660-26-220 PQIA and ILSMs.pdf
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- Solicitation number
- 36C25926R0053_1
About this file
This is an assessment worksheet template for evaluating interim life safety measures (ILSM) required during construction or renovation projects. The document guides project managers through a two-step process to determine whether temporary life safety protections must be implemented during work that may create code deficiencies.
Step 1 requires completion of a Pre-Qualifying Interim Life Safety Measures Assessment (PQIA) that assigns risk scores based on two factors: Value A (specific life safety deficiencies, failures, or impairments ranging from 1-4 points) and Weight B (occupancy type ranging from 1-4 points). Risk scores are calculated by adding Value A and Weight B scores. A combined score of 8 or higher triggers the requirement for ILSM implementation; scores of 1-7 require no further action. For the example project 660-26-220 (replacement of plumbing fixtures, doors, and ceiling systems within an Inpatient Care Unit to address MHEOC findings), the assessment indicates a Value A score of 11 plus Weight B score of 1 equals a Risk Score of 12, requiring ILSM implementation. Step 2 involves selecting and documenting specific interim measures from a list of 14 options, including ensuring emergency egress, notifying emergency forces and staff, maintaining operational life safety systems, posting fire watch, implementing temporary construction barriers, controlling combustible loading, conducting additional fire drills, increasing surveillance, and providing temporary fire alarm and detection systems. The document includes a matrix linking specific life safety code deficiencies to recommended ILSM measures, though the instructions note that measures may be expanded or reduced based on project scope and actual code deficiencies.
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Attachment A: PRE-QUALIFYING INTERIM LIFE SAFETY MEASURES ASSESSMENT
(PQIA) AND INTERIM LIFE SAFETY MEASURES (ILSM) WORKSHEET
Project:
660-26-220 Replace FF&E IPU Project Start Date: TBD
Project End Date: TBD
Other Identifying Information about the project:
Replacement of plumbing fixtures, doors, and ceiling systems within the IPU to address MHEOC findings.
Person Completing Assessment:
Zane Kozarec
Step 1: Go to section 1 and perform PQIA.
Based on PQIA is an ILSM required?
YES X Document ILSM Number Here: I-2025- NO Document PQIA Number Here: P-2025-
If answer to the above question is YES, an ILSM and further action is required. Complete Section 2. Enter the ILSMA number above. Additionally, document ILSM number and the required narrative in the ILSM.PQIA tracking spreadsheet.
If answer to the above question is NO, an ILSM and further action is not required. Enter the PQIA number above. Additionally, document PQIA number and the required narrative in the ILSM.PQIA tracking spreadsheet.
If optional ILSM implementation is elected for PQIA answered NO, complete Section 2.
Section 1: Pre-Qualifying Interim Life Safety Measures Assessment (PQIA)
Indicate selections by highlighting selected blocks in yellow. More than one may be selected.
A Value, Life Safety Deficiency, Service, or Impairment Risk Score Deficiency, Failure, Draining or Disabling of: Other Risk Factors:
Any one fire alarm initiating device 1 Inaccessible damper 2 Any one supervisory Sprinkler device 1 Exit light out/to be installed or repaired 2 Multiple sprinkler devices (more than 1, less than a whole zone) 2 Battery operated egress light egress light repair/replace/install 2 Multiple initiating device (more than 1, less than a whole zone) 2 Cutting metal, Welding, brazing, soldering – requires hot work permit 4 A fire sprinkler system taken out of service for more than 10 hours in occupied building 4 HVAC system does not shut down upon fire alarm condition 3 A fire alarm system taken out of service for more than 8 hours in occupied building 4 Broken rolling or sliding door 3 A fire sprinkler system taken out of service for less than 10 hours in occupied building 3 Penetration in fire wall 4 A fire alarm system taken out of service for less than 8 hours in occupied building 3 Penetration in smoke wall 3 The off-site notification feature of a fire alarm zone or system out of service for 4 or more hours 4 Corridor door latching problems 2 The off-site notification feature of a fire alarm zone or system service for less than 4 hours 3 Compromised smoke or fire compartment 3
Water storage tank low water or temperature alarm failure 3 Blocked exit due to repairs needed or another physical hazard 4
A main drain from the sprinkler system 3 Removal of ceiling tiles for 4 or more hours in sprinkled space 4
A standpipe or sprinkler connection 3 Smoke or fire door or chute door missing rating 1 A dry pipe extinguishing system 3 Deck missing fireproofing 2 A wet pipe extinguishing system 3 Light lens cover missing from in egress path fixture 1 All or part of an Ansul (hood fire protection) system 3 Exit/stairs blocked or deficiencies 4 Fire or smoke dampers 3 Egress path blocked/rerouted 4 Any 1 visual or audible fire alarm notification device 1 Fire door deficiency 3 More than 1 visual and/or audible fire alarm notification device 3
B Occupancy Weight Score Operating Room 4 Ambulatory Patient Care Unit 2 Intensive Care Unit 4 Outpatient Surgery 2 Same Day Surgery (Recovery) 4 Sleep Lab Outpatient 2 Inpatient Care Unit 4 Behavioral Health Residential 1 Hospital Occupancy 4 Behavioral Health Outpatient 1 Community Living Center 4 Outpatient Clinic (CBOC) 1 Ambulatory Occupancy 3 Ancillary Support Business 1 Special Procedures 3 Business Occupancy 1 Emergency Room 3
MRI 3
Section 1: Pre-Qualifying Interim Life Safety Measures Assessment (PQIA) - Continued
Value A and Weight B Metric Scoring (Select from Charts)
+ 1
Value A Weight B Risk Score
Risk score 1-7 No further action required
Risk score 8 or higher X ILSM assessment required
April 30, 2025 MCP 00S.29
Section 2. Interim Life Safety Measure Assessment
Use the ILSM Assessment Matrix as a guideline to determine which ILSM(s) will be implemented.
1. Ensure Emergency Egress
2. Ensure Emergency Forces Access
3. Notify Emergency Forces (VAFD)
4. Notify Staff
5. Ensure Operational Life Safety Systems
6. Post Fire Watch *
7. Temporary Construction Barriers
8. Provide Additional Fire Fighting Equipment
9. Control Combustible Loading
10. Conduct Additional Fire Drill(s) *
11. Increase Surveillance *
12. Provide Temporary Fire Alarm and Detection System (Inspection and Testing Documentation) *
13. Conduct Additional Life Safety Training *
14. Other
*Additional Documentation Required
Description of action taken:
ILSM
Started:
Estimated Date of Completion:
Verification that ILSM hazard corrected/work complete.
Date:
Name: Title:
Section 2. Interim Life Safety Measure Assessment (Continued)
Significant Life Safety Code
Deficiencies Result from Construction or
Other Events.
1) E ns ur e Eg re ss
2) E ns ur e Em er ge nc y
3)
N ot ify E m er ge nc y Fo rc es
(V
AF
D)
4) N ot ify
S ta ff
5) E ns ur e O pe ra tio na l L ife
Sa fe ty
S ys te m s
6) F ire W at ch
7) T em po ra ry
C on st ru ct io n Ba rr ie rs
8) P ro vi de A dd iti on al ire
Fi gh tin g Eq ui pm en t
9)
C on tr ol
C om bu st ib le
Lo ad in g
Co nd uc t A dd iti on al
Dr ill (s
In cr ea se
S ur ve ill an ce
Pr ov id e Te m po ra ry
Al ar m a nd
D et ec tio n Sy st em
Co nd uc t A dd iti on al
L ife
Sa fe ty
T ra in in g
O th er
Construction/major renovation
X X X X X X X X X X X X
Lacking a code-complying smoke barrier
X X X X
Fire exit stairs discharge deficiency
X X X X X X X
Excessive travel distance to an approved exit
X X X X
Lack of two remote exits X X X X X X X X Non-conforming building construction type
X X X
Penetrations in fire barriers
X X
Hazardous areas not properly protected
X X X X X
Fire /Smoke Door Deficiency
X X X
Blocking off an approved exit/egress path
X X X X X X X X X X
Improperly protected vertical openings.
X X X
Fire alarm/detection system (out of service)
X X X X X X X X X X X
Sprinkler system (out of service)
X X X X X X X X X X X X
Panel showing common trouble
X X X
Off-site notification alarm failure X X X
Smoke partition deficiency X X X X
Hot work permit required X X X X Other Life Safety Deficiency not identified above
*This form is a guide for ILSM implementation, however, based on the project scope and/or life safety code deficiency, the ILSM to be implemented may be expanded or reduced from what this table indicates.
File details come from the government source that posted it. Updated .