b) The additions needed to the project by additional research have been identified by highlighted text in yellow

Before submitting a proposal on the work specified herein, the bidder shall examine the site and familiarize themselves with all existing conditions and limitations. No extra compensation will be allowed because of the Contractor’s misunderstanding as to the amount of work involved or because of his lack of knowledge of any existing conditions. Permission for inspection may be obtained from Mr. David Martin, Project Manager at

(608) 372-3971 Ext 61841. Contractor shall contact Project Manager prior to entry into the complex.

B. FACILITY STATUS:

The VA Tomah Campus is occupied and operated on a 24-hour basis and shall remain so throughout the performance of this work. All construction barriers, construction signs and project identification signs shall be the responsibility of the contractor to furnish and install as necessary throughout the various phases of this project.

C. DESCRIPTION OF WORK:

1. The Contractor shall furnish all labor, equipment, tools, materials, and supervision necessary to perform all work repairs in strict accordance with this Statement of Work and all attached Drawings.

2. The intent of this project is to repair the sixty (60) remaining Life Safety findings from our recent Life Safety Surveyor visit.

3. All work shall be performed in accordance with all current NFPA, Local, State and Federal building codes and all stated specific requirements.

D. TIME REQUIREMENTS:

1. Time requirement: Length of Repair time frame is – 90 calendar days from signed Notice to Proceed.

E. PRINCIPAL FEATURES:

1. B400

a) Reattach falling escutcheon; vestibule to the north of Room 1080A 1st floor

b) Relocate the smoke detectors at least 3' away from a HVAC supply grill outside room 3091 3rd floor

c) Relocate the smoke detectors at least 3' away from a HVAC supply grill outside room 3069 3rd floor

d) Relocate the smoke detectors at least 3' away from a HVAC supply grill outside room 3060 3rd floor

e) Reattach astragal on smoke barrier door by Stair S8-4th floor

f) Ensure the sprinkler is not blocked by patient lift and Add an additional sprinkler 6' away from current sprinkler room 4021 4th floor

2. B401

a) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Add additional sprinkler in open cavity: Dining room

b) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 2117

c) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Bathroom 2128

d) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: East wing hall,

e) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: West wing hall,

f) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2111

g) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2109

h) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2107

i) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2105

j) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2117

k) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2119

l) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2124

m) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2126

n) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2128

o) Obstructions were located within 18 inches of the sprinkler deflector in the following areas:

Room 2126, shelf

p) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2172

q) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2174

r) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2176

s) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2184

t) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2185

u) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2187

v) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 2189

w) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3178,

x) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3111

y) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3109

z) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3107

aa) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3105

bb) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3120

cc) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3124

dd) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3126

ee) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3128

ff) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3176,

gg) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3174

hh) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3172

ii) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3184

jj) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3185

kk) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3187

ll) The distance between the sprinkler deflector and the top of the ceiling exceeded 12 inches in the recessed area of the ceilings in the following areas: Room 3189

mm) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors: Hallway in 401 West, three heads were blocked by the track system

nn) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 3128

oo) Room 3258, Wifi box too close to sprinkler head

pp) Provide a cover plate for the old lock in door. Stair 12 1st floor

qq) Sprinkler blocked either move sprinkler or add an additional sprinkler Room 1182 by ventilation hood

rr) Lower or add additional sprinkler below ceiling tile room 1145 1st floor

ss) Install automatic sprinkler into the alcove across from room 1165 1st floor

tt) Remove class D interior finish wood paneling or replace with a resistive coating room 1183 1st floor

uu) Five-year sprinkler obstruction investigations had not been performed on the systems

vv) Smoke dampers were not tested and inspected within the last six years.

3. B402

a) Five-year sprinkler obstruction investigations had not been performed on the systems

b) Smoke dampers were not tested and inspected within the last six years.

c) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Therapy PMRS

d) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 2205

e) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 3205

f) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 3264

4. B403

a) Replace door with broken hinges; Cross corridor door outside room 1370A 1st floor, Slab Replacement

b) Replace door; room 1324 1st floor

c) Maintain 18" clearance from top of storage to sprinkler heads in room 1324 1st floor

d) Five-year sprinkler obstruction investigations had not been performed on the systems

e) Smoke dampers were not tested and inspected within the last six years.

