Att 24-504-21-700 EHRM Amarillo.ADD-1.20250128.pdf

VHA Infection Control Risk Assessment for Construction, Renovation and Maintenance

VHA ICRA-1.2 (October 2024) Page 1 of 7

Introductory Information and Instructions Use this template as a baseline for performing facility Infection Control Risk Assessments (ICRAs) for construction, renovation, and maintenance work (referred to as the “activity” in this document). The template provides minimum requirements for categorizing activity types and patient risk to determine the level of precautions needed to prevent infection risks. Facilities may customize this template to incorporate site-specific information and/or to add more stringent criteria.

This VHA ICRA template pertains specifically to infection prevention. It must be used if required by the VHA Pre-Construction Risk Assessment (PCRA) for the activity. NOTE: The PCRA addresses other activity-related safety concerns (e.g., vibration, noise, hazardous materials) outside the scope of the

ICRA.

To complete the template:

1. Use Table 1 to identify the category of the construction, renovation and/or maintenance activity.

2. Use Table 2 to identify the areas affected by the activity.

3. Use Table 3 to identify the overall patient risk category that will be affected by the activity.

4. Use Table 4 to determine the level of infection prevention and control precautions needed for the activity.

Once all 4 steps above are completed: Refer to Table 5 for the minimum required control measures for the level of infection prevention and control precautions needed for the activity. Refer to Table 6 for the minimum infection prevention and control measures required on completion of the activity.

PERMIT: See the last page of this document for a fillable permit form to be used for posting at the activity site as needed.

Table 1 - Construction, Renovation, and/or Maintenance Activity Category

NOTE: If any of the bulleted criteria in a higher activity category pertains to the work that will be done (even if the other criteria are in a lower category), use the higher activity category for the VHA ICRA.

Activity Category determined from Table 1 (A, B, C, or D):

Category A

Inspection and/or facility upkeep generally defined as follows:

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

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

Work that does not create dust or debris.

Removal of ceiling tile or access to mechanical or electrical chase for visual inspection 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 without sanding) that do not create dust or debris.

Limited building system maintenance such as basic plumbing on potable systems (e.g., faucet replacement) or basic electrical work such as replacement of light bulbs, receptacles, or switches.

B

General maintenance and repair work generally defined as follows:

Prolonged inspection and work that may take longer than a single shift but not exceeding a week.

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

Work that creates minimal dust and debris.

VHA ICRA-1.2 (October 2024) Page 2 of 7

Interior f inish or surface repairs, updates, or modifications such as repair of f irewalls and barriers, and new flooring that produces minimal dust and debris. Controlled sanding activities (e.g., wet or dry sanding) that produce minimal dust and debris.

Plumbing work such as installation or replacement of a single fixture or piping for a single fixture. Any work on sanitary plumbing including snaking of drains.

Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light f ixture that produces minimal dust and debris.

Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit or a single device that produces minimal dust and debris.

C

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

Work requiring longer than a single week to complete but not exceeding 6 months.

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

Demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements.

Demolition/removal of more than 32 ft2 of drywall/framing, hard ceilings, and doors/framing and minimal infrastructure such as electrical circuits and branch piping.

Installation of new walls, ceilings and doors including framing, drywall/plaster and associated work.

Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing.

Shut down of sections of potable water systems.

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.

Modification of existing fire alarm and suppression systems.

Mechanical work such as the installation of ductwork, diffusers, and terminal units for an area.

D

Large-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.

Large-scale demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, f looring, piping, electrical and HVAC.

The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work.

Plumbing work such as the installation of:

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

Shutdown of potable water, steam/heating hot water, condensate, and medical gas systems.

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.

Installation of f ire alarm and suppression systems.

Electrical shutdown of multiple panels.

Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls.

VHA ICRA-1.2 (October 2024) Page 3 of 7

Table 2 - Affected Area Assessment

Identify the areas and associated patients that will be affected by the construction/renovation/maintenance activity (see the Figure for a visual representation of adjacent affected areas).

