Copy of ICRA ILSM.xlsx

XLSX spreadsheet 59 KB Posted Apr 9, 2021

Attached to: K048--629-21-2-690-0074, Installation of 4 inch Control Valve, Testing, and Inspection
Solicitation number: 36C25621Q0639
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

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Other files

File	Type	Posted
36C25621Q0639 0003.docx	DOCX document	Apr 9, 2021
36C25621Q0639 0002.docx	DOCX document	Apr 7, 2021
36C25621Q0639 0001.docx	DOCX document	Mar 31, 2021
Wage Determination 15-5189.txt	TXT text file	Mar 30, 2021
LATEST CEP- PROPOSED NEW OXYGEN LINE-2020 drawings.pdf	PDF	Mar 30, 2021
36C25621Q0639.docx	DOCX document	Mar 30, 2021

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Directions

Instructions

1. On tab 1 fill in information for Project Title or Type of Work, Project No., COTR., and Start and Completion Date.

2. Input a brief Description of work.

3. On tab 8 Give a detailed step by step description of work, and all risks/hazards associated with each step of the work, and the step being taken to reduce/ eliminate the risks/ hazards..

4. review tab 7 and determine what type of work is being done and the level of risk to patients and staff. Once the type and risk level have been determind return to tab1 and input those into the ICRA form just below the Brief Description, then take those findings and locate them on the chart just below that to determine the overall project class.

5. After determining the over all project class go to tab 2. Depending on the over all project class it will tell what precautions that need to be put into place prior to construction starting and remain in place throughout construction, and what steps that need to be done after construction is complete to ensure the work area is completely clean.

6.Review tab 3 and answer the questions Yes/No in the top chart, any yes answers will give you measures in the lower chart that need to be put into place prior to construction and remain in place throughout construction.

7. Once the form has been completed it needs to be sent to the Construction Safety Committee for review and approval. If anyone has any question about the ICRA they will contact the person submitting the form for clarification prior to approval.

8. Please try to submit ICRA's to the committee the week prior to the start date.

9. The committee will be reviewing ICRA's for all current projects and any new ICRA's that have been submitted for approval on Friday's prior to Construction Safety Rounds.

10. Only emergency ICRA's should be walked through for approval.

The committee consists of

Safety Management/ Construction/ GEMS Coordinator/ Industrial Hygiene- Send to VHANOL Safety Management mail group.

Facilities Management/ Project Engineering- Kristen Russell, Angela McKenzie, Tony Clark, Stradford Goins, Kenneth Ward

Police Services- Robert Kenyon, Connie Washington, Joshua Anderson

Quality Management/ Infection Control- Caitlyn Martin-Klinger, Debbie Lepre, Jennifer Frisch, Angela Rozar

Patient Safety- Ayesha Callaway, Randy Decuir, Josette Askratni

Contracting- William Geary (Biloxi)

AFGE/ NFFE Representatives- Eric Alexander, Vickie Charles

Clinical Engneering- Mariel Paciera, Christopher Cain, Jennifer Boudreaux, Meghan Glaviano, Austin Sandlin

1-ICRA

Infection Control Risk Assessment (ICRA) Checksheet
Project Title or Type of Work:____________________________________	Project No._____________________
In-house Representative/ Supervisor______________________________	Location:______________________
COR/ Representative___________________________________________	Start Date:_____________________
	Completion Date:_______________

Brief description of the construction or maintenance project:

Type of construction project--choose from drop-down box (see "Types & Risk" tab):
Patient Risk Group--choose from drop-down box (see "Types & Risk" tab):						A	Low	I
						B	Medium	II
Class of Infection Control Precautions (select from grid)						C	High	III
	Construction Project Type					D	Highest	IV
Patient Risk Group	TYPE A	TYPE B	TYPE C	TYPE D	Project Class
Low	I	II	II	III/IV
Medium	I	II	III	IV
High	I	II	III/IV	IV
Highest	II	III/IV	III/IV	IV

Other Considerations	Comments
Air Quality
Noise
Vibrations
Utilities
Emergency procedures
Security

