36C25621R0148 ICRA.pdf

Pro· ect Risk & Im act Assessment Date of Print Review: Demolition Start Date: TBD

Estimated Project Length: 365 Days

>----- ------------------ - - - - - - -----1Scope of Project: Project No. 502-17-300, Convert Laundry

Areas Effected by the Project:

Building 16

Required OSHA Training: (1 Ohr, 30hr)

Services Render Inoperative: Overall EOC Effect to Which Areas: Buildin 16 Onl

X

X

X

X

Hi h Interest Assessment Items Construction Specific

Noise Type: I Drilling □ Blasting I Pounding □ Heavy Equipment □ Motors □ Other: ____ __ Severity: □ Low I Mild □ Moderate □ High □ Severe Duration: □ Short □ Brief □ Intermittent □ Frequent □ Prolon ed □ Continuous

Vibration Type: □ Primary

I Secondary □ Other: _ _ __

Severity: □ Low Mild □ Moderate □ High □ Severe Duration: I Short □ Brief □ Intermittent □ Frequent □ Prolon ed □ Continuous

ILSM

Air Quality Issues Type: I Fumes I Dust □ Mold □ Smoke □ Chemicals Severity: 'Low □ Mild □ Moderate □ High □ Severe Duration: Short □ Brief □ Intermittent □ Frequent □ Prolon ed □ Continuous Utility Issues Type: I HVAC □ Med Gas □ Power □ Water □ Suction Impact: □ Modified Operational I Shut Down Duration: □ Short □ Brief □ Intermittent □ Frequent □ Prolon ed Continuous

Operational Impact

Asbestos

Access and Waiting Areas

X Infection Control Ha zards Security Systems Impaired

Ov ercrowding/Patient Flow

Impaired Access to Facility Patient Care Effected Trenching/Shoring/Holes X Heat or Flames

X

Team Involvement

High

Medium

Low

Comments

X Electrical Work Limit Access to Care All employee >----X--+-O-v- e-rh_e_a_d _ H_a_za_ r_d -s/-C-ra-in-0-pe- r -at-io_n _________ _,__C _lin- ic_a _l -A-la-rm_ s_ l _m_p _a-irm-en_ t_>----------1 notification on

X Hot Work Permits Generator Power ISLM issued during >----X--+-F- ir _e _ P- la_n _R_ e_q _ u-ire_ d ______________ X _ _,__Eq- u- ip_ m_ e_ n_ t _M_o _d-ifi -ca- t-io _n _s _ _,_ _ __, the construction of

X Fall Protection Air/Oxygen/Suction (A OV) this project X lighting X Smoke Producing

0 erations Portable Heaters Access to IT closets

X Fire Wall Penetrations

X Weekly Inspections required Access to IT data systems

VI SN Notifications Other Special Needs or Considerations Recommendations:

Emergency Management:

Employee Health:

Police Service:

Project C.O.R.:

Revised: 04/14

Date:

Date:

Date:

Date:

Date:

Date:

Date:

Date:

Date:

CLASS PRECAUTIONS REQUIRED CONSTRUCTION ACTIVITY RISK

Type A: Inspection and Non-Invasive Activities.

Includes, but is not limited to:

1. Small scale removal of ceiling tiles for visual inspection or minor installation.

2. Painting (but not sanding).

3. Wall covering, electrical trim work, minor plumbing, and activities that do not generate dust or require cutting of walls.

Type B: Small scale, short duration activities that create minimal dust.

Includes, but is not limited to:

1. Access to chase spaces.

2. Cutting of walls or ceiling where dust migration can be controlled.

3. Installation of telephone and computer cabling

Type C: Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components and assemblies or new construction.

Includes, but is not limited to:

1. Sanding of walls for painting or wall covering.

2. Removal of floor coverings, ceiling tiles, and casework.

3. New wall construction.

4. Uncontained duct, HVAC or electrical work above ceiling.

5. Major cabling activities.

6. Any other project where high levels of dust are generated.

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

2. Immediately replace a ceiling tile displaced for visual inspection.

1.Notify staff in the immediate area.

2. Provide active means to prevent airborne dust from dispersing into air.

3. Water mist work surfaces while cutting.

4. Seal unused doors with duct tape.

5. Block off and seal air vents.

6. Place dust mat at entrance/exit of area.

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

8. Upon completion, wipe work surfaces with disinfectant, wet mop and/or vacuum and remove isolation of HVAC system.

In addition to Class II Precautions above, 1.Obtain IC concurrence before construction begins.

2. Complete all critical barriers, i.e., sheetrock, plywood, plastic, to seal from non-work area or implement control cube method (cart with plastic covering/sealed connection to work site with vacuuming prior to exit) before construction begins.