5. B404

a) Replace Fire Door; Door rating is removed from tag; room 1431 1st floor

6. B406

a) Move escutcheon plate to ceiling room 2649 2nd floor

b) Move escutcheon plate to ceiling room 2645 2nd floor

c) Move escutcheon plate to ceiling room 2644 2nd floor

d) Move escutcheon plate to ceiling room 2630 2nd floor

e) Move escutcheon plate to ceiling in corridor outside room 2625 2nd floor

f) Move sprinkler head in room so that the patient lift rail is not directly under the sprinkler head in room 3667 3rd floor

g) Replace all expired sprinkler heads on second floor; 124 in total

7. B409

a) The built-in electric ranges were not equipped with a locked switch on a timer to disconnect the appliances when unattended by staff in Building 409.

b) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 1905

c) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 1947

d) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 1944, Sprinkler head too close to smoke alarm (must be 12 inches or greater)

e) Sprinklers in the attic were installed with deflectors in a horizontal orientation instead of parallel to the slope of the roof. These sprinklers were not under the peak of the roof.

f) The post indicating sprinkler control valve was locked open but not equipped with supervisory attachments (tamper devices) connected to the fire alarm system to monitor the status of the valves on the equipment servicing Building.

g) Smoke dampers were not tested and inspected within the last six years.

8. B410

a) The built-in electric ranges were not equipped with a locked switch on a timer to disconnect the appliances when unattended by staff in Building 410.

b) Sprinkler spray patterns were obstructed by objects mounted on the ceiling less than ten inches away, and extending down between 1.5 inches and seven inches from the sprinkler deflectors:

Room 11031

c) The post indicating sprinkler control valve was locked open but not equipped with supervisory attachments (tamper devices) connected to the fire alarm system to monitor the status of the valves on the equipment servicing Building.

d) An escutcheon plate was missing in soiled utility room 11057

e) Dropped escutcheon plates were noted in the following rooms: Room 11031

f) Dropped escutcheon plates were noted in the following rooms: Room 11012, bathroom

g) Sprinklers in the attic were installed with deflectors in a horizontal orientation instead of parallel to the slope of the roof. These sprinklers were not under the peak of the roof.

h) Smoke dampers were not tested and inspected within the last six years.

9. Contractor shall provide all proposed repair action data and information to CO/COR for approval and before the start of repairs.

10. “The C&A requirements do not apply, and that a Security Accreditation Package is not required:

F. GENERAL:

1. Contractor shall be responsible for all temporary marking and construction signage during the demolition and construction phases.

2. Contractor shall submit a construction schedule for approval prior to work start. Work under this contract shall be accomplished during normal Tomah VAMC business working hours. Tomah VAMC business working hours are 7:00am through 4:30pm Monday through Friday, excluding holidays.

Construction schedule shall be approved by the COR prior to work start. Contractor may work off hours (evenings and weekends) if desired with prior approval of the COR. Contractor shall have site Superintendence represented during all requested off hour work schedules.

3. Government personnel will be responsible for the moving of any Government equipment and materials in all affected areas.

4. All phasing, scheduling, utility shut-down and coordination of government property needing to be moved/removed or provided shall be done through the COR.

5. Demolition shall be performed with a minimum amount of damage to adjacent property not included in this contract, which is to remain. Any damage to such existing work resulting from demolition work shall be considered a part of work included in this contract and is the responsibility of the contractor and shall be repaired upon completion of project.

6. If removal of materials discloses defective materials, which should be replaced, necessitating work over and above the scope of this contract, Contractor shall immediately contact the Contracting Officer or his/her duly appointed representative in order that corrective action may be taken.

7. Contractor shall take extra measures to ensure any significant amounts of dust and dirt generated from this project are contained within the immediate construction area. Any dirt and debris tracked outside of the immediate working areas will be the responsibility of the contractor for clean up if necessary. Any work being done shall be done in such a manner as to create a minimal amount of disruption to the ongoing work mission on the property and within the remainder of the complex. See attached Pre- Construction Risk Assessment (PCRA) and Infection Control Risk Assessment (ICRA) for details.

8. During the demolition and repair phases contractor shall ensure that all work is accomplished in a safe manner in accordance with OSHA requirements. Contractor shall ensure that all areas where work is to be performed are secured and safe during and at the end of each workday.

