36C26119Q0918-005.docx

Health Care System Memorandum No. 138-16-14 July 22, 2016

VETERANS AFFAIRS PALO ALTO HEALTH CARE SYSTEM

3801 Miranda Avenue Palo Alto, CA 94304-1290

Effective Date: August 14, 1995 Issue Date: July 22, 2016

HEALTH CARE SYSTEM MEMORANDUM No. 138-16-14

SUBJECT: UTILITY SHUTDOWN PROCEDURES

1. SUMMARY: Health Care System Memorandum (HCSM) No. 138-13-14, dated July 22, 2013, is rescinded. Minor changes have been made.

2. PURPOSE: To establish policy, procedures, and responsibilities for planned utility system interruptions or temporary shutdown of any utility throughout this Health Care System. These shutdowns are established to minimize disruption and impact on patient care, yet perform necessary utility work.

3. POLICY: It is the policy of this Health Care System to protect the health and safety of our patients, employees, and visitors. It is also policy to temporarily shutdown utility systems in order to perform necessary preventative maintenance, repairs, and project-initiated improvements. This policy establishes procedures to notify VA Palo Alto Health Care System (VAPAHCS) staff, patients, and visitors affected by these scheduled temporary utility shutdowns with sufficient notice so coordination efforts can be made to patient care activities.

4. DEFINITIONS:

a. Major Interruption or Shutdown contains one or more of the following:

(1) Must be completed outside of normal business hours. (Monday – Friday, 7:00 a.m. to 5:00 p.m.).

(2) Impact of primary utility shutdown causes adverse impact on normal operation of other utilities.

(3) Impacts direct patient care services.

(4) Impacts research operations.

b. Minor Complex Interruption or Shutdown is defined as any utility shutdown that does not meet the criteria listed above.

c. Emergency Interruptions or Shutdowns: Interruptions or shutdowns necessary to minimize further utility loss or failure, utility system and/or equipment damage, or a safety hazard. Advance notification may not be possible during emergency shutdowns.

d. Utility System Loss: Loss of utility service from an adverse event. This usually includes loss of service from utility companies or equipment failure over which VAPAHCS has no control.

e. Utilities Systems: Includes, but is not limited to, systems such as electrical power; steam distribution; potable/domestic water; sanitary sewer; natural gas; medical gases; heating, air conditioning, and ventilation (HVAC); vertical transportations (elevators); and fire alarms/fire sprinklers.

5. PROCEDURES:

a. Utility Shutdown Forms: Requests for utility shutdowns will be submitted by the coordinating official, in writing, on the Utility Shutdown Form (Attachment A), according to the time frames outlined in the Standard Work Process for Utility Shutdowns (Attachment B). All affected Services will be notified in writing via the Utility Shutdown Form. It will be hand-carried by personnel coordinating the shutdown to the offices of affected Services for concurrence signatures. All Utility Shutdown Forms will be concurred by affected Services at least five working days prior to the planned interruption or shutdown.

b. Required Information needed to initiate the process: Utility Shutdown Forms will identify all pertinent information about the shutdown and indicate the necessary individuals for notification and concurrence. This includes, but is not limited to:

(1) Utility Shutdown Form;

(2) Interim Life Safety Measure (ILSM); and

(3) Work Hazard Assessment Form (Attachment C).

c. Communications: Once the Utility Shutdown Form has been concurred by all affected Services, copies of the signed Utility Shutdown Forms will be placed on the Utility Shutdown Calendar on the Engineering SharePoint site.

d. Emergency Shutdowns: All personnel responding to emergency situations requiring utility system service interruption or shutdown will take appropriate action as necessary to minimize disruption to patient care. Before an emergency shutdown, occupants of affected areas and applicable Service Chiefs will be notified as soon as possible or practical under the circumstances. Documentation of any emergency shutdowns will be initiated utilizing the Incident Report in VistA as soon as the information becomes available. This will include any subsequent information and the final solution of the emergency situation. All emergency shutdown incidents will be reported to the Environment of Care Committee (EOCC).

e. Restoration of Utility Service: Upon completion of a utility shutdown, Engineering Service will coordinate efforts to:

(1) Verify it is safe to restore the utility service and that all systems and/or equipment in the affected area are working properly. This includes, but is not limited to, checking reset buttons, pilot lights, breakers, flushometers, etc.

(2) Notify affected areas and Service Chiefs that service has been restored and the shutdown is complete.

6. RESPONSIBILITIES:

a. The Chief, Engineering Service, is responsible for ensuring if utilities systems must be interrupted, the temporary shutdown does not seriously impact patient care and all precautions have been made to accommodate alternate utility services. This includes coordinating, planning, scheduling, and providing the necessary tools, equipment, materials, and manpower necessary to accomplish the utility shutdown work. He/she is also responsible for ensuring the Utility Shutdown Form is completed and receives concurrence in a timely manner. He/she is also responsible for ensuring all utility shutdowns and interruptions are documented and reported in the quarterly Utility Management report to EOCC.

b. The Chief, Office of Information and Technology (OI&T), or designee, is responsible for ensuring OI&T systems are minimally interrupted and proper notification to affected area is provided on the Utility Shutdown form.

c. The Resident Engineers Office shall coordinate all utility shutdowns with Engineering Service and Major Construction Section at VAPAHCS.

d. The Chief, Office of Facility Planning and Development, is responsible for advanced planning and coordination of all major construction utility shutdowns and all facility directed construction utility shutdowns. They shall provide appropriate personnel to be available during the shutdowns.

e. Service Chiefs, or designees, are responsible for ensuring all affected staff in their Service are aware and fully understand the impact of the shutdown and will take necessary action(s) to fully coordinate and minimize impact to the Health Care System.

7. REFERENCES:

a. HCSM No. 138-16-22, “Utilities Management Program.”

b. HCSM No. 138-14-20, “Engineering Work Requests.”

c. “Environment of Care Guidebook,” VHA Center for Engineering & Occupational Safety and Health (CEOSH).

8. RESCISSION DATE: July 31, 2019.

9. RESPONSIBLE OFFICIAL: Chief, Engineering Service.

Thomas J Fitzgerald III Interim Director

Attachments (3)