544 20 107 Columbia EHRM Infrastructure Risk Assessment.pdf

(determined in steps a. and b.) and record the Class of Precautions associated with the project. Dorn VA Medical Center Construction Risk Assessment- June 2015 Page 1 of 32

Dorn VA Medical Center Construction/Renovation Risk Assessment Package

Instructions: Project Managers or VA Supervisors will collaborate with Infection Control, Safety Office, and VA Police to complete the risk assessment package as part of managing the safe design and construction/renovation of the medical center environment. COTRs shall collaborate with Infection Control, the Safety Office, and the VA Police as necessary in the completion of these assessments. COTRs, Infection Control Coordinator, Safety Office staff, and VA Police will ensure all identified actions and control measures are implemented in their respective area of responsibility as long as the potential hazard exists.

The initial assessment should be completed in the design phase. Reassess as conditions change and prior to the beginning of each project phase. The assessments are conducted by the responsible program official using the attached risk assessment forms, and should be completed as follows:

1. NEPA Assessment:

a. Using NEPA Interim Guidance for Projects PG 18-17 determine the level of Environmental Impact of the project.

2. Vertical Environmental Impact Assessment:

a. Show the construction area and the functions/services located in adjacent areas, including floors above and below.

3. Horizontal Environmental Impact Assessment:

a. Using a current drawing of the area, show the construction area and surrounding patient/staff areas as indicated on the example provided.

4. Interim Life Safety Measures:

a. Evaluate each listed “Requirement or Deficiency” as related to the project’s impact on Life Safety components of the facility.

b. Provide a summary of required actions on the sheet provided.

5. Hazard Assessment and Exposure Controls:

a. Evaluate the potential for hazards during construction that may impact patients and staff. Indicate the required control measure for each hazard.

b. Provide a summary of the required control measures on the sheet provided.

6. Ceiling Mounted Patient Lift

a. During 50% and 100% Design Reviews, the COTR will verify that the patient lift design is in compliance with the requirements of VHA Directive 2005-019 Seismic Safety of VHA Buildings and VA Master Design Specification 3.05.041 Seismic Restraint Requirements for Non-Structural Components. The COTR will also ensure the requirements on the “Design Checklist for Ceiling Mounted Patient Lifts” are met.

b. Complete the “After Installation Checklist for Ceiling Mounted Patient Lifts”prior to permitting the equipment to be used for patient movement.

7. Infection Control Risk Assessment:

a. Determine and record the Location Group(s) that will be affected.

b. Determine and record the type of construction and magnitude of disruption.

c. Review the Infection Control Matrix using the Location and Type of Construction Groups

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 2 of 32

d. Complete the Infection Control Measures List and assign responsibility for each measure.

8. Approvals:

a. Upon completion of the risk assessment obtain approval signatures as applicable on the attached sheet. Ensure all signatures are complete prior to submitting to the Safety representative.

9. Contract Documents:

a. Include applicable risk assessment action items in the contract documents.

b. Provide the contractor’s superintendant with copies of the completed risk assessment and action plans.

c. File all risk assessment documents in the project file.

10. Daily Inspections:

a. Ensure the contractor conducts and documents daily construction site inspections.

11. Construction Site Inspection:

a. Each discipline (Infection Control, Safety Office, VA Police) shall inspect the construction site as applicable. All inspections will be documented.

12. Post Project Review:

a. Upon completion of the project conduct a review of risk assessment process.

b. Present the results to the Construction Safety Committee.

CONSTRUCTION RISK ASSESSMENTS AND HAZARD CONTROL APPROVALS

Project Title: Project Number:

Estimated Start Date: Estimated Duration:

Obtain the following approvals, in the order listed, as applicable:

1. VA Supervisor responsible for area under construction

Date

2. Infection Control Coordinator

3. VA Police Representative

4. Project Manager/COTR/Shop Supervisor

5. Maintenance Control Manager, Engineering Service

6. Projects Section Chief, Engineering Service

7. Assistant Chief, Engineering Service

8. Chief, Engineering Service

9. Safety and Emergency Management Service Representative

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 3 of 32

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 4 of 32

Dorn VA Medical Center Construction/Renovation Risk Assessment Package

Project Title: Project Number:

Location:

Date: Project Phase: Design Phase I (25-50%) Final Pre-Con Other

Construction Start Date: Estimated Duration: Completion Date:

Scope of Work:

Note: The risk assessment process should begin in the design phase. Identified risk controls shall be incorporated into the technical plans and specifications as applicable. The risk assessment should be reviewed during all major phases of the project and risk controls updated as necessary.

