36C25623R0031 ICRA ILSM - S02.xlsx
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- Solicitation number
- 629-22-133
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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. |
| The committee consists of |
| Safety Management/ Construction/ GEMS Coordinator/ Industrial Hygiene- Send to VHANOL Safety Management mail group. |
| Facilities Management/ Project Engineering- Naclyn Lombard, Angela McKensie, William Baker, Stradford Goins, Kenneth Ward |
| Police Services- Robert Kenyon, Connie Washington, Joshua Anderson |
| Infection Control- Jennifer Frisch, Deborah Lepre |
| Quality Management- Nana Coggin |
| Patient Safety- Ayesha Callaway, Randy Decuir |
| Contracting- Shrylin Lewis, Travis Sippel |
| AFGE/ NFFE Representatives- Eric Alexander, Vickie Charles |
| Clinical Engneering- Kristen Russell, Christopher Cain, Conner Walsh, Mariel Paciera, Jennifer Boudreaux |
1-ICRA
| Infection Control Risk Assessment (ICRA) Checksheet | |||||||||
| Project Title or Type of Work: | Install Tele-Critical Care Devices | Project No. | 629-22-133 | ||||||
| COTR: | Gerald Faulkner | Start Date: | 9/1/22 | ||||||
| Completion Date: | 12/31/22 | ||||||||
| Brief description of the construction or maintenance project: | |||||||||
| Install critical care observation monitors in 24 patient rooms in 3C of the Inpatient Building. | |||||||||
| Install 24 receptacles, one in each of the 24 3rd floor patient rooms in the C-wing of the Inpatient Building. Also install 24 | |||||||||
| new data drops. | |||||||||
| 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 | It is not anticipated that air quality will be compromised. Work will take place in closed off patient rooms on the 3rd floor of the Inpatient building. Patients will not be in the rooms. The work area will be totally enclosed inside a visqueen barrier with zippered entry doors. Vents within the work area will be covered and a hepa filter will be utilized. Walk off mats will be provided both inside and outside. |
| Noise | Noise will occur during the demolition phase and the work will be coordinated with the nursing staff. Patients will not be greatly affected by the noise. |
| Vibrations | Vibrations may occur during demolition but will be minimal. |
| Utilities | Numerous utilities will be affected during rerouting of existing and will be carefully coordinated with FMS. |
| Emergency procedures | The contractor will abide by established emergency procudures established by the medical center. |
| Security | The contractor will sign in with security every day and all employees will wear security badges. |
| 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 |
2-ICRA2
Infection Control Risk Assessment (ICRA) Checksheet (check appropriate requirements)
| Install Tele-Critical Care Devices | ||||
| September 1, 2022 | ||||
| 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 | x | 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. | x | 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. | |||
| x | Remove or isolate HVAC system in areas where work is being performed to prevent contamination of duct system. | |||
| III | Class II (those checked) plus: | x | Do not remove barriers from work area until completed project is inspected by Safety and Infection Control and thoroughly cleaned by Environmental Management. | |
| x | 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. | x | Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. | |
| x | Maintain negative air pressure within work site utilizing HEPA equipped air filtration units. | x | Vacuum work area with HEPA filtered vacuums. | |
| x | Cover transport receptacles or carts. Tape covering unless solid lid. | x | Wet mop area with disinfectant. | |
| IV | Class III (those checked) plus: | See other Classes. | ||
| x | Seal holes, pipes, conduits, and punctures appropriately. | |||
| x | 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. | |||
| x | All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area. |
3-ILSM Const
| Interim Life Safety Measures (ILSM) Assessment for Construction and Maintenance | ||
| Project Title or Type of Work: | Install Tele-Critical Care Devices | |
| Project No. | 629-22-133 |
| 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 |
| x | 1 | Notify the fire department and initiate a fire watch. |
| x | 2 | Post signage identifying the location of alternative exits to everyone affected. |
| x | 3 | Inspect exits in affected areas on a daily basis. |
| x | 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. |
| x | 5 | Provide additional firefighting equipment. |
| x | 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. |