3. Isolate HVAC system in area and maintain negative air pressure within work site.

4. Cover transport receptacles or carts.

5. Seal holes, pipes, conduits, and punctures.

6. Personnel required ensuring shoes are not tracking when leaving the work site.

7. Upon completion, do not remove barriers until inspected by Safety and IC and thoroughly cleaned by EMS. Remove barrier materials carefully to minimize spreading of dirt and debris.

CLASS

CLASS

Moderate or High Risk Patients

Only Low Risk Requires Class II

Precautions

Low or Moderate

Risk Patients Only

High Risk Requires Class II

Precautions

Low or Moderate

Risk Patients Only

High Risk Requires Class III

Precautions

PATIENT RISK GROUP

Medium Risk Group

Administrative Offices Lobbies Public Corridors Elevators Day Rooms Canteen Retail Store

Outpatient, Urgent Care and Primary Care Clinics Laboratory Radiology and Nuclear Medicine Physical Therapy Respiratory Therapy Pharmacy Food Services Interim Care and Medical Units

SPD Storage/Sterilization TB Negative Pressure isolation rooms Operating Room Urgent Care Morgue

ALEXANDRIA VA HEALTH CARE SYSTEM

CONSTRUCTION PROJECT BLUE PRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

ALEXANDRIA VA HEALTH CARE SYSTEM

CONSTRUCTION PROJECT BLUE PRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

Location of Construction: Building 16 Project Start Date: TBD

Contractor Performing Work: Estimated Duration. 240 Days

Type A: Inspection, non-invasive, minor X Low Risk X Low Risk

Type B: Small scale, short duration, moderate levels.

Medium Risk

Medium Risk

X Type C: Major activity generates moderate to high levels of dust.

High Risk

High Risk

INFECTION CONTROL PRECAUTIONS

TB Risk Assessment , _ . . .

Base upon CDC Guidelines for preventing the transmission of TB in Health-Care Setting 2005

X Low Risk <3 TB Patients/year Inpatient & Outpatient

Medium Risk > 3 TB Patients/year Inpatient & Outpatient

Potential on Going Transmission Evidence of ongoing M. Tubercubsis

Transmission regardless of setting.

Construction Site Location

X Low Risk: Administrative Offices, Lobbies, Public Corridors, Elevators, Day Rooms, Canteen Retail Store, Pharmacy and Food Services

Medium Risk: Outpatient, Urgent Care and Primary Care Clinics, Laboratory, Radiology and Nuclear Medicine, Physical Therapy, and Respiratory Therapy

High Risk: SPD Storage/Sterilization, Intensive Care Units, TB Negative Pressure isolation rooms, Operating Room, Emergency Room, Morgue, Laboratory TB testing room

Patient Population

X Low risk: 0 - 37

Medium Risk: 38 -75

High Risk: 76— 111+

Hospital Layout

X Low risk:

Office Areas Lobbies/Corridors Mechanical Rooms And any other area with exceptions listed in the Medium or High risk

Medium Risk:

Building 7- Yellow team, Green team, Blue team, Dental, Radiology, Gold Team, Short Stay, Surgery, Women's Health, Rehabilitation Medicine, Cardiology Patient Services, Respiratory Therapy, Patient rooms Building 45 Building 9- Mental Health

High Risk:

Urgent care Rm Endoscopy Rm Morgue Outpatient Surgery Pharmacy Recovery Surgical units Negative pressure rooms

Overall Risk Assessment

X Low risk: No TB test required for this project.

Medium Risk: Annual TB test is required by all construction workers for this project.

High Risk: TB test within 90 days prior to construction is required by all construction workers for this project.

CLASS

I

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

2. Immediately replace any ceiling tile displaced for visual inspection.

I

CLASS

II

1. Provides active means to prevent air-borne dust from 5. Place dust mat at entrance and exit of work area.

dispersing into atmosphere. 6. Contain construction waste before transport in tightly

2. Water mist work surfaces to control dust while cutting. covered containers.

3. Seal unused doors with duct tape. 7. Upon completion, wipe work surfaces with disinfectant,

4. Block off and seal air vents, wet mop and/or vacuum and remove isolation of HVAC system.

CLASS

III

In addition to Class II Precautions above, 5. Seal holes, pipes, conduits, and punctures

1. Obtain IC concurrence before construction begins. appropriately

2. Complete all critical barriers or implement control cube 6. Personnel are required to ensure shoes are not method before construction begins, tracking dust and soil when leaving the work site.

3. Control airflow: Isolate HVAC system in areas where 7. Upon completion, do not remove barriers until work is being performed and maintain negative air inspected by Safety and Infection Control and thoroughly pressure within work site. cleaned by EMS. Remove barrier materials carefully to

4. Cover transport receptacles or carts. minimize spreading of dirt and debris.

INTERIM LIFE SAFETY MEASURES

4I CLASS ACTIVITY ILSM PRECAUTIONS

I

Minor: No breech of fire detection, alarm or fighting systems. No egress or access blockage.