Prior to commencing work, the general contractor shall provide proof that an OSHA certified competent person (CP) [29 CFR 1926.32(f)] will maintain a presence at the worksite. An OSHA 30-hour training completion card is considered certification. Any other certification provided will be evaluated by the Project Manager and the Construction Safety Subcommittee in accordance with VA Directive 2011-036 to determine relevancy.

COR Signature:___________________________________________________________________________________

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 5 of 32

NEPA Risk Assessment to be completed utilizing NEPA Interim Guidance for Projects PG 18-17 http://www.cfm.va.gov/til/etc/NEPAGuidance.pdf

Project Title: Project Number:

Location:

Date: Type of Project: Operation and Maintenance Repairs/Renovation New Construction Lease Other

Construction Start Date: Estimated Duration: Completion Date:

Project Description:

Level of NEPA Analysis:

Categorical Exclusion

Environmental Assessment (EA) Needed

Environmental Impact Statement (EIS) Needed

Other Environmental Permits/Analysis Needed:

Project Impacts Would the proposed activity involve or generate any of the following?

Source Yes No Source Yes No Source Yes No Air Emissions including GHGs

Liquid Effluent RCRA or CERCLA Sites

Asbestos Petroleum Storage Wetlands Excess Noise Solid Waste Permit Modification Utility Modification Hazardous Waste Chemical Use/Storage Soil Disturbance Biological Resources Water/Well use Water Treatment Radioactive Waste Other:

Water Flow Modification

Mixed Waste

Determination I find the proposed project qualifies as a CATEGORICAL EXCLUSION with no extraordinary circumstances. Specify which CATEX:

I find that the proposed project MAY have a significant effect on the environment; therefore, an ENVIRONMENTAL ASSESSMENT (EA) will be prepared.

ENVIRONMENTAL IMPACT STATEMENT (EIS)

Project Manager:

GEMS Coordinator:

Completed form will be filed in the project file.

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 8 of 32

CONTRACTOR CONSTRUCTION/RENOVATION AREA ILSM INSPECTION

Week Of:

Project Title/Number: ____Location: ____________

1. Means of egress is clear in construction area:

MON TUE WED THU FRI SAT SUN

2. Accesses for fire department and emergency services are clear:

MON TUE WED THU FRI SAT SUN

3. Fire detection/Sprinkler systems operational:

MON TUE WED THU FRI SAT SUN

Note: If system is impaired ensure a temporary, but equivalent, system is provided. Temporary systems to be tested monthly. Describe temporary system(s) provided:_____________________________________________________________________.

4. Construction partitions are being maintained as a 1 hour fire barrier, all penetrations firestopped at the end of each day:

MON TUE WED THU FRI SAT SUN

5. Good housekeeping practices are being used in construction area. Flammables and combustible fire load is being kept to a minimum:

MON TUE WED THU FRI SAT SUN

6. Buildings, grounds, and equipment are being maintained in a safe manner (pay special attention to excavations, construction areas, and construction storage):

MON TUE WED THU FRI SAT SUN

7. The “No Smoking Policy” is being enforced throughout the project area:

MON TUE WED THU FRI SAT SUN

8. Job site fire extinguishers and other additional fire fighting equipment (if necessary) in place and inspected:

MON TUE WED THU FRI SAT SUN

9. Deficiencies and appropriation corrective actions to be listed here:

10. Inspector’s Initials: MON TUE WED THU FRI SAT SUN

Form Completed By:

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 9 of 32

Interim Life Safety Measure (ILSM) Evaluation for Construction/Renovation Projects

Project Name: Date: Project Manager (COTR):____________________________________ Safety Staff Member: _______________________________________

Instructions: Use this evaluation to identify and implement activities to protect occupants during construction and renovations and during periods when the building and/or construction area does not meet the applicable provisions of the Life Safety Code. This evaluation is to be updated throughout the project to identify code deficiencies that cannot be immediately corrected and the ensuing special measures to be taken to compensate for increased life safety risk. Check all conditions that apply and add any other identified deficiencies and additional special measures:

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Building/area egress routes blocked or altered. This applies to the construction area as well as surrounding areas.

