B01 Section J Attachment 5.11 Pre-Construction Risk Assessment.docx
DOCX document 32 KB Posted
- Attached to
- IHS Nationwide Multiple Award Task Order Contract Federal contract opportunity
- Solicitation number
- 75H70125R00033
About this file
The document is a Pre-Construction Risk Assessment form designed for comprehensive project risk evaluation across multiple critical operational domains. The assessment covers six primary risk sections: Fire Safety, Utilities, Confined Space, Environmental/Occupational, Security, and Infection Control, with detailed checklists for identifying potential project impacts. The form requires classification of the project (Class I, II, III, or IV) and mandates signatures from the Project Manager, Facility Manager, Safety Officer, IP, and Supervisor, with specific sign-off requirements depending on the project complexity and risk level. The form is version-dated September 18th, 2019 and is intended to systematically assess and mitigate potential risks before commencing construction or renovation activities.
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Text version
Pre-Construction Risk Assessment – Cover Page Project Title:
PRSU Coordinator:
PCRA Submit Date:
| Project Conducted by: |
| ☐ Fac. Mgmt. ☐ I.T. ☐ Telecom ☐ Clin. Eng. |
☐ Contractor:
Proposed Start Date:
Staff/Cont. Name:
Est. Duration:
Supervisor Name:
Est. Complete Date:
Telephone:
Date Project Completed:
Email:
Project Description: (include specific sites and tasks)
| ICRA Classification | |
| Class I | |
| ☐ | Class II |
| ☐ | Class III* |
| ☐ | Class IV* |
| ☐ |
Section 1. Initial Project Impact Review
| Topic |
| Will the project negatively impact or involve…? |
| No |
| Yes |
| Responses (If YES to any) |
Fire Safety Section 2A(1)
| Ceiling tile removal (less than 4 hours total) | ||
| ☐ | ☐ | Complete Above the Ceiling Access Permit (ACAP) |
| Existing fire-stop; minor barrier penetrations | |
| ☐ | ☐ |
Fire Safety Section 2A(2)
| Fire detection/alarm/suppression systems | ||
| ☐ | ☐ | Complete Interim Life Safety Measure (ILSM) evaluation. |
| Exit paths or fire/smoke barriers | |
| ☐ | ☐ |
| Hot work practices | |
| ☐ | ☐ |
| Extra fire load or flammable materials | |
| ☐ | ☐ |
Utilities Section 2B (1)
| Water, sewer, electricity, steam, or HVAC (including outside air intakes) | ||
| ☐ | ☐ | Complete the Utility System Risk Assessment (USRA) |
| Medical gases or vacuum | |
| ☐ | ☐ |
| Call systems, telephones, or IT systems | |
| ☐ | ☐ |
| Confined Space Section 2B (2) | ||
| The area designated as a confined space | ||
| ☐ | ☐ | Confined Space Risk Assessment |
Environmental/ Occupational Section 2C
| Lead or asbestos-containing materials | ||
| ☐ | ☐ | Complete Env./Occ. Risk Assessment (EORA) |
| Chemical hazards (i.e. mercury, volatile organics) | |
| ☐ | ☐ |
| Exposure to infectious agents or mold | |
| ☐ | ☐ |
| Crushing or falling hazard | |
| ☐ | ☐ |
Security Section 2D
| Security systems (badge readers, cameras) | ||
| ☐ | ☐ | Complete Security Risk Assessment (SRA) |
| Security processes (tours, foot/vehicle traffic) | |
| ☐ | ☐ |
Infection Control Section 2E
| Patient care areas or critical utilities | ||
| ☐ | ☐ | Complete an Infection Control Risk Assessment (ICRA) |
| Moderate to high levels of dust, noise, vibration | |
| ☐ | ☐ |
| More than one work shift | |
| ☐ | ☐ |
Project Approval
| Version: September 18th, 2019 | |
| Project Manager Signature |
Date:
Required for: All
Facility Manager Signature
Date:
Required for: All
Safety Officer Signature
Date:
Required for: All
IP Signature
Date:
Required for: USRA and ICRA
Supervisor (affected area)
Date:
Required for: All
Project Close-out Facility Manager Signature
Date:
Required for: All
Safety Officer Signature
Date:
Required for: All
IP Signature
Date:
Required for: ICRA-Class III & IV
Supervisor (affected area)
Date:
Required for: All
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