Figure: Isometric drawing of affected 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

Activity Area**

Area Above

Area Below

Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

* There may be more than one Service/type of area for each row. List all.

** List the area(s) in which the construction/renovation/maintenance activity will occur. NOTE: When the Activity Category is B, C, or D, the control measures are determined by the Patient Risk in the adjacent affected areas.

VHA ICRA-1.2 (October 2024) Page 4 of 7

Table 3 - Patient Risk Category

Using Table 3, identify the patient risk category for each area listed in Table 2. Of the patient risk categories identif ied, select the one with the greatest risk as the overall Patient Risk Category for the activity.

Overall Patient Risk Category determined from Table 3 (Low, Medium, High, or Highest):

Low Risk

Non-patient care areas such as:

Medium Risk

Patient care support areas such as:

High Risk

Patient care areas such as:

Highest Risk

Procedural, invasive, sterile support and highly compromised patient care areas such as:

Public hallways and gathering areas not in clinical areas

Office areas not in clinical areas

Breakrooms not in clinical areas

Bathrooms or locker rooms not in clinical areas

Mechanical/electrical rooms not in clinical areas

Waiting areas

Clinical engineering (biomedical)

Materials management

Sterile processing department – dirty side

Kitchen, cafeteria, gift shop, coffee shop, and food kiosks

Patient care rooms and areas, including spinal cord injury units

All acute care units, including mental health

All outpatient units and clinics

Emergency department

Community Living Centers, domiciliaries, and transitional residences

Employee health

Pharmacy – general work zone

Medication rooms and clean utility rooms

Imaging suites – diagnostic imaging

Laboratory

All transplant units

All intensive care units

All oncology units and chemotherapy/infusion centers

OR theaters and restricted areas

Hemodialysis units

Procedural rooms*

Pharmacy compounding area

Sterile processing department – clean side

Transfusion services

Imaging suites – interventional imaging

Dedicated isolation wards/units for infectious diseases

* Procedural Rooms are designated for the performance of patient care activities that may require high-level disinfected or sterile instruments and some environmental controls but is not required to be performed with the environmental controls of an operating room (OR). The room is intended for procedures that are performed in an aseptic surgical field and penetrates the protective surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea) or entry into or opening of a sterile body cavity. Examples of these spaces include, and are not limited to, Cardiac Catheterization Suites, Electrophysiology Suites, Endovascular/GI Suites, Angio Suites and other spaces which may have high risk patient populations.

VHA ICRA-1.2 (October 2024) Page 5 of 7

Table 4 - Level of Infection Prevention and Control Precautions

Match the Overall Patient Risk Category (Low, Medium, High, Highest) determined from Table 3 with the planned Construction/Renovation/Maintenance Activity Category (A, B, C, D) from Table 1 to determine the minimum Level of Infection Prevention and Control Precautions (I, II, III, or IV) using Table 4 below.

Level of Precautions determined from Table 4 (I, II, III, or IV):

An infection prevention and control permit is required for Level III and Level IV. Consult with Infection Prevention and Control for Level I and Level II.

Table 5 - Required Infection Prevention and Control Measures, by Level of Precautions Controls defined below for the Level of Precautions identified for the activity must be in place before the activity begins and maintained until work is completed and the area is activated. Control measures for each Precaution Level must also include the control measures in the preceding Level(s).

As the activity progresses, a full re-evaluation of remaining activity type and patient risk is required prior to downgrading the Level of Precautions.

Level of Precautions

Control Measures

Level I

1. Perform work activity in a manner that does not create dust.

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

3. Any materials and equipment being brought into the facility must be free of contaminants and loose material.

Level II

All control measures in Level I and the following:

1. Provide active means to control airborne dust from dispersing into occupied areas and/or water mist surface to control dust (e.g., Mobile Dust Containment Cart or some other system).

2. Ensure worker clothing is clean and free of visible dust before leaving the work area.

3. Remove or isolate air diffusers (supply and return) to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

Patient Risk Category

Activity Category

A B C D Low Risk I II II III Medium Risk I II III IV High Risk I II IV IV Highest Risk II III IV IV

VHA ICRA-1.2 (October 2024) Page 6 of 7

4. When the work involves or impacts potable water systems including stagnation due to reduced usage, the piping shall be flushed twice a week or isolated from the main system.

5. Seal doors to prevent dust migration.

6. Contain all trash and debris in the work area. Perform daily cleaning and disposal of trash (covered) from work area using an identif ied exit route.

7. Any equipment, tools, or materials removed from the work area must be in sealed containers and/or cleaned of dust and debris prior to removal from the area.

8. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

9. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy. Sticky mats must be changed routinely and when visibly soiled.

10. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces at least daily.

Level III

All control measures in Levels I and II and the following:

1. Ensure availability of equipment for cleaning hands.

2. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

3. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to floor and ceiling (or f loor/roof deck above) and secure from movement or damage.

4. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

5. Maintain .01 inches /water gauge negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors, or comply with the alternative method outlined in Appendix A of this document. These control measures must be maintained continuously 24/7 for the duration of the project. HEPA filtered exhaust if discharged directly to the outdoors must be at a distance of 25 feet or greater from entrances, air intakes and operable windows. Exhausting discharged air into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is prohibited.

6. Install a differential pressure sensing device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor and document negative pressurization. The “ball in the wall” or similar apparatus are not acceptable.

Level IV

All control measures in Levels I, II and III and the following:

1. Barriers must be hard barriers unless temporary to install f inal barrier.

2. Containment must include an anteroom to ensure pressure control. Anteroom must be large enough for equipment staging, cart cleaning, workers’ PPE and cleaning.

3. Worker clothing and/or PPE must be removed or clean and free of visible dust before leaving the work area anteroom. HEPA vacuuming of clothing or use of cover suits is acceptable.

4. Workers must wear shoe covers or have a method to clean shoes in anteroom.

Shoe covers must be removed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be changed immediately.

VHA ICRA-1.2 (October 2024) Page 7 of 7

Table 6 - Minimum Infection Prevention and Control Measures Required Upon Completion of the Activity

Controls defined below shall be completed upon completion of the activity and inspected prior to terminating measures defined in Table 5.

Level of Precautions Measures

Levels I - II

Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and f looring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air dif fuser surfaces.

HVAC Systems:

1. Remove isolation of HVAC system in areas where work is being performed. Verify that HVAC systems are clean and operational.

2. Verify the HVAC systems meet original airf low and air exchange design specif ications.

Water systems:

1. Until the potable water system is activated and in use, flushing shall continue at least twice per week in accordance with VHA Directive 1061.

Levels III - IV

Construction areas must be inspected by an infection preventionist and engineering representative (and others as determined by the facility) for final activity/project close out and removal of infection prevention and control measures.

Work Area Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and f looring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air dif fuser surfaces.

Removal of Critical Barriers:

1. Critical barriers must remain in place during all work involving drywall removal, creation of dust and activities beyond simple touch-up work. The barrier may NOT be removed until a work area cleaning has been performed. Additional cleaning may be needed after removal of barrier.

2. All (plastic or hard) barrier removal activities must be completed in a manner that prevents dust release. Use the following precautions when removing hard barriers:

i. Carefully remove screws and painter tape.

ii. If dust will be generated during screw removal, use hand-held HEPA vacuum.

iii. Drywall cutting is prohibited during removal process.

iv. Clean all stud tracks with HEPA vacuum before removing outer hard barrier.

v. Use a plastic barrier to enclose area if dust could be generated.

Negative Air Requirements:

1. The use of negative air must be designed to remove contaminants f rom the work area.

2. Negative air devices (fans, f ilters, monitoring and documentation equipment) must remain operational at all times and in place for a period after completion of dust creating activities to remove contaminants f rom the work area and before removal of critical barriers.