Egress routes for all personnel (including construction workers) must be maintained at all times.

List blocked egress route locations: 1. Provide alternate means of egress.

Personnel in the area shall be given additional training when alternative egress routes are designated. Signage shall be posted identifying the location of the alternate means of egress or exit to everyone affected.

2. Exits in affected area(s) shall be inspected daily.

3. Conduct one additional fire drill per shift per quarter in the affected area.

Required

Required

Required

N/A

N/A

N/A

Obstructed or altered access to emergency services and for fire, police, and other emergency forces.

List access routes blocked: 1. Provide and mark alternate access routes.

2. Inspect routes daily.

Required

Required

N/A

N/A

Fire alarm, detection, and/or suppression systems out of service. Each outage will be assessed based on duration, location, building occupancy, existing fire barriers, and type of system out of service to determine necessary measures.

Compliance with the applicable chapter of the LSC required.

List each system out of service:

List each temporary system required:

1. Provide temporary, equivalent alarm and detection systems.

2. Inspect and test temporary systems monthly. The completion date of the test shall be documented.

3. Fire alarm, detection, and suppression system outages > 4 hours in a 24-hour period require a fire watch and fire dept. notification.

Fire watch shall be documented.

4. Conduct one additional fire drill per shift per quarter in the affected area.

Required

Required

Required

Required

N/A

N/A

N/A

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 10 of 32

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Temporary construction separation requirements (see attached “Construction Partition Evaluation Criteria”)

List project separation requirements and locations:

Inspect partitions daily. Ensure all smoke tight and fire barrier features are in place at the end of each workday.

Required N/A

Additional fire-fighting equipment:

Minimum requirement for all projects = properly maintained fire extinguisher every 75 ft. Assess all construction work and require other equipment based on criteria contained in NFPA 241.

List all additional fire fighting equipment:

1. Fire Extinguisher(s) 2.

3.

4.

1. Contractor to provide equipment and properly train all personnel in the use of all additional fire fighting equipment. Training shall be documented. Equipment shall be properly maintained.

2. Provide additional fire fighting equipment and training to medical center staff.

Required

Required N/A

Hot Work: evaluate all stages of construction to determine the type of hot work to be conducted.

List hot work tasks/locations:

1.

2.

3.

4.

1. Obtain Hot Work Permit in accordance with medical center procedure/project specifications.

2. Provide additional fire fighting equipment.

3. Provide fire watch in accordance with NFPA 241. Documentation required.

4. Additional requirements for hot work operations and fire prevention precautions, including permits and fire watches, shall be in accordance with NFPA 51 and 51B as applicable. List other requirements:

1.

2.

3.

4.

Required

Required

Required

Required

Required

N/A

N/A

N/A

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 11 of 32 life safety risk:

Smoking prohibited in all buildings and in and near construction areas.

Applicable to all projects. Strict enforcement of no smoking policy. Required

Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

Applicable to all projects. Accumulations of combustible waste material, dust, and debris shall be removed from the construction area and the immediate vicinity at the end of each work shift or more frequently as necessary for safe operations.

Required

Fire/smoke barrier penetrations.

Determine if construction will require the penetration of existing fire and/or smoke barriers.

List locations of project fire/smoke barriers required to be maintained for the duration of the project:

1. Floor and ceiling barriers.

2.

3.

4.

All barrier penetrations shall be properly sealed at the end of each work shift. Sealing methods shall be in accordance with VA specifications.

Required N/A

Increased hazard surveillance is required when any Life Safety Code deficiency is identified during period of construction.

Required for construction in occupied buildings.

List LSC deficiencies:

1.

2.

3.

4.

Increase surveillance of building(s), grounds, and equipment, giving special attention to construction areas and storage (lay down locations), excavation, and field offices as applicable.

Required N/A

Construction occurring adjacent to occupied areas of the building.

List ILSMs implemented for this project:

1.

2.

3.

4.

Department specific education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. This is the responsibility of the area Supervisor with assistance from the COTR and Safety Office.

Required N/A

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 12 of 32 life safety risk:

During construction the building’s structural or compartmental fire safety features (fire zones) are impaired or altered.

List features impaired:

1.

2.

3.

4.

Medical Center workers in the affected building will be trained to compensate for impaired structural or compartmental fire safety features (fire zones). This is the responsibility of the COTR and Safety Office.