None required beyond routine general safety precautions.

Ensure egress. Ensure access for Emergency forces.

Ensure operational Life Safety Systems.

Prohibit smoking.

CLASS

II

Moderate: Short-term breech of fire detection, alarm or fighting systems < a single work shift. Blockage of egress or access but second means available.

In addition to Class I ILSMs, apply at-the-site measures.

Notify staff in the immediate area.

Control combustible loads.

Repair/construction staff immediately available at the site.

Compensate for compartmentalization deficiencies?

Each single breech of fire barrier immediately replaced.

III

Major: Multiple or continuous breech of fire detection, alarm or fighting systems.

Blockage of egress or access. Work > a single shift.

In addition to Class I and II ILSMs, obtain Safety Manager concurrence before construction begins.

Construct temporary smoke tight barriers of non-combustible materials.

Provide additional fire fighting equipment.

Designate alternative exit/access routes.

Increase Hazard Surveillance.

Provide additional education to applicable Medical Center Staff/Incident Response Team Conduct 2 fire drills per shift in local areas vs. all areas.

Notify Emergency Forces.

INTERIM LIFE SAFETY MEASURE

LOCATION: REASON: ILSM Start Date:

ESTIMATED COMPLETION: ILSM Implemented: POC:

ILSM Problems/Issue(s):

ILSM Action(s) Taken:

MANDATORY ILSM SURVEY ITEMS STATUS

Item Yes No Comments

1. Exits free and unobstructed egress

2. Free and unobstructed emergency vehicle access

3. Fire alarm systems not impaired or equivalent

4. Temporary partition are smoke tight

5. Additional fire fighting equipment

6. Prohibit smoking

7. Ensure housekeeping standards

8. Two drills qtr where ILSM are evident

9. Increased hazard surveillance's

10.Training personnel of changes in procedures

11.0rganizational wide awareness of ILSM

ILSM Action Items from Above

Target Date Completion Date Problems Noted

Dates of Drills

COMMENTS:

Fire Plan Worksheet

Project Title & Project No: Project No. 502-17-300, Convert Laundry

Type of Project: El In-House Purchase and Hire Construction Contract

This worksheet completed by: The Risk Assessment Team

Date Completed:

Updated #1: 4/9/2021

* Be sure to clearly mark/date addendum comments under Section 2 where updates are made

Updated #2:

Updated #3:

SECTION 1

1. Will this project affect any of the following: If so details shall be provided for the corresponding numbered paragraph addressing the interim life safety measures that will be taken in Section 2

Item Yes No N/A

a. Exits or exit passageways.

X

b. Stairwells.

c. Storage space for construction materials. X

d. Heating devices shall be needed.

e. Temporary partitions shall be needed.

f. Fire extinguishing systems will be modified. X

g. Fire/smoke partitions will be affected.

h. Fire/smoke detection systems shall be modified.

i. Fire/smoke detection or extinguishing systems shall be down periodically.

j. Fire/smoke doors and/or frames will be affected including automatic devices.

k. Access to the building from any entrance shall be periodically blocked.

I. Exterior distribution systems will be periodically shut down interrupting the building's service or backup sources.

m. Shall passageways for the physically handicapped be affected?

n. Shall emergency power to any of the following areas be affected?

1) Alarm systems.

2) Blood/bone and tissue storage units.

3) Egress illumination.

4) Elevators.

5) Emergency care areas.

6) Emergency communication systems.

7) Exit sign illumination.

8) Medical air compressors.

9) Medical/surgical vacuum systems.

10) Operating rooms.

11) Postoperative recovery rooms.

12) Special care units (CCU, MICU, SICU).

o. Shall emergency shutoff valves or isolation valve of any system be affected.

1) Inside work area only.

2) Adjacent occupied areas.

p. Shall modifications/additions require updating existing policies for emergency response/reporting actual procedures?

q. Will there be any work performed within "confined workspaces?"

r. Shall HVAC systems be shut down during the construction work? X

s. If an "Engineered Smoke Control System" exists, will it be affected? X

t. Shall the work require readying other space to relocate existing functions?

u. If other areas are needed for domino moves, has each area been analyzed separately via attaching a completed work sheet to this plan for the other area(s)?

v. Shall any "Hot Work" activities be required during construction? X

w. Shall exterior excavation/trenching be performed during construction?

x. Are any hazardous chemicals within the existing space? X

y. Are any flammable storage areas within existing space?

z. Will asbestos or asbestos containing materials be associated with this work?

FORM DISPOSITION: RETURN TO THE SAFETY STAFF FOR EVALUATION.

SECTION 2- SAFETY STAFF USE ONLY

(The following discussion for each item marked "Y" shall state interim measures to be taken or initiated).