| x | 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. |
| x | 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. |
| x | 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. |
| x | 10 | Conduct one additional fire drill per shift per quarter. All areas. |
| x | 11 | Conduct one additional fire drill per shift per quarter. Local area. |
| x | 12 | Inspect and test temporary systems monthly. |
| x | 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. |
| x | 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. |
4-ILSM Defic
| Interim Life Safety Measures (ILSM) Assessment for Life Safety Code Deficiency | ||
| Deficiency: | Install Tele-Critical Care Devices |
| 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. |
5-ILSM Contract ILSM Formal Contract
| Project Title / Deficiency: | Install Tele-Critical Care Devices | Project No.: | 629-22-133 |
| COTR: | Gerald Faulkner | Contractor: |
Location and Description of Work:
| Install critical care observation monitors in 24 patient rooms in 3C of the Inpatient Building. |
| Install 24 receptacles, one in each of the 24 3rd floor patient rooms in the C-wing of the Inpatient Building. Also install 24 |
| Date of this Formal Contract: | September 1, 2022 | ||||||
| Mandatory ILSM | Yes | No | |||||
| 1 | Notify the fire department and initiate a fire watch. | X | |||||
| 2 | Post signage identifying the location of alternative exits to everyone affected. | X | |||||
| 3 | Inspect exits in affected areas on a daily basis. | X | |||||
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. | X | |||||
| 5 | Provide additional fire-fighting equipment. | X | |||||
| 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. | X | |||||
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. | X | |||||
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. | X | |||||
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. | X | |||||
| 10 | Conduct one additional fire drill per shift per quarter. All areas. | X | |||||
| 11 | Conduct one additional fire drill per shift per quarter. Local area. | X | |||||
| 12 | Inspect and test temporary systems monthly. | X | |||||
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. | X | |||||
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. | X | |||||
| Staff Training | |||||||
| Subject(s) | |||||||
| (use above numbers) | Names/Groups Trained | Date |
| Dates of Fire Drills | |||||
| Area | Date | Time | Area | Date | Time |
6-Inspection
MEDVAMC CONSTRUCTION SAFETY INSPECTION FORM
Project Title: Install Tele-Critical Care Devices Project Number: 629-22-133
| 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. | X | |||
| 2 | Post signage identifying the location of alternative exits to everyone affected. | X | |||
| 3 | Inspect exits in affected areas on a daily basis. | X | |||
| 4 | Provide temporary but equivalent fire alarm and detection systems for use when a fire system is impaired. | X | |||
| 5 | Provide additional firefighting equipment. | X | |||
| 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. | X | |||
| 7 | Increase surveillance of buildings, grounds, and equipment, giving special attention to construction areas and storage, excavation, and field offices. | X | |||
| 8 | Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level. | X | |||
| 9 | Provide additional training to those who work in the hospital on the use of firefighting equipment. | X | |||
| 10 | Conduct one additional fire drill per shift per quarter. All areas. | X | |||
| 11 | Conduct one additional fire drill per shift per quarter. Local area. | x | |||
| 12 | Inspect and test temporary systems monthly. | X | |||
| 13 | Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. | X | |||
| 14 | Train those who work in the hospital to compensate for impaired structural or compartmental fire safety features. | x |
| 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: |
7-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
8-Detailed Description of Work
| Detailed Description of Work |
| It is required by SLVHCS New Orleans that certain critical care patient rooms be monitored on a 24-hour basis both locally and remotely to insure the safety and proper care response to critical care patients. A total of 24 patient rooms on the third floor section C of the Inpatient building will be outfitted with these devices. |
| Two receptacles will be fed from each circuit, for a total of 12 circuits. All circuits will be fed from panel in 3C114B |
| Install 24 new data drops, one in each of the 24 3rd floor patient rooms in the C wing of Inpatient Building. |
Sheet1
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