Required N/A

Construction Partition Evaluation Criteria:

The VA Fire Safety Design Manual:

C. Separate all occupied areas from demolition, renovation, or construction activities by temporary smoke-tight construction partitions of gypsum board or other approved non-combustible or limited-combustible material. Partitions shall be full height, extending through suspended ceilings to the floor slab or roof deck above and shall be one-hour fire rated, unless sprinklers are installed and are operational on both sides of the temporary partition whereupon the partition may be permitted to terminate at the ceiling in accordance with NFPA 241.

Note: This requirement is due to the inherently greater potential for fire or hazardous materials incidents associated with the combustibles and operations of demolition/construction. This risk is made worse by the likelihood of compromised fire protection systems and fire/smoke resistant construction. This does not obviate the need to provide other protective measures to contain dust and debris as specified by VAMCS 01010 section 1.6(D)(5). Sprinklers are considered to be operational when they are installed in accordance with NFPA 13 (spacing, protection, distance from the ceiling, etc.) and there is a sufficient automatic water supply.

NFPA 101 Chapter 4

4.6.10 Construction, Repair, and Improvement Operations.

4.6.10.1* Buildings, or portions of buildings, shall be permitted to be occupied during construction, repair, alterations, or additions only where required means of egress and required fire protection features are in place and continuously maintained for the portion occupied or where alternative life safety measures acceptable to the authority having jurisdiction are in place.

4.6.10.2* In buildings under construction, adequate escape facilities shall be maintained at all times for the use of construction workers.

Escape facilities shall consist of doors, walkways, stairs, ramps, fire escapes, ladders, or other approved means or devices arranged in accordance with the general principles of the Code insofar as they can reasonably be applied to buildings under construction.

A.4.6.10.1 Fatal fires have occurred when, for example, a required stair has been closed for repairs or removed for rebuilding, or when a required automatic sprinkler system has been shut off to change piping.

A.4.6.10.2 See also NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations.

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 13 of 32

NFPA 241 Chapter 8

8.6.2 Temporary Separation Walls.

8.6.2.1 Protection shall be provided to separate an occupied portion of the structure from a portion of the structure undergoing alteration, construction, or demolition operations when such operations are considered as having a higher level of hazard than the occupied portion of the building.

8.6.2.2 Walls shall have at least a 1-hour fire resistance rating.

8.6.2.3 Opening protectives shall have at least a 45-minute fire protection rating.

8.6.2.4* Nonrated walls and opening protectives shall be permitted when an approved automatic sprinkler system is installed.

A.8.6.2.4 Construction tarpaulins would not be considered appropriate barriers or opening protectives.

vhacmsbrownj2 Highlight

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 14 of 32

ILSM Implementation List

Project Name: Date: Project Manager or VA Supervisor:

Instructions: List all “required” actions from the above ILSM evaluation.

1. Applicable to all projects: Contractor to provide and maintain fire extinguishers and other fire-fighting equipment, on-site.

2. Applicable to all projects: Strict enforcement of no smoking policy.

3. Applicable to all projects: Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 15 of 32

Hazard Assessment and Exposure Controls

Project Name: Date: Project Manager or VA Supervisor:

Instructions: Identify potential hazards and required control measures. See attached list for sample control measures.

Hazard: Concern? Control Measure(s): Remarks:

Asbestos Containing Material (ACM)

Yes No

Dust Yes No Also see Infection Control Risk Assessment

Moisture/Water Leaks Yes No

Vapors/Fumes Yes No

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 16 of 32

Hazard: Concern? Control Measure(s): Remarks:

Noise Yes No

Vibration Yes No

Air Pressure Relationships Yes No

Traffic Flow Yes No

Proximity to HVAC intakes Yes No

Utility Outages Yes No Minimize impact to the medical center. Ensure proper notifications are made. COTR to ensure compliance with Engineering Specification requirements for utility outages.

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 17 of 32

Hazard: Concern? Control Measure(s): Remarks:

Security Systems Yes No

Ceiling-Mounted Patient Lifts

Yes No Lift systems shall be evaluated and inspected in accordance with Patient Safety Alert #AL 10-07. Utilize the attached “Design Checklist for Ceiling Mounted Patient Lifts” and “After Installation Checklist for Ceiling Mounted Patient Lifts.”

Ensure specification 11 73 00 is included in the construction specifications. All required tests and inspections must be documented.