HVAC systems:

1. Upon removal of critical barriers, remove isolation of HVAC system in areas where work is being performed.

2. Verify that HVAC systems are clean and operational.

3. Verify and document through a TAB the HVAC systems meets original airf low and air exchange design specif ications.

Water systems:

1. Until the potable water system is activated and in use, flushing shall continue at least twice per week in accordance with VHA Directive 1061.

VHA ICRA-1.2 (October 2024)

Infection Prevention and Control Construction/Renovation/Maintenance Permit This page must be posted at the entrance to the project area for Level III and Level IV activities.

Unique permit number:

Location of construction/renovation/maintenance Project manager Project start date Contact phone number Completion date Contractor Permit expiration date

Activity Category (A, B, C, or D)

Overall Patient Risk Category (Low, Medium, High, or Highest)

Level of Infection Prevention and Control Precautions (I, II, III, or IV)

Level of Precautions

Control measures to be in place for the duration of the activity (Check the box for the activity’s Level of Precautions to indicate the Control Measures)

Level I 1. Perform work activity in a manner that does not create dust.

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

3. Any materials and equipment being brought into the facility must be free of contaminants and loose material.

Level II

All control measures in Level I and the following:

1. Provide active means to control airborne dust from dispersing into occupied areas and/or water mist surface to control dust (e.g., Mobile Dust Containment Cart or some other system).

2. Ensure worker clothing is clean and free of visible dust before leaving the work area.

3. Remove or isolate air diffusers (supply and return) to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

4. When the work involves or impacts potable water systems including stagnation due to reduced usage, the piping shall be flushed twice a week or isolated from the main system

5. Seal doors, to prevent dust migration.

6. Contain all trash and debris in the work area. Perform daily cleaning and disposal of trash (covered) from work area using an identified exit route.

7. Any equipment, tools, or materials removed from the work area must be in sealed containers and/or cleaned of dust and debris prior to removal from the area.

8. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

9. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy. Sticky mats must be changed routinely and when visibly soiled.

10. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces at least daily.

Level III

All control measures in Levels I and II and the following:

1. Ensure availability of equipment for cleaning hands.

2. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

3. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to floor and ceiling (or floor/roof deck above) and secure from movement or damage.

4. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

5. Maintain .01 inches /water gauge negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors, or comply with the alternative method outline in Appendix A of the VHA ICRA template. These control measures must be maintained continuously 24/7 for the duration of the project. Exhausting discharged air into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is prohibited.

Check box to indicate exhaust method: Exterior Alternative Interior Method

6. Install a differential pressure sensing device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor and document negative pressurization. The “ball in the wall” or similar apparatus are not acceptable.

Level IV

All control measures in Levels I, II and III and the following:

1. Barriers must be hard barriers unless temporary to install final barrier.

2. Containment must include an anteroom to ensure pressure control, Anteroom must be large enough for equipment staging, cart cleaning, workers’ PPE and cleaning.

3. Worker clothing and/or PPE must be removed or clean and free of visible dust before leaving the work area anteroom. HEPA vacuuming of clothing or use of cover suits is acceptable.

4. Workers must wear shoe covers or have a method to clean shoes in anteroom Shoe covers must be removed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be changed immediately.

Additional requirements:

Project Manager signature Date

Infection Preventionist signature Date

VHA ICRA-1.2 (October 2024)

Appendix A: Alternative To Outdoor Exhaust Requirements

This Appendix provides an equivalent ICRA control measure to requirements detailed in this VHA ICRA template (Table 5 Level III, item 5) that would allow interior construction space exhaust.

Interior Construction Space Exhaust:

If the facility is not able to exhaust to the building exterior, the Healthcare Environment and Facilities program office has identif ied an alternate industry-recognized standard interior exhaust procedure that is accepted as providing an equivalent level of infection prevention and control (IPC), and safety. The alternate interior exhaust procedure is implemented by completing the following:

a. If exhaust is directed indoors, then the system must be HEPA filtered. Prior to start of work, including assembly of the ICRA barriers, initial baseline air sampling measurements for particulate levels must be taken in the planned area of discharge. Once containment is erected and completed, HEPA filtration must then be verif ied by particulate measurement, using a particle counter with multi-channel capabilities to measure down to 0.3 microns, to confirm that the discharge of the HEPA unit does not exceed the baseline particulate count of the area to which the exhaust is directed. Verif ication must continue at least three times per day (once every 8 hours), 7 days per week, during the use of the negative air machine and HEPA filter.

