Att 2 PCRA - Pre-Construction Risk Assessment.pdf

VHA Pre-Construction Risk Assessment (PCRA)

VHA PCRA-1.1 (May 21, 2024) Page 1 of 13

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

Small Scale

Buildings 113, 200, and 228

Installation of Data Drops and Power Outlets (DDPO) for EHRM.

VHA PCRA-1.1 (May 21, 2024) Page 2 of 13 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 ☐

VHA PCRA-1.1 (May 21, 2024) Page 3 of 13

• 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-1.1 (May 21, 2024) Page 4 of 13

• 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**

A125 in Building 113 Margaret

Elgersma margaret.elgersmasoule@va.gov Yes

Area Above

Blind Rehabilitation Margaret

Area Below

N/A

Adjacent Area margaret.elgersmasoule@va.gov Yes margaret.elgersmasoule@va.gov Yes margaret.elgersmasoule@va.gov Yes

VHA PCRA-1.1 (May 21, 2024) Page 5 of 13

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

A002, ASU 1, ASU 2,

and ASU 3 in Building

Fred Luchette 708-202-8387 x24858 frederick.luchette@va.gov

Yes

Emergency Department Paul Nemeth 708 202-8387 x24176 paul.nemeth@va.gov

Adjacent Area 1

Ambulatory Surgery Fred Luchette 708-202-8387 x24858 frederick.luchette@va.gov

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact (POC)

POC Contact Information Construction plan communicated

B023, B027 (GU 1),

B028 GU 3), and B029 (GU 2) in Building 200

Marisol Vazquez Edmonds

708-202-5595 marisol.vazquezedmonds@va.gov

Cardiology Susan Howe 708-202-8387 x20716 susan.howe@va.gov

GU/Urology Clinic Marisol Vazquez Edmonds

708-202-5595

708-202-5595

708-202-5595

708-202-5595

VHA PCRA-1.1 (May 21, 2024) Page 6 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

D008 in Building 200 James Welsh 708-202-8387 x24197 james.welsh@va.gov

Lab Saeedeh Masoom 708-202-8387 x21293 saeedeh.masoom@va.gov

Radiation Oncology James Welsh 708-202-8387 x24197

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

1324 and 1349 in Building 200

Marlon Jose 708-202-8387 x27458 marlon.jose@va.gov

Pulmonary/Respiratory Care and Admin Offices

Raenita Mears raenita.mears@va.gov Yes

Dental John Haxton 708-202-8387 x21057 john.haxton@va.gov

GI Lab/Procedure Marlon Jose 708-202-8387 x27458 marlon.jose@va.gov

VHA PCRA-1.1 (May 21, 2024) Page 7 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

1162 in Building 200 Rani Kappen 708 400-6680 rani.kappen@va.gov

Women’s Health Brenda Fritz brenda.fritz@va.gov Yes

Observation Susan Howe 708-202-8387 x20716

CLC Transitional Care Unit

Rani Kappen 708 400-6680 rani.kappen@va.gov

Rani Kappen 708 400-6680 rani.kappen@va.gov

Rani Kappen 708 400-6680 rani.kappen@va.gov

Rani Kappen 708 400-6680 rani.kappen@va.gov

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

656 in Building 200 Graham Lawless (708) 202-8387 ext. 21472 graham.lawless@va.gov

Toilets N/A N/A N/A

ACS Specialty Care Krista Allen Sanders 708-202-8387 x21715 krista.allen-sanders1@va.gov

Dialysis Graham Lawless (708) 202-8387 ext. 21472

VHA PCRA-1.1 (May 21, 2024) Page 8 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

4064, 4068, 4069 in

Francisco Olmeda francisco.olmeda@va.gov Yes

ACS Specialty Care Krista Allen Sanders 708-202-8387 x21715 krista.allen-sanders1@va.gov

Primary Care Patrena McGee 708-202-8387x20891 patrena.mcgee@va.gov

4th Floor Outpatient Clinics

Exterior Wall N/A N/A N/A

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

2116 (OR 7) in Building

Fred Luchette 708-202-8387 x24858 frederick.luchette@va.gov

N/A - Roof

Radiology Arra Reddy 708-202-8387 x22882 arra.reddy@va.gov

Surgery Fred Luchette 708-202-8387 x24858

VHA PCRA-1.1 (May 21, 2024) Page 9 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

A104, D108, D100C in

Saeedeh Masoom 708-202-8387 x21293 saeedeh.masoom@va.gov

Lab

Saeedeh Masoom 708-202-8387 x21293

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

A142-7 in Building 200 Paul Nemeth 708 202-8387 x24176

MICU Susan Howe 708-202-8387 x20716

Emergency Department

Paul Nemeth 708 202-8387 x24176

VHA PCRA-1.1 (May 21, 2024) Page 10 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

B109 in Building 200 Elizabeth Stone 708-202-8387 x25620 elizabeth.stone1@va.gov

Nutrition Carol George 708-932-7995 carol.george@va.gov

Inpatient Pharmacy

Elizabeth Stone 708-202-8387 x25620

Inpatient Pharmacy Elizabeth Stone 708-202-8387 x25620

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact (POC)

POC Contact Information Construction plan communicated

B121A in Building 200 Susan Howe 708-202-8387 x20716

SICU Theresa Christenson

708-202-8387 x21747 theresa.christenson@va.gov

GU/Urology Clinic Marisol Vazquez Edmonds

708-202-5595

Cardiac Cath Lab

Susan Howe 708-202-8387 x20716

Yes

Yes

Yes

VHA PCRA-1.1 (May 21, 2024) Page 11 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

C105 (CT) in Building

Arra Reddy 708-202-8387 x22882 arra.reddy@va.gov

Engineering Joseph Tumpis 708-202-8387 x21131 joseph.tumpis@va.gov

Imaging

Arra Reddy 708-202-8387 x22882

Imaging Arra Reddy 708-202-8387 x22882

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

B1001 in Building 228 Marilyn Pacheco 708-202-8387 x24981 marilyn.pacheco@va.gov

Mental Health

Alvi Nadia 708-202-8387 x24659 nadia.alvi@va.gov

Physical Medicine and Rehabilitation

Marilyn Pacheco 708-202-8387 x24981

VHA PCRA-1.1 (May 21, 2024) Page 12 of 13

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc)*

Point of Contact

(POC)

POC Contact Information

Construction plan communicated

2030, Corridor outside 2036D, and 2046 in Building 228

Alvi Nadia 708-202-8387 x24659 nadia.alvi@va.gov

* 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 patient infection risks associated with the activity and the need for control measures. For example, activities such as a boiler plant project and/or facility steam shutdown, if properly planned, should have minimal to no patient infection risk impacts and likely do not require an ICRA. See VHA Directive 7715 and the VHA ICRA Template for more information.

Is an ICRA required for the Activity? Yes ☒ No ☐

VHA PCRA-1.1 (May 21, 2024)

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

EHRM requires each VHA site to provide additional Data Drops and Power Outlets (DDPO) for specific equipment and devices. This project will provide for the installation of needed data drops and power outlets to support this effort in Buildings 113, 200, and 228.

Project manager Javier Martinez Project start date 6/1/26 Contact phone number 708-979-6096 Completion date 10/1/26 Contractor or lead shop Permit expiration date 10/2/26

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

VHAHINMartiJ7 Text Box 4.10.2026

VHAHINStarrV Text Box 4/13/26

VHAHINStarrV Text Box