Other (describe): Yes No

Lead Based Paint or Elemental Lead:j j j j j

Yes j j j j j

No j j j j j vhacmsbrownj2 Rectangle vhacmsbrownj2 Rectangle vhacmsbrownj2 Rectangle

Serial #: ____________________

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Facility: Manufacturer:

Model:

COMPLETE

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

Serial Number: EE Number:

Work Order:

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts The commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Lift Location:

VAMC Contact:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

Verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.

NOTES:

Installation

Ceiling Mounted Patient Lifts If not applicable check here:

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 18 of 32

PASS FAIL

PASS FAIL

COMPLETE

Rails/Tracks and End Stops

NOTES:

Lift Unit and Straps

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light) Inspection and verification of all emergency functions of the lift unit.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

Confirm track is clean and clear of all debris. (Use manufacturer’s recommended cleaning materials to avoid damage to the motor case and other components.)

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

Verification that the lift unit charges properly.

Perform operational test to verify lift functionality.

NOTES:

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Post-Installation

NOTES:

Verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

Verification that all manufacturer specified end stops or docking gates are properly installed.

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 19 of 32

PASS FAIL

2 Verify that training and competency are documented prior to release for use with patients.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

COMPLETE

COMPLETE

Full extension and inspection of lift strap for loose threads or frays.

Verification of any “soft start” or “soft stop” features and that lifting speed does not exceed 2.5 inches per second with “zero” load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

NOTES:

NOTES:

Training

NOTES:

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Load Testing

NOTES:

Manuals

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 20 of 32

DATE:

DATE:

DATE:

SIGNATURE:

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in place to provide ongoing training on the proper use of ceiling mounted lifts.

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the installing contractor shall release the ceiling mounted lift installation to VA representative.

SIGNATURE:

TITLE:

VA Representative After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the installing contractor prior to releasing the ceiling mounted lift into service to ensure completion of all requirements.

COMPLETE

SIGNATURE:

TITLE:

TITLE:

COMPLETE

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 21 of 32

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 22 of 32

Hazard Control Measure List

Project Name: Date: Project Manager or VA Supervisor:

Instructions: List all identified hazard controls from the assessment above.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Location Group 0

Location Group 1 Lowest Risk

Location Group 2 Medium Risk

Location Group 3 Medium High Risk

Location Group 4 Highest

• Unoccupied Buildings and/or outside projects involving demolition or excavation remote from air intakes

• Biomedical

• Engineering

• Environmental

Services

• HIM

• Morgue

• Non-clinical Office areas

• Non-patient care areas

• Outside projects or excavation near air intakes

• Acute Nursing Units-2W, 4W, 2N, IP Mental Health, CLC

• Cafeteria

• Cardiology

• CBOCs

• Clean Linen storage

• Dental

• Dermatology

• Echocardiography

• Endoscopy/GI

• Laboratory

• Prosthetics

• Radiology, Ultrasound

• Rehab/PT/OT/ST

• Respiratory Care

• Bronch Suite

• ICU, SDU

• Emergency

Department

• Hemodialysis

• Interventional

Radiology

• MRI/CT/ Nuclear Med

• Outpatient Oncology/

Chemotherapy

• Pharmacy areas othe than Clean Room

• Sterile Supply

Storage Areas

• Anesthesia areas

• Cardiac Cath Lab

• Negative Pressure

Isolation Rooms

• Operating Rooms, Holding/PACU

• Pharmacy Clean

Room

• Sterile Processing

Type of Construction Project Activity Type A Inspections 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 through conduit and/or not involving drilling/anchoring

• access to chase spaces

• cutting of walls or ceiling where dust migration can be controlled.

Type C Work which 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:

• any kind of sanding to include sanding walls for painting or wall covering

• removal of floor coverings, ceiling tiles and casework

• new wall construction

• minor ductwork, or electrical work above ceiling

• major cabling activities, i.e. installation of new conduit, anchoring conduit into concrete, etc.

• any activity which cannot be completed within a single work shift.

Type D Major demolition and construction projects.

Includes, but is not limited to:

• activities which require consecutive work shifts

• require heavy demolition or removal of a complete ceiling system

• new construction.

