36C25622R0008 ICRA ILSM NEPA 110421.xlsx

XLSX spreadsheet 83 KB Posted Nov 17, 2021

Attached to: Z1DZ--629-22-705 EHRM Infrastructure Upgrades – St John CBOC
Solicitation number: 36C25622R0008
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

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Other files

File	Type	Posted
36C25622R0008 0003.docx	DOCX document	Jan 19, 2022
629-22-705 RFI Register.docx	DOCX document	Dec 16, 2021
36C25622R0008 0002.docx	DOCX document	Dec 16, 2021
629-22-705 EHRM Infrastructure Upgrades _ St John CBOC -- Pre Bid Sign In Sheet 113021.jpg	JPG image	Dec 1, 2021
36C25622R0008 0001.docx	DOCX document	Dec 1, 2021
36C25622R0008 SOW.docx	DOCX document	Nov 17, 2021
36C25622R0008 WD LA20211005 Mod 5 09242021.pdf	PDF	Nov 17, 2021
36C25622R0008 SOW Signed Attachment 03 .pdf	PDF	Nov 17, 2021
36C25622R0008 SOW Attachment 04-Revised.pdf	PDF	Nov 17, 2021
36C25622R0008 SOW Attachment 02 .pdf	PDF	Nov 17, 2021
36C25622R0008 VAAR 852.219-77.docx	DOCX document	Nov 17, 2021
36C25622R0008 FAR 52.223-99.docx	DOCX document	Nov 17, 2021
36C25622R0008 SOW Attachment 01 .jpg	JPG image	Nov 17, 2021
36C25622R0008 RFP.docx	DOCX document	Nov 17, 2021

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Directions

Instructions

1. On tab 1 fill in information for Project Title or Type of Work, Project No., COR., 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 2 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 3. 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 4 for any Life Safety Conditions 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. Review tab 9, fill all blpcks a possible. Any question Contact the GEMS coordinator at ext 72015.

7. Once the form has been completed it needs to be sent/ brought 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- Michael Adams, Kim Robinson, Latricia Walrath, Matthew Rowley, Jeremy Sellers

Facilities Management/ Project Engineering/ Mainteance & Operations- Kristen Russell, Angela McKenzie, Tony Clark, Kenneth Ward, Gerald Faulkner, Edwin Chin, Femi Osunbunmi, Robert Chaplin, Jabari Jones

Police Services- Robert Kenyon, Connie Washington, Joshua Anderson, Rodney Robvias

Quality Management/ Infection Control- Serelda Bowman-Young , Lori Jefferson, Debbie Lepre

Patient Safety- Randy Decuir, Chris Cahill, Jenny Duplantier

Contracting- William Geary (Biloxi), Kaitlyn West(Biloxi), Charles Powell(Biloxi)

AFGE/ NFFE Representatives- Yolan Bender, Anne Fisher

Clinical Engneering- Mariel Paciera, Jennifer Boudreaux, Austin Sandlin, Liana Soileau

1-ICRA

Infection Control Risk Assessment (ICRA) Checksheet
Project Title or Type of Work:__St. John CBOC EHRM Infrastructure Upgrades________________________________	Project No._629-22-705________________
In-house Representative/ Supervisor_Ray Bender_________________	Location: St. John CBOC _
COR/ Representative___Jeff Pujol_________________________________	Start Date:_March 1, 2022_________________
	Completion Date:May 31, 2022____________

Brief description of the construction or maintenance project: The work shall include, but is not limited to, upgrading facility fiber throughout the buildings to each IT closet specifically Building 1 Room 109 (see floor plan), provide a redundant fiber run throughout the facility to each IT closet, provide redundant fiber mains to the demarcation room from the provider point, provide additional outlets in each IT closet, upgrade facility power distribution as required, upgrade UPS for OIT equipment, upgrade facility HVAC distribution as required, physical security, and assessment and upgrades

Type of construction project--choose from drop-down box (see "Types & Risk" tab):						B
Patient Risk Group--choose from drop-down box (see "Types & Risk" tab):						Medium	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	II
Medium	I	II	III	IV
High	I	II	III/IV	IV
Highest	II	III/IV	III/IV	IV

Other Considerations	Comments
Air Quality	Engineering Controls-HEPA
Noise	Moderate at times during construction
Vibrations	Moderate at times during construction
Utilities	Interuptions to electrical and data at times
Emergency procedures	First aid as needed
Security	Escorting of Workers

Construction Safety Assessment Team Concurrence
Member	Signature	Date
Construction Safety
Safety Management
Engineering Services (CE, M&O, Projects)
Infection Control/ QM
Patient Safety
GEMS
Industrial Hygiene
EMS
SPHM&FPM

Other Comments

Sheet1

Sheet2

Sheet3

Sheet4

Sheet5

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)

