36C25623R0089 PRA v2.pdf

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

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

Building Roof Building 2

Required OSHA Training: (10hr, 30hr) Scope of Project: Project 502-21-105 Replace Roof

Building 2

Services Render Inoperative: Overall EOC Effect to Which Areas: Building 2

High Interest Assessment Items

Construction Specific

Operational Impact

Team Involvement

X Noise Type: III Drilling CI Blasting M Pounding 0 Heavy Equipment 0 Motors El Other:

X Asbestos

High

Severity: 0 Low 0 Mild El Moderate 0 High CI Severe Duration: 17 Short El Brief 111 Intermittent 0 Frequent LI Prolonged 0 Continuous

X Vibration Type: El Primary Secondary El Other:

Access and Waiting Areas X Medium

Severity: 0 Low Mild 0 Moderate 0 High 0 Severe Duration: 1 Short 0 Brief D Intermittent 0 Frequent Li Prolonged CI Continuous

ILSM X Infection Control Hazards

Low X Air Quality Issues

Type:. Fumes M Dust 0 Mold El Smoke 0 Chemicals Severity: %Low CI Mild 0 Moderate 0 High Li Severe Duration: Short 0 Brief El Intermittent El Frequent 0 Prolonged 0 Continuous

Security Systems Impaired

Utility Issues Type: 0 HVAC 0 Med Gas 111 Power 111 Water 0 Suction Impact: 0 Modified Operational 0 Shut Down Duration: 0 Short Li Brief 0 Intermittent 0 Frequent CI Prolonged 0 Continuous

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

Fall Protection

Air/Oxygen/Suction (AOV)

Lighting

Smoke Producing Operations

Portable Heaters X Weekly Inspections required

Access to IT closets

Access to IT data systems

Fire Wall Penetrations

VISN Notifications

Other Special Needs or Considerations Recommendations:

Chief Engineering Service ", Date: 3 Facilities Safety Manager:

1"/ Date: 3

Patient Safety Manager: ..-le-9-kt-ei-c.-' 1----,--X Date: 3/ 2,00

Date: 5,/,,,q793 Date:13,5/ 2-3

AFGE Safety Representative:

Infection Control Nurse: OttialAtZt4.44..../ Green Environmental Mana er: Date: 3 -zt_z3

Date: 3 Emergency Management. ,a, c Employee Health: Date: 3 ----z LI-23

',/ Police Service:

4J

Date:

Project C.O.R.: Date:

Revised: 04/14 plus 120 calendar days for pre-construction

ALEXANDRIA VA HEALTH CARE SYSTEM

CONSTRUCTION PROJECT BLUE PRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

CLASS CONSTRUCTION ACTIVITY PRECAUTIONS REQUIRED RISK

CLASS

CLASS

Moderate or High Risk Patients

Only Low Risk Requires Class II

Precautions

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

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

Location of Construction: Building 2 Roof Project Start Date: TBD

Contractor Performing Work:

Type A: Inspection, non-invasive, minor X 1 Low Risk

Estimated Duration

X

365 Days

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 ra sing 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: Replace Roof Building 2 502-21-105

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: 03/28/2023 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.

X

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.

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. X

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 work spaces?"

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

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

y. Are any flammable storage areas within existing space?

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

Chief Engineering Servic- • I Date: 2

Facilities Safety Manager: cW m.---.. Date: 3 -„29 -;z3 Patient Safety Manager: ,,,,,,,..c ---ypc.a..„..4----e Date: _37.2-97.z 3

Date:--1/ 49/AS Date:

AFGE Safety Representativ: 4,44-4 4, Infection Control Nurse: at,,,ti /4" ..;> iy,,,,,_-/,„ Green Environmental Mana er

Date: 8 ..- ...- 2.3 Emergency Manage en C

Date:

Employee Health:6 A to c- . _ ) Date: 3 , 2, (-4 - 3 Police Service: 11 v eAA....-----

Date: 3 -0c -&:

Rev_02

Statement of Work

Project No. 502-21-105 Replace Roof on building 2

Alexandria VA Health Care System, Pineville, LA

Scope:

The primary scope of the project is to reroof this building. The existing roof will be removed in its entirety. There are four roofs, the original tile roof, two modified bitumen roofs on either side, and a connecting corridor roof to Building 1. All aforementioned roofs are to be replaced. Historic preservation requirements must be taken into account and thus new clay tile will be matched to the tile used on Building 3 re-roof project. This project was our prototype for the site. Submittals will be provided by the COR.

Waterproof membrane with new copper flashing will be installed. The dormers will be reroofed and re-sided. The gutters will be replaced, and downspouts will be added connecting to the existing rainwater collection system. All gutters, downspouts, roof drains, and overflow scuppers will be reworked as necessary to provide a functioning drainage system. The fascia (molding) on the outside of the walls will be replaced as needed. Salvaged half-round windows with new louvers will be installed at the dormers.