Construction Safety Assessment Team Concurrence
Member	Signature	Date
Safety Management
QM/ Infection Control
Patient Safety

Other Comments

2-Types & Risk TYPE A Inspection and Non-Invasive Activities Includes, but is not limited to:

Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet Painting (but not sanding) Wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

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 floor coverings, 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 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 complete cabling systems New Construction

Low Risk	Medium Risk	High Risk	Highest Risk
Office areas

Medical records Non-patient care areas Cafeteria Cardiology clinic Echocardiography Endoscopy Nuclear Medicine Physical Therapy Radiology/MRI Respiratory Therapy CCU Emergency Room Laboratories (specimen) Admissions Outpatient Surgery Pharmacy Post Anesthesia Care Unit (PACU) Surgical Units Any area caring for immunocompromised patients Cardiac Cath Lab

SPS

Intensive Care Units Medical Units Negative pressure isolation rooms Oncology Operating rooms Invasive procedure rooms

3-ICRA2

Infection Control Risk Assessment (ICRA) Checksheet (check appropriate requirements)

0
				December 31, 1899
Class	During Construction Project		Upon Completion of Project
I		Execute work by methods to minimize raising dust from construction operations.		Immediately replace ceiling tile displaced for visual inspection.
II		Provide active means to prevent airborne dust from dispersing into atmosphere.		Wipe work surfaces with disinfectant.
		Water mist work surfaces to control dust while cutting.		Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area.
		Seal unused doors with duct tape.		Remove isolation of HVAC system in areas where work is being performed.
		Block off and seal air vents.		Contain construction waste before transport in tightly covered containers.
		Place dust mat at entrance and exit of work area.
		Remove or isolate HVAC system in areas where work is being performed to prevent contamination of duct system.
III		Class II (those checked) plus:		Do not remove barriers from work area until completed project is inspected by Safety and Infection Control and thoroughly cleaned by Environmental Management.
		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.		Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.
		Maintain negative air pressure within work site utilizing HEPA equipped air filtration units.		Vacuum work area with HEPA filtered vacuums.
		Cover transport receptacles or carts. Tape covering unless solid lid.		Wet mop area with disinfectant.
IV		Class III (those checked) plus:		See other Classes.
		Seal holes, pipes, conduits, and punctures appropriately.
		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 the worker leaves the worksite.
		All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

4-ILSM Const

Interim Life Safety Measures (ILSM) Assessment for Construction and Maintenance
	Project Title or Type of Work:	0
	Project No.	0

Evaluate the project using the criteria below to determine which ILSM are applicable.
	Deficiency	Y or N?	Deficiency	Y or N?
	Blocking off an approved exit	N	Installing sprinkler system (out of service)	N	Y
	Rerouting of primary egress path	N	Significantly modifying smoke or fire barrier walls	N	N
	Rerouting of secondary egress path	N	Adding an addition to an existing structure	N
	Rerouting of traffic to emergency care center	N	Taking fire alarm / sprinkler system out of service >4 hours	N
	Major renovation of an occupied floor	N	Disconnecting 4 or more alarm devices >4 hours	N
	Replacing the fire alarm system (out of service)	N	All / part of medical gas alarm panels out of service	N

1	Notify the fire department and initiate a fire watch.
2	Post signage identifying the location of alternative exits to everyone affected.
3	Inspect exits in affected areas on a daily basis.
4	Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired.
5	Provide additional firefighting equipment.
6	Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire.
7	Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices.
8	Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level.
9	Provide additional training to those who work in the hospital on the use of firefighting equipment.
10	Conduct one additional fire drill per shift per quarter. All areas.
11	Conduct one additional fire drill per shift per quarter. Local area.
12	Inspect and test temporary systems monthly.
13	Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety.
14	Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features.