				December 31, 1899
Class	During Construction Project		Upon Completion of Project
I	x	Execute work by methods to minimize raising dust from construction operations.	x	Immediately replace ceiling tile displaced for visual inspection.
II		Provide active means to prevent airborne dust from dispersing into atmosphere.	x	Wipe work surfaces with disinfectant.
	x	Water mist work surfaces to control dust while cutting.	x	Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area.
	x	Seal unused doors with duct tape.		Remove isolation of HVAC system in areas where work is being performed.
	x	Block off and seal air vents.	x	Contain construction waste before transport in tightly covered containers.
	x	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	EHRM Infrastructure Upgrades – St John CBOC
	Project No.	629-22-705

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:	EHRM Infrastructure Upgrades – St John CBOC	Project No.:	629-22-705
COTR:	Jeff Pujol	Contractor:	TBD

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: EHRM Infrastructure Upgrades – St John CBOC Project Number: 629-22-705

	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

The work shall include, but is not limited to, upgrading facility fiber throughout the buildings to each IT closet specifically Building 1

Room 109 (see floor plan), provide a redundant fiber run throughout the facility to each IT closet, provide redundant fiber mains to the demarcation room

from the provider point, provide additional outlets in each IT closet, upgrade facility power distribution as required, upgrade UPS for OIT equipment

upgrade facility HVAC distribution as required, physical security, and assessment and upgrades. Contractor shall field verify all conditions associated

with the project during a pre-bid visit

9- NEPA checklist

9- NEPA

	Project: ST. John CBOC EHRM Infrastructure Upgrades							Location: St. John CBOC
								Project Number: 629-22-705
	Type of Project:							Project Description: The Contractor shall provide construction services necessary at St. John CBOC to support the Veterans Health Administration’s (VHA) change to the new Electronic Health Record Management (EHRM).
				Operation and Maintenance Activities
	X			Repairs/Renovation Project
				New Construction Project
				Lease
				Other
	Level of NEPA Analysis:							Other Environmental Permits/Analysis Needed:
	X		Categorical Exclusion					None Needed
			Environmental Assessment Needed
			Environmental Impact Statement Needed
	Project Impacts:
	Would the proposed activity involve or generate any of the following?
	SOURCE			YES	NO	SOURCE	YES	NO	SOURCE	YES	NO
	Air Emissions
including GHGs				x	Liquid Effluent		x	RCRA or CERCLA
Sites		x
	Asbestos				x	Petroleum Storage		x	Wetlands		x
	Excess Noise			x		Solid Waste	x		Permit
Modification		x
	Utility Modification			x		Hazardous Waste		x	Chemical
Use/Storage		x
	Soil Disturbance				x	Biological
Resources		x	Aesthetics		x
	Water Treatment				x	Radioactive Waste		x	Water/Well Use		x
	Water Flow
Modification				x	Mixed Waste		x	Other
	Determination:
		x		I find the proposed project qualifies as a CATEGORICAL EXCLUSION with no
				extraordinary circumstances. Specify which CATEX:
				I find that the proposed project MAY have a significant effect on the environment;
				therefore, an ENVIRONMENTAL ASSESSMENT will be prepared.
				EIS
	Recommended by:						Project Manager		Date: 11/4/2021
	Approved by:						Chief, Eng. Service		Date:
	Approved by:						GEMS PM		Date:

1. Repair, replacement and new installation of primary or secondary electrical distribution systems; 2. Repair, replacement and new installation of components such as windows doors, roofs, and site elements such as sidewalk, patios, fences, retaining walls, curbs, water distribution line and sewer lines which involve work totally within VA property boundaries;

3. Routine VA grounds and facility maintenance activities;

4. Procurement and activities for goods and services for routing facility operations maintenance and support;

5. Interior construction or renovation;

6. New construction of 75,000 gross square feet or less;

7. Development of 20 acres of land or less within an existing cemetery, or development on acquired land of five acres or less.

8. Actions which involve support or ancillary appurtenances for normal operation;

9. Leases, licenses, permits, and easements;

10. Reduction in force resulting from workload adjustments, reduced personnel or funding levels, skill imbalances or other similar causes;

11. VA policies, actions and studies which do not significantly affect the quality of the human environment; 12. Preparation of regulations, directives, manuals, or other guidance that implement, but do not substantially change, the regulations, directives, manuals, or other guidance of higher organizational levels or another Federal agency, and

13. Actions, activities. Or programs that do not require expenditure of Federal funds.

*38CFR Part 26.6(b)(1)

Examples of VA's Extraordinary Circumstances The following examples are illustrative of Extraordinary Circumstances where an action would typically require further NEPA evaluation (an EA or EIS).

These are not intended to be comprehensive, but they will help you to identify extraordinary circumstances when they exist.

1. Greater scope or size than normally experienced for a particular categorical exclusion

2. Actions in highly populated or congested areas

3. Potential for degradation, although slight, or existing poor environmental conditions

4. Use of unproven technology

5. Potential presence of an endangered species, archaeological remains, or other protected resources

6. Potential presence of hazardous or toxic substances

File details come from the government source that posted it. Updated Nov 17, 2021.