36C25623R0051 Project Risk Assessment .pdf

Project Risk & Im act Assessment Date of Print Review: TBD Demolition Start Date: TBD

Estimated Project Length: 365 Days Areas Effected by the Project:

Roof Bldg. 7

Required OSHA Training: (10hr, 30hr)

Scope of Project: Project 502-21-104 Roof Repair Building 7

Services Render Inoperative: Overall EOC Effect to Which Areas: Building 7 Roof

High Interest Assessment Items

Construction Specific

Operational Impact

Team Involvement

X Noise Type: 0 Drilling 0 Blasting II Pounding 0 Heavy Equipment 0 Motors 0 Other:

X Asbestos X High

Severity: M Low 0 Mild 0 Moderate 0 High 0 Severe Duration: 0 Short 0 Brief O Intermittent 0 Frequent 0 Prolonged 0 Continuous

X Vibration Type: 0 Primary Secondary 0 Other:

Access and Waiting Areas

Medium

Severity: O Low Mild 0 Moderate O High 0 Severe Duration: I Short 0 Brief 0 Intermittent 0 Frequent 0 Prolonged 0 Continuous

ILSM X Infection Control Hazards

Low X Air Quality Issues

Type: M Fumes M Dust 0 Mold 0 Smoke 0 Chemicals Severity: 1lLow 0 Mild 0 Moderate 0 High 0 Severe Duration: Short 0 Brief 0 Intermittent ID Frequent 0

Security Systems Impaired

X Utility Issues Type: El HVAC 0 Med Gas D Power 0 Water El Suction Impact: 0 Modified Operational 0 Shut Down Duration: El Short 0 Brief 0 Intermittent 0 Frequent 0

Overcrowding/Patient Flow

Impaired Access to Facility

Patient Care Effected

Comments

All employee notification on ISLM issued during the construction of this project

Trenching/Shoring/Holes

Heat or Flames

Electrical Work

Limit Access to Care

X Overhead Hazards/Crain Operation

Clinical Alarms Impairment

X Hot Work Permits

Generator Power

X Fire Plan Required

Equipment Modifications

X Fall Protection

Air/Oxygen/Suction (AOV)

Lighting X Smoke Producing Operations

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:

Chief Engineering Service: F Date: -/---. ,.Z Facilities Safety Manager: . Date: 3 .

Date: 3 y-zz i/72_, Date: 3.1

Patient Safety Manager:

AFGE Safety Representativ

Infection Control Nurse: Date: 34 - z2_

Green Environmental Manager: - Date:

Emergency Manager/1;mM. 1'1-a Date:

Employee Health: ' / ou)--, A -c-A Date: 6) -of Ad o-

Police Service: , Date: i 1 ... 21, Project C.O.R.: ...- • • Date:

Revised: 04/21

CLASS

ALEXANDRIA VA HEALTH CARE SYSTEM

CONSTRUCTION PROJECT BLUE PRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

-LASS CONSTRUCTION ACTIVITY RISK PRECAUTIONS REQUIRED

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.

Low or Moderate

Risk Patients Only

High Risk Requires Class II

Precautions

Low or Moderate

Risk Patients Only

High Risk Requires Class III

Precautions

Moderate or High-Risk Patients

Only Low Risk Requires Class II

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

Project Start Date: TBD ' ocation of Construction: Building 7 Roof

..;ontractor Performing Work: Estimated Duration. 365 Days

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

X Low risk: 0 - 37 High Risk: 76 — 111+ Medium Risk: 38 - 75

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

ALEXANDRIA VA HEALTH CARE SYSTEM

CONSTRUCTION PROJECT BLUEPRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

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

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

High Risk High Risk

Medium Risk > 3 TB Patients/year Inpatient & Outpatient

Construction Site Location

Potential on Going Transmission Evidence of ongoing M. Tubercubsis

Transmission regardless of setting.

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

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

X

Patient Population

Hospital Layout 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

Overall Risk Assessment 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.

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

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

1. Provides active means to prevent air-borne dust from dispersing into atmosphere.

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents.

In addition to Class II Precautions above,

1. Obtain IC concurrence before construction begins.

2. Complete all critical barriers or implement control cube method before construction begins.

3. Control airflow: Isolate HVAC system in areas where work is being performed and maintain negative air pressure within work site.

4. Cover transport receptacles or carts.

5. Place dust mat at entrance and exit of work area.

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

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

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

6. Personnel are required to ensure shoes are not tracking dust and soil when leaving the work site.

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

INTERIM LIFE SAFETY MEASURES

Low risk:

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

High Risk:

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

CLASS

CLASS

Ill

X

4 1 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:

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

This worksheet completed by: The Risk Assessment Team

Date Completed: * Be sure to clearly mark/date addendum comments Updated #1: 3/1/2022 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.

b. Stairwells.

c. Storage space for construction materials. X

d. Heating devices shall be needed. X

e. Temporary partitions shall be needed. X

f. Fire extinguishing systems will be modified.

g. Fire/smoke partitions will be affected. X

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 valves 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?

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

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?

y. Are any flammable storage areas within existing space?

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

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).

Roofing material may contain Asbestos.

Chief Engineering Service:

Date: 3 - / - -

Facilities Safety Manager:

Facilities

Date:

Patient Safet Mana er: -41.

Date: 3,-/ ---..?„)._ AFGE Safety Representativ

Date,L3/ 2se___

Infection Control Nurse:

.awee Date:3-/ - z.-z_

Date: 1 .-N —2_0 rt._ Green Environmental Manager : °IP _

Emergency Manage Alaf : ' dig • i C - Date: 3 -i - Z 2_

Employee Health: W ' 4FV, uo vti Date: C13- olduo?

Police Service: 1 or • ,,, ,, Date: j -/-Q A Project C.O.R.: . '

Date: