36C25622R0073 Revised ICRA .pdf

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

Estimated Project Length: 300 Days

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Scope of Project: Bldg. 9 3rd Floor Anti-Ligature

Areas Effected by the Project:

Bldg. 9

Required OSHA Training: (10hr, 30hr)

Services Render Inoperative: None Overall EOC Effect to Which Areas: Locked MH Unit

X

X

X

X

Hi h Interest Assessment Items Construction Specific

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

Vibration Type: □ Primary I Secondary □ Other: ___ _ Severity: I Low □ Mild □ Moderate □ High ·o Severe Duration: □ Short I Brief □ Intermittent □ Frequent □ Prolon ed □ Continuous

ILSM

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

Operational Impact

Asbestos

X Access and Waiting Areas

X Infection Control Hazards Security Systems Impaired

O vercrowding/Patient Flow

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

Team Involvement

X High

-Medium

Low

Comments

X E lectrical Work Limit Access to Care All employee 1---X--+-O- v_e_rh_ e_a_d _H_ a_z _a -rd_s _/C_ r_a -in- O-pe- r -at-io_n_(_S_e_e_N_o_te_B_) ---+----+-C- 1 -in -ic_a _l A-la _rm_ s -lm_p_a-irm_e _n _t --+-----< notification on

X Hot Work Permits Generator Power ISLM issued during 1---X--+-F- i -re _ P_ l -an _R_e -qu- i -re_d _ ____ ___________ E_q_u-ip_m_ e_ n_t _M_o_d _ifi-c-at-io_n _s_--+-----< the construction of

X Fall Protection Air/Oxygen/Suction (AOV) this project Lighting X Smoke Producing

0 erations Portable Heaters X Weekly Inspections required Access to IT closets Access to IT data systems

X Fire Wall Penetrations VISN Notifications Other Special Needs or Considerations Recommendations: Must comply to all infection control permit requiremenU Reminder even though there is no Asbestos noted for the building please be aware that anyth ing that should look like asbestos should be tested. Must comply with Mental Health environment of Care and all Contractors work ing the building must be trained on Mental health safe rior to workin in the buildin

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