9. All non-hazardous excess material and debris generated from this project shall be disposed of off site in a

State of Wisconsin licensed landfill upon completion of project. The Contractor shall remove all debris resulting from this contract from the site.

a) With each application for progress payment, Contractor shall submit a summary of construction and demolition debris diversion and disposal including beginning and ending dates of period covered.

b) The Contractor shall quantify all materials diverted from landfill disposal through salvage or recycling during the period with the receiving parties, dates removed, transportation costs, weight tickets, manifests, invoices. Include the net total costs or savings for each salvaged or recycled material. Delivered to COR upon each site removal.

c) The Contractor shall quantify all materials disposed of during the period with the receiving parties, dates removed, transportation costs, weight tickets, tipping fees, manifests, invoices.

Include the net total costs for each disposal. Delivered to COR upon each site removal.

10. Public restrooms will be available for use during contract. Contractor shall not wash construction tools and equipment in any facility bathroom sinks/etc. The Tomah VA will provide any water needed for construction purposes. Contractor shall coordinate with COR for locations.

G. PROTECTION:

1. All existing station complex property shall be suitably protected against damage and it shall be the Contractor’s responsibility to replace any such items as may become damaged as a result of his failure or negligence in fully protecting same. Any damage done to the buildings or grounds by the contractor during the construction period will be the responsibility of the contractor and shall be repaired upon completion of project.

H. STORAGE AREA:

Storage area will be available at the VAMC Campus during construction phases. Contractor shall coordinate with project COR for storage location.

I. SAFETY:

Safety is the responsibility of the Contractor. Contractor shall submit a safety plan for approval prior to work start. Contractor shall assume all liability for damage or injury. Contractor shall cease operations and notify Contracting Officer’s Representative if safety appears to be endangered. Do not resume operations until safety is restored. All work shall be performed in accordance with all applicable VHA/OSHA standards. See Attachment B for PCRA (Pre-Construction Risk Assessment)

J. INFECTION CONTROL:

1. See Attachment C for Infection Control Risk Assessment (ICRA) for details of Contractors responsibility to maintain a clean work environment during construction.

K. INTERIM UTILITY SYSTEM OUTAGE MEASURES:

1. See Attachment E for IUSOM for details of Contractors responsibility to schedule with the COR the utility shut-down ensuring a safe work environment during repairs. Must submit 7 days in advance of expected date of outage.

L. INTERIM LIFE SAFETY ASSESSMENT:

1. See Attachment D for ILSA/ILSM for details of Contractors responsibility to schedule with the COR the patient/pedestrian traffic zone closure ensuring a safe work environment during repairs.

M. PHYSICAL SECURITY:

1. Contractor Identification

a) On the first day of work, the Contractor shall coordinate with COR/Resident Engineer to acquire the proper security badging. Identification badges shall be worn and visible on your person at all times while on campus.

b) Contractor shall keep issued Identification badge on their person when leaving campus.

There will be instances that the VA Police will be verifying ID’s at the entrance to the campus and identification will be required. Please have ID’s with you.

c) When project is complete each person will be REQUIRED to turn their Identification Badges back into the Tomah VA Police.

2. Contractor Access and Key Requests

a) Contractor shall coordinate with COR/Resident Engineer to request any required keys needed to gain access into any required non-public spaces. Request shall be made via email to COR/Resident Engineer. COR/Resident Engineer will coordinate internal process with Contractor for issuance. Email requests for keys shall have the following information.

1) Name of Contractor

2) Name of Company that Contractor works for

3) Type(s) of key(s) that is/are being requested

4) Quantity of each key needed.

END OF SECTION

VAMC TOMAH

Pre-Construction Risk Assessment (PCRA)

Attachment B (MCM FS – 50)

Project: Location(s): Start Date:

COTR: Contractor:

Brief Description of Work:

Category Factors YES N/A Initials Noise *Industrial Hygienist (IH)

Impact, Duration

Vibration *Industrial Hygienist (IH)

Tool use, Demolition, Distance

Infection Control *Infection Control Coordinator

Category of Risk [1] see below Level: I - II - III - IV

Dust *Infection Control Coordinator

Cutting, Grinding, Sanding, etc.

Life Safety Impact *Fire Department

ILSM Issues: [2] – see below

Security *Chief, Police Service

Site Security, Access Control

Disruption of Utilities *COTR - Facilities

Planned Shutdowns, Construction Near Utility system Supplies

[1] Infection Control Risk Assessment (ICRA) is for evaluation of the level of practices necessary to provide appropriate levels of patient safety.