Construction Activity

Type “A” Type “B” Type “C” Type “D”

Risk Level ↓ Group 0 0 0 0 0 Group 1 I II II III/IV Group 2 I II III IV Group 3 I III III/IV IV Group 4 III III/IV III/IV IV

Page 25 of 29Dorn VA Medical Center Construction Risk Assessment-October 2021

Class 0 Locations:

Building Level Room/Area of Work Lo ca tio n

G ro up

Ty pe o f

Co ns tr uc tio n

Pr oj ec t

Ac tiv ity

Cl as s pe r G rid

N ot es

5 2 Education Lobby 1 B II 5 2 Education Storage 1 B II 5 3 Common corridor 1 B II 5 3 Tenant Space 302 1 B II 6 1 On-site Laundry unit (rm 110) 1 B II 7 1 Logistics Vault- 103 1 B II 9 1 Research Off 109 1 B II 9 1 Research Corridor 1 B II 9 1 Research off 117a 1 B II 9 1 Research 117 1 B II 9 2 Research IT Closet 211 1 B II 9 2 Research Off 209 1 B II 9 2 Research Corr 9220 1 B II

20 1 Engineering Shop 125A 1 C II 20 1 Engineering Corr 114 1 B II 20 1 Engineering Off 112A 1 B II 20 1 Engineering Wrk Rm 111 1 B II 20 1 Engineering Shops 124 1 B II 20 1 Engineering TLT 117 1 B II

20 1 Outside building by Engineering TLT 1 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

21 1 IT 108 1 B II

21 1 Corridor 112 1 B II 22 1 Nrsng Serv. Admin 1B112 1 B II 22 1 Nrsng Serv. RN Recruiter 1B113 1 B II 22 1 Common Corridor RCC110R 1 B II 22 1 Common Admin Staff 1B117 1 B II 22 1 Common Corridor RCC102R 1 B II 22 1 Common Corridor RCC111R 1 B II 22 1 Police Major Training 1A102 1 B II 22 2 Space Under Const. RCC203R 1 B II 22 2 Common Lobby RCC208R 1 B II 22 3 Common Corr. RCC304R 1 B II 22 3 Logistics Conf Rm 3B105 1 B II

100 B Health care Admin Records LC113 1 B II 100 B Engineering Sup. 2nd Shift lC112 1 B II 100 B Info Mgmt Chief Info Off. LA109A 1 B II 100 B Pathology HAC LB163 1 B II 100 B Pathology Demonstration LB159 1 B II 100 B Envir Mgmt Off LB173 1 B II 100 B Info Mgmt IRM Off LB175 1 B II 100 B Rehab Med Exam Rm LB109 2 B II 100 B Rehab Med Exam Rm LB110 2 B II 100 1 Urgent Care Exam Rm 1C130B 2 B II 100 1 Common Corr C120 1 B II

100 1 Outside of building by Nursng Svc Admin

Off/pt advocate 1C103A 1 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

100 1 pathology Coridor C18 2 B II 100 1 pathology Specimen ACC 1B182 2 B II 100 1 Pathology Chief med Tech 1B181 2 B II 100 1 Pathology Chemistry & Hema 1B175 2 B II tio n

G ro up

Ty pe o f

Co ns tr uc tio n

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100 1 Behav Health Social Work Off 1B108A 2 B II 100 1 VSO/Vet/union Off 1B108 1 B II 100 1 VSO/Vet/Union Governers Off 1B109 1 B II 100 1 Common Corr C116 1 B II 100 1 Common Corr C115 1 B II 100 1 Common Corr C115 (Second location) 1 B II 100 1 Chap Chancel 1B147 1 B II

100 2 Outside Bldng outside of Surg Exam Rm

2C119 2 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

100 2 Common Corr RCC217R 2 B II 100 2 Common Corr C221 2 B II

100 2 Outside of Bldng outside of Surg Pat Holding

2A140 2 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

100 2 Bed Med/Surg Pt Rm 2B174 2 B II 100 2 Beds Med/surg staff lounge 2B176 2 B II 100 2 Common Corr C218 2 B II 100 3 Surgical Nrs Station 3A146 2 B II 100 3 Common Corr C314 2 B II 100 3 Surgical Exam- Podiatry 3A183 2 B II 100 3 Common Corr C39 2 B II 100 3 SPS SVC Clean util 3A126 2 B II 100 3 Common Corr C301R 2 B II 100 3 Common Corr C32 2 B II

100 3 Info Mgmt IT Clos 3A125 2 B II 100 4 Exist. Mech 4A188 1 B II Within current OR barriers

100 4 Com Net 4A199 1 D, changed to

C II

remians location group 1 as long as it is still within the current OR construction project.

