Attachment J.07 FAA Form 3900-20_Pre-Construction and Maintenance Checklist.pdf

Pre-Maintenance Environmental and Occupational Safety and Health Checklist

Section A. Purpose

This checklist is intended to be used to review maintenance projects prior to their commencement. The purpose of this checklist is to assess indoor air quality risks associated with planned maintenance activities. This checklist may not necessarily apply to all maintenance activities, but should be used to manage activities with the highest risk. The District Office Manager and/or their designee should rely on technical guidance provided by the Safety and Environmental Compliance Manager (SECM) to assess the risks associated with maintenance projects in their NAS facilities and based on their risk assessment, determine the need to apply the Pre- Maintenance Checklist.

This checklist relies on the training and professional judgment of the user. EOSH personnel, such as the SECM or designated EOSH professional should be consulted as needed for additional guidance and assistance. A facility point-of-contact (POC) with an understanding of facility procedures and equipment considerations should participate in site evaluation.

Section B. Maintenance Project Summary

The purpose of this section is to provide a brief description of the specific maintenance tasks and identify key personnel responsible for project completion. Fill in the requested site-specific information. Indicate if this work will occur in or adjacent to an occupied space.

FAA Form 3900-20 (03/15) Electronic Version (PDF) Pag

Project Name and Description:

Project Location: Facility:

Planned Start Date: Expected Completion Date:

Project/Design Representative Name: Phone:

EOSH Contact Name: Phone:

Facility Representative: Phone:

Section C. Potential Airborne Contaminants

Think about the project and its potential hazards. Consider sensitive NAS operations and all facility personnel that may be impacted by the projects. For each potential project hazard, indicate (with a checkmark) a potential for exposure/release/incident.

Potential Airborne Contaminant Project Hazards

Asbestos (e.g., tiles, insulation) A

O

U

C

O irborne dust (not lead or asbestos) Lead based paint

Wall coverings (paneling, wall paper) Paints/varnishes ther chemicals Combustion products (CO, hydrocarbons) se of sealants/caulks/glues/mastics Solvents

Molds/mildew/fungus Animal feces (rodents, birds) onstruction/demolition Grinding/sanding

Welding/cutting outdoors

Installation of carpet/vinyl flooring

New furniture/cubicles/cabinets

Cleaners/detergents

Pesticides

Roofing products

Welding/cutting indoors Other:

Other: ther: Other:

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SIR 693KA8-20-R-00008

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Section D. Site Ventilation

After reviewing the potential airborne contaminants in Section C, ensure that measures and controls to address applicable site airborne contaminants and ventilation issues are addressed. In your judgment, have appropriate measures been addressed to minimize the potential airborne contaminants? If yes, select the appropriate response below. If a potential airborne contaminant has been identified in Section C and no associated measures or controls are evident, then select “No” below. If a “No” is indicated use the closeout date box to indicate when appropriate measures or controls have been addressed.

Program Elements Yes/No/

N/A

* If No, Indicate Closeout Date

Notes

Chemical Substances (all projects)

1. Safety data sheet(s) (SDS) are available on-site for all substances.

2. SDS have been reviewed.

3. Substitute products have been evaluated.

4. Building occupants have been notified of potential odors/hazards.

5. Will odors have dissipated prior to shift change?

(a) If no was answered to the above question [5], has following shift been notified?

6. Substance is without strong odors/vapors that may migrate into or near occupied areas. If yes, skip to question 7.

(a) If no was answered to above question [6], can work be done when building is unoccupied? If yes, skip to question 7.

(a)(i) If no was answered to above question [(6)(a)], can area be pressurized? If yes, the section on supplemental ventilation must be completed.

(a)(ii) If no was answered to above question [(6)(a)(i)], is the existing air handling unit (AHU) adequate for ventilation as configured? If no, section on supplemental ventilation must be completed.

7. AHU intake vents have been sealed in accordance with appropriate procedures.

8. All other means by which vapors may enter the facility (e.g., open windows, window air conditioning (AC) units) have been eliminated.

For Indoor Projects (painting, remodeling)

9. Existing AHU is adequate for ventilation. If no, supplemental ventilation section must be completed.

10. Means of egress from occupied areas will remain clear and unaffected during the project.

Supplemental Ventilation

11. Existing AHU is adequate for ventilation needs associated with this project as configured. If yes, skip to question 18.

12. System can be reconfigured to meet ventilation requirements.

(a) If yes was answered to question 12, are personnel trained to reconfigure system available?

13. Does facility have adequate power supply and outlets for supplemental ventilation units?

14. Exhaust from units is prevented from being reintroduced to facility.

15. Is adequate return air available for ventilation units?

Program Elements Yes/No/

N/A

* If No, Indicate Closeout Date

Notes

Air Monitoring

16. The project may proceed without air monitoring.

(a) If no was answered to above question (16), has an air sampling plan been completed and air monitoring company been contracted?

17. Have arrangements been made for air monitoring in case of accidental substance release?

18. Has the Facility Asbestos Coordinator been notified as applicable?

Other

FAA Form 3900-20 (03/15) Electronic Version (PDF) Page 3 of 3

Section E. Review Information

The appropriate FAA EOSH professional and the Facility Manager, as applicable, will sign below to document discussion of the items on this form.

Reviewed By

EOSH Contact

Facility Manager

Facility POC

Other

Name Signature Date

Notes (e.g., provide further explanation of potential hazards, locations, etc. below and attach additional sheets if necessary)