36C25624R0115 PRA 502-24-904 .pdf

Control Measures

1. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

2. Site visits of construction area are required weekly by member of multi-disciplinary team. Site visits will be documented on standard checklist.

3. Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved where a contact is in place.

For internal work the shop involved must work with Safety to ensure proper precautions are in place.

4. Must address identified hazards and controls that will be implemented to ensure minimal impact to patients, employees, contractors, and facility.

Communication and coordination plan for all affected areas

Project Risk & Impact Assessment Appendix D

Date of Print Review: Demolition Start Date:

Estimated Project Length: 180 Days

Project Risk NO# 2024-006

Required OSHA Training: (10hr, 30hr)

Scope of Project: 502-24-904 Fire Door Replacement

Services Render Inoperative: None Overall EOC Effect to Which Areas:

Stairwells Bldg. 9 & 7

Activity Type and Description and Class:

Activit T •e and Descri•tion Inspection/upkeep generally defined as follows:

• Work can be completed in a single shift, not to exceed 10 hours.

• Patients, employees and/or visitors may be in the area depending on the activity.

• Work that does not create dust or debris.

• Work that does not create vapors or fumes.

• Removal of ceiling tile or access to mechanical or electrical chase for visual inspection that will not impair fire safety systems and are limited to 1 tile per 50 square feet with limited exposure time (not to exceed an hour for each tile) within the shift.

• Minor interior updates (e.g., replacing floor or ceiling tiles, carpentry work to include hanging signage, and painting with hand tools) that do not create vibration or noise.

Limited building system maintenance that does not require Lock Out Tag Out (LOTO) such as plumbing on potable systems limited to faucet replacement, steam trap replacement etc. and electrical work such as replacement of bulbs, receptacles, or switches.

Small scale Construction, Renovation and general maintenance/repair work, generally defined as follows:

• Prolonged work that may take longer than a single shift but not exceeding six months.

• Patients and employees are not to be in the area until activity is completed.

• Work that creates some noise and vibration due to power tool use.

• Selective demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements that

All control measures in the row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. Where construction, Renovation and maintenance are done in an accredited facility, and ILSM assessment is required to be done and ILSMs put into place in accordance with TJC LS.01.02.01 and the local facility policy including Fire watch if necessary. Staff is trained and the ILSM is verified regularly

3. Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

Daily inspections of the site are to be conducted by the

General Contractor or shop supervisor and documented on their daily log.

may o disturb asbestos, lead or silica o create the potential for falling objects o create vibration and/or noise more than 80 dB(A) in surrounding areas.

o cause penetrations in fire or smoke barrier

• Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing that requires utility outages or work on the steam system that may require:

o LOTO o The use of compressed gas cylinders

• Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that require LOTO.

• Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit, a single device and the installation of ductwork, diffusers, and terminal units for an area that may require:

o Work on ladders o Rigging, hoisting, or lifting of equipment or materials overhead

• Modification of existing fire alarm and suppression systems requiring system outages and ILSMs or obstruction of exits and or impact on corridors.

• Architectural, structural, or any other work that may cause vapors or fumes such as:

o Roofing work o Flooring work

Painting or other large-scale use of such substances.

All control measures in the two rows above and the following Activity Hazard Analyses and Control Plans (check all that apply):

1. Excavation safety plan in place 0

2. Dust control plan in place E

3. Pollution prevention plan in place E

4. Dig safe paperwork in place El

5. Crane lift plan in place CI

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained 0

7. Confined entry plan in place and staff trained 0

Larqe-scale construction, renovation, or maintenance generally defined as follows:

• Work exceeding 6 months in duration.

• Patients and employees are not to be in the area until activity is completed.

• Excavation or heavy equipment use taking place o Dig safe required utility location o Trench safety o Dust control plan o Equipment exhaust, Noise, Vibration

• Confined space entry required (permit required or not)

• Requires crane work o General crane work o Lift over buildings

• Includes elevated work o Roof work, fall protection o Window work, scaffolding and fall protection o Odor control

• Welding, cutting or use of torches requiring burn permits

• Demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC that may o require asbestos, lead or silica abatement o create the potential for falling objects o create vibration and/or noise more than 90 dB(A) in surrounding areas.

o cause breaches to fire or smoke barrier

• The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work that requires transport of significant materials through building and up elevators i.e., weight limits of floors and elevators

• Plumbing work requiring LOTO and system shutdown and startup such as the installation of:

o new medical gas systems, o steam/heating hot water, condensate systems, o Potable water and sanitary drainage, multiple sinks, showers, and toilets including associated plumbing.

• Electrical work such as installation of electrical feeders, distribution panels, conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. requiring LOTO and system isolation.

• Installation of fire alarm and suppression systems requiring outages of those systems and ILSMs or closure of exits/corridors Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls requiring lifting and support of equipment and systems.