Would change location group when OR is turned over for patient use.

100 4 Soiled utility 4A146 1 B II Within current OR barriers 100 4 Common Corr C48 2 B II 100 4 Common Corr C48 numb. 2 2 B II 100 4 Common Corr C42 2 B II 100 4 Beds Med/Surg Corr 4B19A 2 B II 100 4 Beds/Meds/Surg HAC 4B124 2 B II 100 5 Spec Care Corr C521 2 B II

100 5 outside building outside of Envir Mgmt HAS

5A138 1 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

100 5 Common Corr 5A02 2 B II 100 5 Common Corr C520 2 B II

100A B Engineering Mech Rm BD100 1 B II 100A 1 Primary Care Corr C1-101 2 B II 100A 1 Primary Care Corr C1-101 2 B II 100A 1 Primary Care Corr C1-100 2 B II 100A 1 Primary Care Exam Rm 1D115 2 B II 100A 1 Primary Care Corr C1-106 2 B II 100A 1 Primary Care Exam Room 1D163 2 B II tio n

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100A 1 Engineering Mech Chase RCC105C 2 B II In primary care in bank of exam rooms 100A 2 Surgical Corr C2103 2 B II 100A 2 Eye Clinic Optometry Off 2D144 2 B II 100A 2 Surgical Exam Rm 2D130 2 B II 100A 2 Engineering Mech Chase RCC201C 2 B II In eye clinic/surgical/GU exam space 103 1 Beds CLC Corr RCC103R 2 B II

103 1 Beds CLC HAC 1B-105 2 B II in same hallway in CLC where patient care items are stored

103 1 Beds CLC Corr c1-4 2 B II 103 1 Beds CLC Head Nrs 1A-107 2 B II

103 2 Primary Care HAC 2B106 2 B II In primary care offices next to clean linen storage

103 2 Primary Care Corr RCC209R 2 B II 103 2 Nutrition/Food Dietetics 2A104 2 B II

103A 1 Beds CLC Elec 1H10E 2 B II In warrior's walk nursing, kitchen, and dining area

103a 1 Beds CLC Corr 1G12 2 B II 103a 1 Beds CLC Porch 1F22 2 B II 103A 2 Beds CLC Corr 2F06 2 B II

103A 2 Beds CLC Porch 2F09 (in space open to below) 2 B II 103A 2 Beds CLC Dining 2G10 2 B II 106 1 Outside building by Common Util A128 1 B II Air vent on wall at this location 106 1 Common Core C1-4B 1 B II 106 1 Behav Health Off A124 1 B II 106 1 Vehav health Off B134 2 B II 106 1 Behav Health Off B133 2 B II 106 1 Behav Health Group Rm B124 2 B II 106 1 Education Multipurpose Rm D100 1 B II 106 1 Research Off E111A 1 B II

106 1 Outside of the building OutSIde of E109A 1 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

106 2 Dirs Suite/Qlt Mgmt Corr C2-6C 1 B II

106 2 Inpat Psy & Sub Abuse HAC B203 1 B II

In current construction area/ pain clinic reno.;

if so, can be completed within that barrier which is a level IV

106 2 Inpat Psy Corr C2-18 1 B II

In current construction area/ pain clinic reno.;

if so, can be completed within that barrier which is a level IV

120 1 Common Corr RCC101R outside of W134 2 B II 120 1 Envir Mgmt Jan 2 B II 122 1 Armory Clean Rm 107 2 B II

122 1 HAC 105 2 B II

122 1 Toilet 2 2 B II

122 1 Armory & Weapon 107A 2 B II

For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

T25 1 Engineering Off RCC101R 1 B II 23,24 tio n

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Varo 1 No room number- in building 1 B II IC recommends this class

Varo 1 No room number- out of building 1 B II

Recommendation- For any interior work done in this location only. Work done completely outside, with no communication to the inside is a class 0.