Chief Engineering Service: Date: Wi ii 0.01 ( Facilities Safety Manager: Date: 9-7- z/ Patient Safety Manager: Date:

AFGE Safety Representativ Date:

Infection Control Nurse: (4444,r1,2.--- illot,d-- Date: effri// 2.-/ Green Environmental Manager: Date:

Emergency Management:

Date: LI , / 3 ei

Employee Health: Datele• (*.tq ( Police Service: / Date:

Project C.O.R.: Date: </j/Cjj, /

Rev_02

Statement of Work

Project No. 502-17-300 Convert Laundry to Storage

Alexandria VA Health Care System, Pineville, LA

Scope:

The scope of this project is to provide all labor, supervision, materials, tools, transportation, equipment, and construction services necessary to renovate the existing laundry and convert it to a linen storage and distribution facility (Project No. 502-17- 300, Convert Laundry to Distribution Storage, located in Building 16 at the Alexandria VA Medical Center, Pineville LA, 71360). This will be a total renovation of the space and includes Architectural, Structural, Mechanical, Electrical, Fire Alarm, Plumbing, and Civil work.

The existing laundry in Building 16 contains laundry equipment that is no longer in service. The space is to be renovated to function as a laundry storage and distribution facility for the hospital, and to provide emergency linen storage for neighboring facilities served by Alexandria VA.

VA employees currently performing laundry storage and distribution functions in Building 16 will be temporarily relocated for the duration of the construction period, estimated at 7 months. The contractor must adhere to the construction schedule and complete the work within the allotted time to minimize the increased cost and complexity of this already logistically-complex function.

Objectives:

To ensure all requirements of contract drawings and specifications are met and completed by the completion date provided in contract documents.

To ensure that all construction activities are performed in such a manner as to ensure safe and correct operation in compliance with applicable local, state and federal regulations and contract drawings and specifications.

Tasks:

Furnish all labor, tools, materials, equipment and supervision necessary for the work to renovate the existing laundry and convert it to a linen storage and distribution facility.

The work includes:

1. Demolition: Interior partitions; plumbing, electrical, mechanical units, and ductwork; exterior landings and stairs; exterior access.

2. Architectural: Renovation of interior spaces; metal studs with gypsum board;

R19 wall insulation; R30 polyurethane insulation on bottom of roof deck; new landings and stairs; ramp at one exit.

3. Structural: Concrete ramp, retaining wall, dock extension; framing for rooftop mechanical units, exhaust fans, and openings.

4. Mechanical: Smaller units designed for renovated building, exhaust fans, new low-pressure steam to hot water heat exchanger system, VAV boxes with reheat coils, heating hot water pumps, condensate return, new main shut-off valves on HPS and condensate return lines. Units ducted directly into interior space through existing roof penetrations.

5. Electrical: Relocation of existing switchboard and panels, new water heater, circulating pump, LED lighting with occupancy sensors, voice / data outlets, new fire alarm devices and wiring, relocation of existing fire alarm panel.

6. Plumbing: Cold and hot water piping, waste and vent piping, restroom fixtures, condensate piping.

7. Fire Protection: Alter existing fully-sprinklered system for renovated building.

Duration:

The estimated construction duration from Notice to Proceed is 240 calendar days.

Delivery:

All personnel in the contractor's services shall have certified or proper training on the tasks they perform. Trades include HVAC, Electrical, Concrete, Carpentry, and miscellaneous construction labor.

The Project Engineer or COR shall be informed by the contractor of the following situations/events in writing:

• The anticipated start date of any contract work.

• As soon as it is known that the work will take longer than expected.

• As soon as it is known that a possible change order will have to happen.

• To provide a written plan for corrective action for any work that cannot be completely within contract specified time.

• At completion of work prior to leaving the facility.

• Contractor Payment Application shall be provided at the beginning of each month for the previous month work that has been completed.

All work shall be completed in accordance with contract drawings and specifications.

All required contract works completed shall be approved and accepted by Project Engineer or COR prior to accepting and approving contractor application for payment.

Work on this project shall not begin until authorized by the Contracting Officer.

The title Project Engineer or COR shall refer to the Contracting Officer's Representative.

Work to be conducted on a Fully Operational VA Hospital Campus, in and around Mental Health and Long Term Care facilities. Tools and equipment shall be kept under close watch to prevent patient injury.

Place of Performance:

Work shall be performed, with issuance of Notice to Proceed, at the Alexandria VA Health Care System, Pineville, LA, or in the immediate vicinity as required by this Scope of Work.

Equipment or Government property may be removed from the facilities with prior permission from Project Engineer or COR and the Department Director.

Period of Performance:

All contractually required work and tests must be successfully completed within 240 calendar days of issuance of Notice to Proceed.

ISO Requirements:

The C&A requirements do not apply, therefore a Security Accreditation Package is not required.