5-ILSM Defic

Interim Life Safety Measures (ILSM) Assessment for Life Safety Code Deficiency
	Deficiency:	0

Evaluate the deficiency using the criteria below to determine which ILSM are applicable.
	Deficiency	Y or N?	Deficiency	Y or N?
	Corridor door latching / gap / rating problems	N	Nonconforming building construction type	N		Y
	Fire door latching / gap / rating problems	N	Improperly protected vertical openings	N		N
	Smoke door latching / gap / rating problems	N	Large penetration in fire / smoke barriers	N
	Lacking a code-compliant barrier	N	Corridor walls do not extend to the structure	N
	Fire exit stairs discharge improperly	N	Fire protection systems* failure <4 hours	N	*alarm, detection or

suppression

Excessive travel distance to approved exit	N	Fire protection systems* failure >4 hours	N
Lacking two remote exits	N	Hazardous area not properly protected	N

1	Notify the fire department and initiate a fire watch.
2	Post signage identifying the location of alternative exits to everyone affected.
3	Inspect exits in affected areas on a daily basis.
4	Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired.
5	Provide additional firefighting equipment.
6	Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire.
7	Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices.
8	Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level.
9	Provide additional training to those who work in the hospital on the use of firefighting equipment.
10	Conduct one additional fire drill per shift per quarter. All areas.
11	Conduct one additional fire drill per shift per quarter. Local area.
12	Inspect and test temporary systems monthly.
13	Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety.
14	Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features.

6-ILSM Contract ILSM Formal Contract

Project Title / Deficiency:	0	Project No.:	0
COTR:	0	Contractor:

Location and Description of Work:

	Date of this Formal Contract:			December 31, 1899
	Mandatory ILSM					Yes	No
	1	Notify the fire department and initiate a fire watch.
	2	Post signage identifying the location of alternative exits to everyone affected.
	3	Inspect exits in affected areas on a daily basis.
	4	Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired.
	5	Provide additional fire-fighting equipment.
	6	Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire.
	7	Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices.
	8	Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level.
	9	Provide additional training to those who work in the hospital on the use of firefighting equipment.
	10	Conduct one additional fire drill per shift per quarter. All areas.
	11	Conduct one additional fire drill per shift per quarter. Local area.
	12	Inspect and test temporary systems monthly.
	13	Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety.
	14	Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features.
	Staff Training
	Subject(s)
(use above numbers)			Names/Groups Trained		Date

Dates of Fire Drills
Area	Date	Time	Area	Date	Time

7-Inspection

MEDVAMC CONSTRUCTION SAFETY INSPECTION FORM

Project Title: Project Number:

	Inspector:			Inspection Date:
Possible ILSMs from the Construction Safety Assessment		Required?		In Place?	Comments
		Yes	No
1	Notify the fire department and initiate a fire watch.
2	Post signage identifying the location of alternative exits to everyone affected.
3	Inspect exits in affected areas on a daily basis.
4	Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired.
5	Provide additional firefighting equipment.
6	Use temporary construction partitions that are smoke-tight, or made of noncombustible or limited-combustible material that will not contribute to the development or spread of fire.
7	Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices.
8	Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level.
9	Provide additional training to those who work in the hospital on the use of firefighting equipment.
10	Conduct one additional fire drill per shift per quarter. All areas.
11	Conduct one additional fire drill per shift per quarter. Local area.
12	Inspect and test temporary systems monthly.
13	Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety.
14	Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features.

Other Construction Issues
	Y	N	N/A		Y	N	N/A	Comments
Construction area warning sign posted?				Adequate lighting provided in all work areas?
All construction doors (including interstitial) closed and locked?				Hand held and mounted equipment properly guarded?
Evidence of dust and debris tracked to outside of barrier?				Aisles and passageways in good repair, kept clear and properly marked?
Mat/carpet at entrance?				Egress to and from work site unobstructed?
Floor, wall, ceiling penetrations sealed properly?				Fire extinguisher on site?
				Ladders in good condition?
Hot Work or Confined Space Permits posted?				MSDS available on site?
Area free of insects and rodents?				Gas cylinders secured?
Area under negative pressure?				Evidence of smoking?
Ventilation system adequately removes toxic dust and gases from work environment?				Electrical power cords in good condition?
Workers wearing or have available appropriate PPE?				Guardrails and toe boards provided for scaffolding that is open at all sides?
Safety harnesses being worn for work >6’ off the ground?				Additional Comments:

8-Detailed Description of Work Detailed Description of Work

File details come from the government source that posted it. Updated Apr 9, 2021.