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5 1 109A convert to 109-a and b 1 D III

5 2 Education Kitchen convert to two spaces 1 D III 5 3 Tenant Space Storage Room 1 D III 6 1 Room build in 110 (adding 110-a) 1 D III 6 1 Primary Care Off 112 1 B III

7 1 Room build in Logistics Warehouse 102R 1 D III 9 1 Research Lab 110 1 D III 9 2 Research Admin 210 1 D III

22 1 Police/Sec Evid. Room 1A101 1 D III

22 2 DIRS Suite/QLT Mgmt 2B116- to add 2B114A 1 D III 22 3 Tenant Space Off 3B105A 1 D III

100 B Info Mgmt. Comp Server Rm LA108 (See pg

22 for plans 1,2,3) 1 D III

100 B Info Mgmt Micro-comp Lab Off LA107 1 D III

100 B Info Mgmt Stor LB174 1 D III

100 1 Nrsng Svc Admin Stakeholder Relations, Pat

Adv. RCC101R/1A102A 1 D III

100 1 Chap Chaplain 1B145 1 D III 100 5 SPS SVC Clean util 5A133 3 B III 105 1 Logistics 1A101A 1 D III

106 1 Dirs Suite/QLT Mgmt Community Relations

& Engagement Off E114 1 D III 106 2 Behav Health Off A233 1 D III

106 2 INPAT Psy & Sub Abuse Off B226 1 D III 114 1 Diag img 102 3 B III T36 1 Dirs Suite/Qlt Mgmt Off RCC104R 1 D III Varo 1 No room number- in building 1 D III tio n

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100 B Envior. Mgmt Clean Linen LC115 (See pg 20 for plans 1,2,3) 2 D IV

100 B Rehab Med SCI Exam Room LB106 2 D IV

100 1 Pathology Conf Rm 1A170 creating 1A171A 2 D IV

100 2 Surgical Anest Off 2A129 2 D IV Not in the OR proper

100 2 Beds Med/surg wrk Rm 2B152 2 D IV

100 3 Surgical Nrs Station 3A146 2 D IV

100 4 Med Svc Admin NP-Off 4A134 2 D IV

100 4 Beds Med/Surg Equip Stor 4B131 (4,5,6) to be 4B145A 2 D IV

100 5 Spec Care Off RC512R- to be 5B146 2 D IV

100 5 Pharmacy Off 5A131 3 D IV Next to sterile storage, bronch room, pharmacy clean room and drug storage.

100A B BD110a 2 D IV 100A 1 Primary Care Off 1D133B 2 D IV 100A 2 2D127 Surgical Biopsy Room 2 D IV 103 1 Library 1C-101/TR 1C-100 2 D IV 103 2 Office 2B103B 2 D IV

103a 1 Beds CLC NRS1G10A, Beds CLC Dining 1G10, Beds CLCL Porch 1F22- MOVING WALLS 2 D IV 106 1 Canteen Svc Vending A131 2 D IV 114 1 Diag Img 101 AND 103 3 D IV

120 1 TR W135 AND 134 2 D IV

122 1 Equipment Storage 102B 2 D IV

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 30 of 32

POST-CONSTRUCTION ASSESSMENT

PROJECT:

LOCATION:

PROJECT TYPE:

PROJECT START(NTP) DATE:

PROJECT COMPLETION DATE:

Final Occupancy Review Checklist (engineering Share Point) has been completed and all required documentation submitted?

Yes No NA (N/A for in-house projects)

Air quality:

Review comments:

Additional action taken:

Infection control:

Review comments:

Additional action taken:

Utility requirements:

Review comments:

Additional action taken:

https://sharepoint.visn7.med.va.gov/sites/cms/Engineering%20Service/Construction%20Safety/Shared%20Documents/Final%20Occupancy%20Review%20Checklist.docx

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 31 of 32

Noise and vibration:

Review comments:

Additional action taken:

Physical security:

Review comments:

Additional action taken:

Emergency procedures:

Review comments:

Additional action taken:

General comments:

Submitted by:

Obtain the following approvals, in the order listed, as applicable:

1. Maintenance Control Manager, Engineering Service Date

2. Project Section Chief, Engineering Service Date

3. Assistant Chief, Engineering Service Date

4. Infection Control Coordinator Date

5. VA Police Representative Date

6. Safety and Emergency Management Service Representative Date

7. Chief, Engineering Service Date

Dorn VA Medical Center Construction Risk Assessment-June 2015 Page 32 of 32

1. Project Manager/COTR/Shop Supervisor Date

1.Identifies space as 'Construction Personnel Only' and

2. Directs occupants to alternate means of egress.