Any exceedance must trigger a work stoppage and an immediate response and resolution. All particulate measurements, including the baseline measurement, must be documented and retrievable.

b. To accommodate the sampling, the negative air pressure machine must be fitted with a 2 ft section of ridged ductwork at the discharge. The sample port for monitoring must be in the ridged ductwork section.

c. Vapor generating processes must be assessed and appropriate filtration must be installed to mitigate transmission to the facility.

d. Engineering must do a complete flow and pressure analysis and document the area to which the air is being discharged to ensure the flow and pressure relationships in that area are not being adversely impacted by the additional f low. Ideally, this is done as part of the construction package to ensure the design is implementable and no additional HVAC changes are required to accommodate the exhaust from the negative air equipment.

e. Install device on exterior of work containment to continually monitor negative pressurization. To ensure proper pressure is continuously maintained, the device(s) shall have a visual pressure indicator, data collection and alarm.

f. Exhaust must be directed to Low Risk areas as defined in Table 3 in this VHA ICRA template.

Ideally this discharge must be located so as not to impinge on high traffic areas or create a nuisance with noise or excessive airflow.

NOTE: Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

VHA Pre-Construction Risk Assessment (PCRA)

PCRA Introductory Information and Instructions

Use this template as a baseline for performing facility Pre-Construction Risk Assessments (PCRA) for Construction, Renovation, and Maintenance work (referred to as the “activity” in this document). The template provides minimum requirements for categorizing activity type(s) and safety risk to determine the level of precautions needed to prevent impact related to Construction, Renovation and Maintenance on patients, employees, and contractors.

Ensure that the activity statement of work and any drawings available are used for the PCRA assessment and included in the project file with the completed PCRA.

Communication and coordination of all types of activity with affected areas are to be included among the control measures. The development of communication and coordination plans must begin during the activity planning phase.

Facilities may customize this template to incorporate site-specific information and requirements.

NOTE: This VHA PCRA template pertains specifically to non-infection-related safety for Construction, Renovation, and Maintenance activities. It must be used in conjunction with the VHA Infection Control Risk Assessment (ICRA) for the activity, if required, which specifically addresses infection risks outside the scope of this PCRA.

PERMIT: See the last page of this document for a fillable permit form to be used for posting at the activity site.

Activity Location:

Activity Name, Number, and/or Brief Description:

Table 1 - Construction, Renovation, and/or Maintenance Activity Type and Control Measures NOTE: If any of the bulleted criteria in a higher activity type pertains to the work that will be done (even if the other criteria are in a lower type), use the higher activity type for the VHA PCRA.

Controls defined in Table 1 for the activity must be in place before the activity begins and maintained until work is completed and the area is activated. Control measures for each activity must also include the control measures in the preceding row(s).

As the activity progresses, a full re-evaluation of remaining activity type and risk is required prior to changing the level of control measures.

Activity Type determined from Table 1:

Activity Type and Description Control Measures 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

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 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.

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.

5. Communication and coordination plan for all affected areas

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 may o disturb asbestos, lead or silica o create the potential for falling objects o create vibration and/or noise in excess of 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 o Painting or other large-scale use of such substances.

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.

6. Daily inspections of the site are to be conducted by the General Contractor or shop supervisor and documented on their daily log.

Large-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.

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

2. Dust control plan in place

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 in excess of 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.

3. Pollution prevention plan in place

4. Dig safe paper work in place

5. Crane lift plan in place

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained

7. Confined entry plan in place and staff trained

Table 2. Affected Adjacent Area Assessment In addition to the minimum precautions noted above for the Activity Type, it is critical that the activity be coordinated with the areas adjacent to the activity to ensure operations in those areas are not disrupted or impacted. List the adjacent areas in Table 2 below and develop activity-specific coordination plans and associated communication plans with each area to address activity work that could impact or disrupt the operation of the areas, in general as follows:

If adjacent area is vacant (e.g., work outside, construction of new building, etc.):

o Coordination is typically not necessary other than potentially traffic flow and pedestrian access.