High Interest Assessment Items

Construction Specific

Operational Impact

Team Involvement

X

Noise Type: 0 Drilling 0 Blasting I Pounding 0 Heavy Equipment D Motors D Other:

Asbestos

High

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

X

Vibration Type: 0 Primary• Secondary D Other:

Access and Waiting Areas

Medium

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

X Interim Life Safety Measure (ILSM) (Obtained through the VA Fire Department)

Infection Control Hazards (See Infection control permit)

X Low

X

Air Quality Issues Type: 0 Fumes I Dust D Mold 0 Smoke 0 Chemicals Severity: I Low 0 Mild 0 Moderate 0 High 0 Severe Duration: I Short 0 Brief 0 Intermittent 0 Frequent 0 Prolonged 0 Continuous

Security Systems Impaired

Utility Issues

Overcrowding/Patient Flow

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

Impaired Access to Facility

Patient Care Effected

Comments

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

Trenching/Shoring/Holes (Excavation safety Plan with permit required)

Heat or Flames

Electrical Work (Live electrical plan required if working in Live panel)

Limit Access to Care

Lock Out Tag Out (LOTTO) (LORD Plan required)

Clinical Alarms Impairment

Hot Work (Hot work Permits Required)

Generator Power

Scaffolding (Scaffolding Plan required with Card system)

Equipment Modifications

Fall Protection (Fall Protection Plan required)

Air/Oxygen/Suction (AOV)

Overhead Hazards/Crain Operation (Lift Plan required with permit)

Smoke Producing Operations

X Infection Control Permit is required and continuous monitoring in place (Permit should be posted Prior to work)

X Weekly Inspections required

Confined Space (Confined Space Plan required with Permit)

Access to IT Closet or data systems

X Fire Wall Penetrations

VISN Notifications

Affected Adjacent Area Assessment

Area Service(s)/Type(s) of Area(s)

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact (POC)

POC Contact Information

Construction plan communicated to POC?

Activity Area** Stairwell Shivers, Shaun

Shaun.Shivers@va.gov Contractor

Area Above Stairwell Shivers, Area Below Stairwell Shivers, Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

Adjacent Area 5

CONSTRUCTION PROJECT BLUEPRINT AND IN FIELD

SAFETY AND HEALTH ASSESSMENT RISK BASED CRITERIA

CLASS CONSTRUCTION ACTIVITY RISK PRECAUTIONS REQUIRED

CLASS

I

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.

Low or Moderate

Risk Patients Only

High Risk Requires Class II

Precautions

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

2. Immediately replace a ceiling tile displaced for visual inspection.

CLASS

II

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

Low or Moderate

Risk Patients Only

High Risk R equires Class III

Precautions

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.

CLASS

ID

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.

Moderate or High-Risk Patients

Only Low Risk Requires Class II

Precautions

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.

PATIENT RISK GROUP

c--, Administrative Offices Lobbies Public Corridors Elevators Day Rooms Canteen Retail Store

Medium Risk Group

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

INFECTION CONTROL PRECAUTIONS

TB Risk Assessment Base upon CDC Guidelines for preventing the transmission of TB in Healthcare 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, Physical Therapy, and Respiratory Therapy

High Risk: SPD Storage/Sterilization, TB Negative Pressure isolation rooms, Operating Room, Morgue, ,)ulation

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.

I

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

2. Immediately replace any ceiling tile displaced for visual inspection. (No permit required)

1. Provides active means to prevent air-borne dust 5. Place dust mat at entrance and exit of work

CLASS from dispersing into atmosphere. area.

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

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

3. Seal unused doors with duct tape.

4. Block off and seal air vents. (Permit Required)

7. 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

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

, - III & IV begins.

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

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

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.

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.

(Permit Required) , . r_

Additional requirements:

Chief Engineering Service:

Date: z% Facilities Safety Manager cs i'

Date:-7 //0/Z (f' Patient Safety Manager:

Date: 7 -Q-Z/

AFGE Safety Representat . I

Date: --7 - /40 --9 Infection Control Nurse:

Date: 7 y 4) - ay Date: -illiz,y Date: 7 1 -zy

Green Environmental Manager:

Emergency Management:0 k„,______

Employee Health-Fp -

Date: 7 i ibiN Police Service:

Date:

Project C.O.R.: ---. ._...----, Date: -7 pa/ L y

FORM DISPOSITION: RETURN TO THE SAFETY STAFF FOR EVALUATION.

Rev_02

Statement of Work

Project No. 502-24-904 Fire doors for Building 7 and 9 Joint commission requirement

Alexandria VA Health Care System, Pineville, LA

Scope:

Joint Commission has identified several fire doors that are not up to NFPA code. Prior to ordering said doors, a submittal of proposed doors must be provided to the VA for review and approval.

The project objectives are the following:

1) To bring fire doors and frames up to current codes

2) Match existing salient characteristics and material but with fire rated requirements

3) Building 9 doors must be anti-ligature if patients will have access to it.

4) Doors to be replaced are as follows:

Building 7 Room 346-7 Room 447c-7

Building 9 Room 125-9 Room 321

3rd floor center stair well metal ( 2 hour) 4th floor north stair well metal (2 hour)

1st floor wooden stair well with window ( 2 hour) 3rd floor store room wooden with window ( 2hour)

Architectural and Structural

• Remove non rated fire frames and doors

• Replace with fire rated frames and doors

• ICRA barriers will be required

• Recertification where necessary

• All new fire doors must be 2 hour rated

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:

All contractually required work and tests must be successfully completed within 60 calendar days of issuance of Notice to Proceed.