All exterior woodwork at the exterior roof soffit and on the dormers will be replaced and repainted. The connector to building 1 will be reroofed. The scope includes, in part, new architectural finishes, asbestos abatement where necessary, and lead abatement.

Demolition of the roof and fascia will be coordinated with the presence of hazardous materials. Lead abatement on the outside of the building will be necessary prior to replacement. Lead abatement will include all molding/trim on outside of building that will be replaced per the AE drawings. Demolition on the roof will take the existing roofing and flashing and underlayment off entirely. This is to include all flashings, dormer siding and trim, gutter flashing and trim. All damage to the roof deck or supporting structure to be repaired.

New mini-split units will be added to attic to dehumidify and temper the temperature in the attic. Broken or missing windows in the Penthouse will be repaired or replaced, as necessary, including the window now used for the window A/C unit and the mesh screen window on the North side under the existing hood.

Building 2 is a multi-story reinforced concrete framed building constructed circa 1929.

The building is constructed of reinforced concrete pan joists, slabs, beams and columns.

Per the structural analysis, additional structural support will be added in the attic.

Objective:

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

2. To ensure that all construction activities are performed in such a manner as to ensure safe and correct operation and 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 replace the existing Alexandria VAHCS Roof on Building 2 as detailed in the Drawings and Specifications for this project.

The work for this project includes, but is not limited to the following improvements:

Contractor shall completely prepare site for operations. A tunnel must be erected on both the East and West sides of Building 2 as well as a fenced in area to provide protection for personnel entering and exiting the building.

Special Condition:

Prior to mobilization and commencement of any construction, the contractor shall conduct a mandatory thorough survey and investigation of all the work sites for the Replace Roof on Bldg. 2 Project.. The contractor shall be responsible for choosing the process He/She deems necessary to employ that will provide the most accurate data of the existing conditions at these sites. Once this information is obtained, the contractor shall prepare a report listing all discrepancies, conflicts and remedies to all conflicts. This report shall be submitted as Submittal #1. The Resident Engineer/COR will review for technical feasibility. Once approved, the Contracting Officer will request a formal proposal for the corrective work. Approval of this cost proposal will be required prior to the commencement of any corrective construction.

Delivery:

All personnel in the contractor's services shall have certified or proper training on the tasks they perform.

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.

• Inform COR if contractor needs to stay outside of normal operating hours.

• 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.

Security and General Requirements:

All on-site work should be completed between the hours of 8am and 4:30pm CST, Monday through Friday excluding holidays unless otherwise listed in the tasks section or other working hours are approved by the COR.

Contractor shall obtain an access badge from the VA Police Departmentwhile performing work on-site for their self, their employees and all subcontractors under their authority.

Security and privacy requirements vary depending on the equipment to be serviced and the service being performed. Contractor personnel may be required to complete any or all of the following but not limited to:

• Online training.

• Read, sign, and comply with 'Contractor Rules of Behavior'.

• Submit to finger printing and background investigation.

• Provide network security information as requested for any equipment used in the

VA facilities.

• The extent of these requirements shall be determined by Project Engineer or COR using current facility Information Technology and Privacy rules in cooperation with experts in those departments.

Parking shall be limited to established concrete or improved rock parking lots, Project Engineer or COR will advise which parking lots to use. Contractors and personnel are not allowed on the grass area unless specifically authorized by the Project Engineer. U.S.

District Court Violation Notices shall be issued for parking violations.

The contractor and all employees shall comply with all applicable Alexandria VA Health Care System fire, safety, and traffic regulations.

The contractor is to field verify existing conditions.

All work is to be performed within all ASME, OSHA, EPA, VA, and Federal, State and local codes and regulations.

Proper Lock-out/Tag-out procedures shall be used when appropriate.

No roadway, drainage ditch, pedestrian walkway, or any other service, utility, or access to any of the above is to be blocked or rendered unusable for any length of time during this project unless previously approved by the Project Engineer.

All work, materials, storage of materials and equipment, repair procedures and unforeseen problems or circumstances are to be coordinated with the Project Engineer.

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:

The construction portion of this project will consist of two separate periods, each of which must be preceded by a NTP issued by contracting.

1. Pre-construction period — 120 Days — Contractor to provide the following deliverables before the end of this period:

a. Submittal log of all submittals to be approved during the course of the project

b. Pre-tab report

c. Site survey of pre-existing conditions as described in paragraph titled "special conditions".

d. All submittals which are to be approved by the AE and VA COR.

2. Construction period — All contractually required work and tests must be successfully completed within 365 calendar days of issuance of Notice to Proceed for construction.

ISO Requirements:

- The C&A requirements do not apply, therefore a Security Accreditation

Package is not required.