VHA-PCRA-202 -1 Page 4 of 5

If adjacent area is non-continuously occupied (e.g., areas where outpatient care is provided, employee health, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., conduct work after hours).

If adjacent area is occupied continuously (e.g., areas where inpatient care is provided, residential areas such as Community Living Centers, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., move affected party temporarily).

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**

Area Above

Area Below

Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

* There may be more than one Service/type of area for each row. List all. The information entered on this table must be used in the ICRA if required.

** List the area(s) in which the construction/renovation/maintenance activity will occur.

Infection Control Risk Assessment (ICRA)

Consult with Infection Prevention and Control regarding the assessment of potential infection risks associated with the activity and the need for control measures.

See VHA Directive 7715 and the VHA ICRA Template for more information.

Is an ICRA required for the Activity? Yes No

Pre-Construction Risk Assessment (PCRA) Permit This page must be posted at the entrance to the project area, or other designated area

Unique permit number:

Location and brief description of construction/renovation/maintenance Project manager Project start date Contact phone number Completion date Contractor or lead shop Permit expiration date

Activity Type Inspection/Upkeep, Small-scale, or Large-scale)

Activity Type Control measures to be in place for the duration of the activity (Check the box for the Activity Type to indicate the Control Measures)

Inspection/Upkeep

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.

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

5. Communication and coordination plan for all affected areas

Small-scale

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. ILSMs in place and staff trained on situation

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.

6. Daily inspections of the site are to be conducted by the General Contractor and documented on their daily log.

Large-scale

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

1. Excavation safety plan in place

2. Dust control plan in place

3. Pollution prevention plan in place

4. Dig safe paperwork in place

5. Crane lift plan in place

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained

7. Confined entry plan in place and staff trained

*The location of all Activity Hazard Analyses and Control Plans (excavation, dust, pollution, etc.) as applicable shall be identified on this permit and shall be made available to all workers on the job.

Additional requirements:

Is an Infection Control Risk Assessment (ICRA) required for the Activity? Yes No Infection Prevention and Control signature:

Date:

Project Manager signature Date

Safety Officer signature Date

Chair, Construction Safety Committee signature

Date

EHRM Infrastructure Upgrades - Amarillo VAMC Project #: 504-21-700

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Cast-In-Place Concrete

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SECTION 03 30 00

CAST-IN-PLACE CONCRETE

PART 1 - GENERAL

1.1 DESCRIPTION

A. This section specifies cast-in-place structural concrete and materials and mixes for other concrete.

1.2 RELATED WORK

A. Section 01 45 29, TESTING LABORATORY SERVICES: Materials testing and inspection during construction: Section 01 45 29, TESTING LABORATORY SERVICES.

B. Section 01 81 13, SUSTAINABLE CONSTRUCTION REQUIREMENTS

C. Section 32 05 23, CEMENT AND CONCRETE FOR EXTERIOR IMPROVEMENTS: Concrete roads, walks, and similar exterior site work.

1.3 TESTING AGENCY FOR CONCRETE MIX DESIGN

A. Testing agency for the trial concrete mix design retained and reimbursed by the Contractor and approved by COR. For all other testing, refer to Section 01 45 29 Testing Laboratory Services.

B. Testing agency maintaining active participation in Program of Cement and Concrete Reference Laboratory (CCRL) of National Institute of Standards and Technology. Accompany request for approval of testing agency with a copy of Report of Latest Inspection of Laboratory Facilities by

CCRL.

C. Testing agency shall furnish equipment and qualified technicians to establish proportions of ingredients for concrete mixes.

1.4 TOLERANCES

A. Formwork: ACI 117, except the elevation tolerance of formed surfaces before removal of shores is +0 mm (+0 inch) and -20 mm (-3/4 inch).