[2] ILSM Risk Assessment is for determining whether ILSM are necessary and which ILSM are to be implemented.

Other Risk Assessments: YES N/A Permit Required Confined Space (PRCS) entry will be necessary. *FD Asbestos/lead or other hazardous abatement will be necessary. *IH Construction debris will be produced. (Recycling Program) *IH Chemicals will be on site. (Hazard Communication/MSDS sheets necessary.) *IH Compressed gas cylinders will be on site. (Appropriate storage) *IH Penetration in floors, walls, ceilings will be necessary. (Permit required) *FD Cutting, burning, or welding will be necessary. (Hot Work Permit) *FD Off tour construction/work will be necessary. (Supervision) *FD Lock-Out/Tag-Out of the following systems be necessary: *Facilities

□ Domestic Water □ Electrical Systems □ HVAC System □ Medical Gas

□ Steam Systems □ Security Alarms □ IT Systems

Safety/FD/designee COTR Date

Concerns to address: Measures to take:

Select Control Procedures:

Impact of Building Trades on Healthcare

System Possible Interruption Possible Effect to Patients Electrical - Changing position of switches and breakers

- Cutting or splicing into wires

- Disconnecting wires or terminals

- Disturbing Junction

Boxes/Electrical Panels

- Core Drilling

- Demolition of walls

- Excavation

Electrical Systems provides LIFE SUPPORT (Directly and Indirectly)

- Can cause DEATH to patients

Water Lines - Turning valves

- Cutting into lines

- Demolition & Excavation

HVAC, GPICU, X Ray, etc Can cause DEATH to patients Infection Control issues Major Cleanup issues

Medical Gases:

Oxygen Air Vacuum Nitrous Oxide Nitrogen

- Cutting or disturbing into lines (labeled, unlabeled)

- Changing valve positions

- Deactivating alarms

- Demolition & Excavation

Oxygen, vacuum, air, etc.

GPICU, Med/Surg.

Can cause DEATH to patients

HVAC - Shutting down

- Modifying

- Changing controls

- Cutting into the roof

- Producing foul odors near intakes

- Cutting into chilled water lines

- Obstruct fresh air intake

Temperature is critical in GPICU, etc. Infection Control issues Major Air Quality Issues

Fire Alarm and Sprinklers - ANY modifications

- covering or removing smoke heads

- Demolition & Excavation

- Damage or set off sprinkler heads

- Duct work modifications

- Compromising Fire Safety

- False Alarms

- Floods

- Major disruptions and distractions

ALL THE ABOVE CAN

RESULT IN DEATH

Code Alarms Nurse Call Wander Guards

- Demolition & Excavation

- Unplugging

- Changing position of switches/breakers

Lack of communicating system can result in patient death or injury

Select Control Procedures:

VAMC TOMAH

Infection Control Risk Assessment (ICRA)

Attachment C (MCM FS – 50)

Step 1. - Use the following chart to identify the Type of Construction Project Activity (Type A-D)

Type A

Inspect and Non-invasive Activities: Includes, but not limited to:

Removal of ceiling tiles for visual inspection 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 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 t high level of dust or requires demolition or removal of any fixed building components or assemblies: Includes, but not limited to:

Sanding of walls for painting or wall covering Removal of floorcovering, 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 workshift

Type D

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

Activities that require consecutive work shifts.

Requires heavy demolition or removal of a complete cabling system.

New construction

Selected Type of Construction:

Step 2. - Using the following table, identify the Patient Risk Group that will be affected. If more than one group is affected, select the higher risk group.

Low Risk Medium Risk High Risk Highest Risk Office areas Cardiology

Echocardiography Endoscopy Nuclear Medicine Physical Therapy Radiology/MRI Respiratory Therapy

CCU

Emergency Room Laboratories Outpatient Surgery Pharmacy Post Anesthesia Care Unit Surgical Units

Any area caring for immunocompromised patients

Cardiac Cath Lab Central Supply Intensive Care Units Medical Units Negative airflow rooms Oncology Operating Rooms

Select Patient Risk Group:

Step 3. - Match the Patient Risk Group with the planned Construction Project Type (A, B, C, D) on the following matrix, to find the Class of Precautions (I, II, III, IV) or level of infection control activities required.

Patient Risk Group

Type A Type B Type C Type D

Low risk I II II III/IV Medium risk I II III IV High risk I II III/IV IV Highest risk II III/IV III/IV IV

Attachment C (MCM FS – 50)

During Construction Project

Upon Completion of Projects

C la ss I

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

2. Immediately replace a ceiling tile displaced for visual inspection

1. Clean work upon completion of task

C la ss

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 disinfectant.

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

3. Wet mop &/or vacuum before leaving work area.

4. Remove isolation of HVAC system in area where work is being performed.

C la ss

II

I

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 & sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

3. Maintain negative air pressure within worksite utilizing HEPA-equipped air filtration units.

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

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

1. Do not remove barriers from work area until completed project is inspected by Safety Management & Infection Control & thoroughly cleaned by Environmental Management.

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

3. Vacuum work area with HEPA-filtered vacuums.

4. Wet mop with disinfectant.

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

C la ss

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 & sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins.

3. Maintain negative air pressure within worksite utilizing HEPA-equipped air filtration units.

4. Seal holes, pipes, conduits and punctures appropriately.

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 the can wear cloth or paper coveralls that are removed each time they leave the work site.

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

7. Do not remove barriers from work area until completed project is inspected by Safety Management & Infection Control & thoroughly cleaned by Environmental Management.

1. Remove barrier materials carefully to minimize spreading of dirt & debris associated with construction.

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

3. Cover transport receptacles or carts.

Tape covering unless solid lid.

4. Vacuum work area with HEPA-filtered vacuums.

5. Wet mop with disinfectant.

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

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

Project Class Type

VAMC Tomah Interim Life Safety Measures (ILSM)

Attachment D (MCM FS -50)

Project: Location(s): Evaluation Date: Start Date:

COTR: Contractor:

Guidelines Y/N If any answer is no, need ILSM in place:

Will exit egress routes from occupied areas remained unchanged?

Will exit stairs remain unobstructed & fire separated?

Will sprinkler system stay functional?

Will fire and smoke compartments remain intact and unchanged?

Will fire alarm detection systems remain functional & unimpaired?

Will construction area be separated by noncombustible smoke tight partitions?

Will access to emergency access by fire department remain unobstructed?

Will the construction area have two remote exits?

Adequate distance to exit?

Hazardous areas protected?

Interim Life Safety Measures (ILSM) – circle the letters for action required (Refer to Matrix)

a. Ensure Egress h. Prohibit Smoking

b. Ensure Emergency Forces Access i. Conduct 2 Fire Drills per Shift per Quarter

c. Ensure Fire Department Notification j. Increase Hazard Surveillance

d. Ensuring Operational Life Safety Systems k. Compartmentation Training of Personnel

e. Temporary Construction Partitions l. Conduct Organizational Training on Life

Safety

f. Additional Fire Fighting Equipment m. Daily removal of debris and hazardous waste material

g. Control Combustible Loading n. Institute a Fire Watch

Life Safety Narrative:

Assessed by: Fire Department Date

Agreed by: COTR Date

Contractor Date

O

AFFECTED SYSTEMS: STEAM WATER NORMAL POWER EMERGENCY POWER

NURSE CALL MED. GAS

OTHER

FIRE PANEL FIRE SUPPRESSION ELEVATOR

AFFECTED BUILDINGS/LOCATIONS:

INTERIM MEASURES REQUIRED:

AFFECTED STAFF NOTIFIED COMMENTS:

ADDITIONAL EQUIPMENT REQUIRED SPECIFY:

BACK-UP PROCEDURES IN PLACE SPECIFY:

EMERGENCY PROCEDURES REVIEWED COMMENTS:

OTHER:

OTHER:

ADDITIONAL COMMENTS:

REQUEST APPROVED BY: APPROVED DATE:

WORK COMPLETION REVIEW: WORK COMPLETION DATE:

OUTAGE FOLLOW UP:

INTERIM UTILITY SYSTEM OUTAGE MEASURES

REQUESTING SHOP: Project Section NAME OF REQUESTER: David Martin

DATE REQUESTED:

WORK START DATE:

PROJECT NUMBER:

676-19-116

AFFECTED TIMEFRAME:

DESCRIPTION OF W RK/PROJECT: Repair Campus Life Safety Findings