B. Reinforcement Fabricating and Placing: ACI 117, except that fabrication tolerance for bar sizes Nos. 10, 13, and 16 (Nos. 3, 4, and 5) (Tolerance Symbol 1 in Fig. 2.1(a), ACI, 117) used as column ties or stirrups is +0 mm (+0 inch) and -13 mm (-1/2 inch) where gross bar length is less than 3600 mm (12 feet), or +0 mm (+0 inch) and -20 mm (-3/4 inch) where gross bar length is 3600 mm (12 feet) or more.

C. Cross-Sectional Dimension: ACI 117, except tolerance for thickness of slabs 12 inches or less is +20 mm (+3/4 inch) and - 6 mm (-1/4 inch). Tolerance of thickness of beams more than 300 mm (12 inch) but less than 900 mm (3 feet) is +20 mm (+3/4 inch) and -10 mm (-3/8 inch).

D. Slab Finishes: ACI 117, Section 4.5.6, F-number method in accordance with ASTM E1155, except as follows:

1. Test entire slab surface, including those areas within 600 mm (2 feet) of construction joints and vertical elements that project through slab surface.

2. Maximum elevation change which may occur within 600 mm (2 feet) of any column or wall element is 6 mm (0.25 inches).

3. Allow sample measurement lines that are perpendicular to construction joints to extend past joint into previous placement no further than 1500 mm (5 feet).

1.5 REGULATORY REQUIREMENTS

A. ACI SP-66 – ACI Detailing Manual.

B. ACI 318 - Building Code Requirements for Reinforced Concrete.

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C. ACI 301 – Standard Specifications for Structural Concrete.

1.6 SUBMITTALS

A. Submit in accordance with Section 01 33 23, SHOP DRAWINGS, PRODUCT DATA, and

SAMPLES. All items indicated below are required submittals requiring Contracting Officer’s Representative (COR) review and approval.

B. Shop Drawings: Reinforcing steel: Complete shop drawings

C. Mill Test Reports:

1. Reinforcing Steel.

2. Cement.

D. Manufacturer's Certificates:

1. Abrasive aggregate.

2. Lightweight aggregate for structural concrete.

3. Air-entraining admixture.

4. Chemical admixtures, including chloride ion content.

5. Waterproof paper for curing concrete.

6. Liquid membrane-forming compounds for curing concrete.

7. Non-shrinking grout.

8. Liquid hardener.

9. Waterstops.

10. Expansion joint filler.

11. Adhesive binder.

E. Testing Agency for Concrete Mix Design: Approval request including qualifications of principals and technicians and evidence of active participation in program of Cement and Concrete Reference Laboratory (CCRL) of National Institute of Standards and Technology and copy of report of latest CCRL, Inspection of Laboratory.

F. Test Report for Concrete Mix Designs: Trial mixes including water-cement fly ash ratio curves, concrete mix ingredients, and admixtures.

G. Test reports on splitting tensile strength (Fct) of lightweight concrete.

1.7 DELIVERY, STORAGE, AND HANDLING

A. Conform to ACI 304. Store aggregate separately for each kind or grade, to prevent segregation of sizes and avoid inclusion of dirt and other materials.

B. Deliver cement in original sealed containers bearing name of brand and manufacturer, and marked with net weight of contents. Store in suitable watertight building in which floor is raised at least 300 mm (1 foot) above ground. Store bulk cement and fly ash in separate suitable bins.

C. Deliver other packaged materials for use in concrete in original sealed containers, plainly marked with manufacturer's name and brand, and protect from damage until used.

1.8 PRE-CONCRETE CONFERENCE

A. General: At least 15 days prior to submittal of design mixes, conduct a meeting to review proposed methods of concrete construction to achieve the required results.

B. Agenda: Includes but is not limited to:

1. Submittals.

2. Coordination of work.

3. Availability of material.

4. Concrete mix design including admixtures.

5. Methods of placing, finishing, and curing.

6. Finish criteria required to obtain required flatness and levelness.

7. Timing of floor finish measurements.

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8. Material inspection and testing.

C. Attendees: Include but not limited to representatives of Contractor; subcontractors involved in supplying, conveying, placing, finishing, and curing concrete; lightweight aggregate manufacturer; admixture manufacturers; COR; Consulting Engineer; Department of Veterans Affairs retained testing laboratories for concrete testing and finish (F-number) verification.

D. Minutes of the meeting: Contractor shall take minutes and type and distribute the minutes to attendees within five days of the meeting.

1.9 MOCK-UP

A. In addition to the other specified samples and tests, construct a mock-up using the materials, reinforcing, forming system and construction methods proposed for use in exposed architectural concrete.

B. Construct the mock-up with at least a 2.5 m by 2.5 m (8 feet by 8 feet) exposed surface and suitable foundations. Include the following where applicable: Control joints, reglets, recesses or other typical architectural details.

C. Before casting the mock-up, submit full detailed Shop Drawings of the mock-up formwork for review by the Architect. Perform all necessary preliminary tests to ensure that concrete used for the mock-up will exactly match the approved sample in color and texture.

D. Perform the surface treatment proposed for use on one or more areas not less than 300 mm by 300 mm (1 foot by 1 foot) on the back side of the mock-up to establish the texture of finish required by the Architect. Repeat as required until a sample satisfactory to the Architect has been obtained.

E. Treat the finished front surface of the mock-up to produce a uniform appearance similar in every respect to the approved sample area.

F. The completed mock-up shall be inspected by the Architect. Failure of the mock-up to match the approved sample will require the construction of further mock-ups until approval is obtained.

Remove rejected mock-ups immediately.

G. Maintain the approved mock-ups in good condition at the job site until all architectural concrete surfaces have been completed and approved by the Architect. Remove the mock-up from the site after completion of the above.

1.10 APPLICABLE PUBLICATIONS

A. Publications listed below form a part of this specification to extent referenced. Publications are referenced in text by basic designation only.

B. American Concrete Institute (ACI):

117-10 ................................... Specifications for Tolerances for Concrete Construction and

Materials and Commentary

211.1-91(R2009) ................... Standard Practice for Selecting Proportions for Normal, Heavyweight, and Mass Concrete

211.2-98(R2004) ................... Standard Practice for Selecting Proportions for Structural Lightweight Concrete

214R-11(R2019) ................... Guide to Evaluation of Strength Test Results of Concrete

301-16 ................................... Specifications for Structural Concrete

304R-00(R2009) ................... Guide for Measuring, Mixing, Transporting, and Placing Concrete

305.1-14 ................................ Specification for Hot Weather Concreting

306.1-90(R2002) ................... Standard Specification for Cold Weather Concreting

308.1-11 ................................ Specification for Curing Concrete

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309R-05 ................................. Guide for Consolidation of Concrete

318/318-19 ............................ Building Code Requirements for Structural Concrete and Commentary

347R-14 ................................. Guide to Formwork for Concrete

SP-66-04 ............................... ACI Detailing Manual

C. American National Standards Institute and American Hardboard Association (ANSI/AHA):

A135.4-2012 .......................... Basic Hardboard

D. ASTM International (ASTM):

A615/A615M-20 .................... Standard Specification for Deformed and Plain Carbon Steel

Bars for Concrete Reinforcement

A653/A653M-20 .................... Standard Specification for Steel Sheet, Zinc Coated (Galvanized) or Zinc Iron Alloy Coated (Galvannealed) by the Hot Dip Process

A706/A706M-16 .................... Standard Specification for Deformed and Plain Low-Alloy Steel Bars for Concrete Reinforcement

A767/A767M-19 .................... Standard Specification for Zinc Coated (Galvanized) Steel Bars for Concrete Reinforcement

A775/A775M-19 .................... Standard Specification for Epoxy Coated Steel Reinforcing Bars

A820/820M-16 ....................... Standard Specification for Steel Fibers for Fiber Reinforced Concrete

A996/A996M-16 ....................