ATT 5 - 675-103 - PCRA.pdf

675-103 SAFETY REQUIREMENTS

Create Cardiovascular Center at Lake Nona 05-01-24 VAMC Orlando, FL

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1.28 PRE-CONSTRUCTION RISK ASSESSMENT (PCRA) PERMIT

Pre-construction Risk Assessment PCRA Orlando VA Medical Center (OVAMC)

Project Title: Project Number:

Competent Person (CP): Date:

In-House or contracted Out:

CP Qualifications:

Scope of Project:

DE-ESCALATION CHECKLIST – (IF APPLICABLE)

FINAL INSPECTION (END OF PROJECT):

Infection Control has inspected and approved barrier removal:

Date: ________________ IC staff initials _________________

Please check all applicable boxes.

___ 1. Dust-producing construction activities are complete.

___ 2. Construction debris/ waste has been removed.

___ 3. Area has been cleaned of all dust AND inspected by Infection Control or Safety.

___ 4. Infection Control or Safety staff approval for removal of negative air or other de-escalation: Date: _________________ Initials: ______________ ___ 5. New PCRA classification

Cardiovascular Center Lake Nona 675-103 10/16/2024

Contract-Out

VHA Pre-Construction Risk Assessment (PCRA)

VHA-PCRA-2023-1.0 Page 1 of 5

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

Cardiovascular Center Lake Nona. Frist Floor

Project 675-103

Large Scale

VHA-PCRA-2023-1.0 Page 2 of 5 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-2023-1.0 Page 3 of 5

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-2023-1.0 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

Cardiovascular Center Lak

VHA-PCRA-2023-1.0

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:

Project Manager signature Date

Safety Officer signature Date

Chair, Construction Safety Committee signature

Date

Date

Large Scale

Project 675-103 Cardiovascular Center

Kevin Glover 1/1/25 407-840-1725 1/1/27

ADDITIONAL CONSTRUCTION SAFETY QUESTIONS

Will project place contracted workers at risk for transmission of Mycobacterium tuberculosis? _______ If yes, refer to MCP 00Q-09 for guidance.

Has the Job Site been evaluated for ACM (asbestos) or other environmental hazards? _____ If yes provide comments.

Will Project create potential air quality issues other than identified in ICRA? _____ Is any work or equipment near air intakes?

______ Are Volatile Organic Compounds VOC being used? ______ If yes, please explain and note plans to minimize:

Will project create potential noise issues? ___ If yes, please explain and note plans to minimize:

Will project create potential vibration issues? ___ If yes, please explain and note plans to minimize:

Is contractor required to provide 14 days-notice for utility shutdowns? ____ Will contractor/COR follow Utility Shutdown SOP when utilities are shut down? ____ Will contractor be given emergency notification telephone numbers for unplanned utility failures? ____

Will project create a potential for leaks? ___ If yes, please include in contract for contractor to dike any floor penetration in construction area.

Any additional potential issues that affect EOC( Environment of Care).

Will contractors be instructed to wear badges at all times while on site? ___ Will badges identify name, employer name, project name and location and expiration date? ___ Will police be notified if project takes place on off-hours? ____

Will contract require general and sub-contractor’s construction workers all complete the OSHA 10-hour construction worker course or the 30-hour construction course with OSHA certified training? ______

Has/will the construction safety committee reviewed drawings and specs and signed off on each design submission? ______

Will Contracting Officer be requested to evaluate and consider past safety records of prospective contractors in the awarding of contracts? _______

Will contractor submittals include the names, qualifications and training dates for contractor CP designated to administer the site specific safety program, as well as the CP for other activities as required by OSHA regulation (such as scaffolds, cranes, excavation, etc.) ____ Will COR provide copy of the site specific safety program to the Construction Safety Committee? ___

Is any portion of the project related to a special field that the CP does not have the required background for (for example, scaffolding, cranes, or excavation)? _______ Will another VA Employee be CP for those special fields? ______

No

YES

No asbestos present

NO

The contractor cutting floor and Jack hammer

Yes Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes Yes

Yes

NO

The contractor will working in the Interstitial.

OVAMC ILSM Requirement Assessment Worksheet

These criteria will be used to evaluate smoke compartments in which a Life Safety Code deficiency has been identified, or in which construction, renovation or alteration activities are planned. Any “Yes” answers below may require ILSM to address occupant safety.

Document any methods you plan on using, and what measures were taken under comments.

Submitter: ________________ Date Submitted: _____________

Project: _________________ Building: ________________ Floor: ______________ Expected Duration: __________

Criteria YES NO

The issue/work alters or significantly compromises exit access, exiting, or exit discharge building elements

The issue/work compromises building compartmentation including fire or smoke walls, floor/ceiling assemblies, corridor walls, use area doors, or other defend in place elements The issue/work impairs the building Fire Protection Systems (alarm, sprinklers, suppression) for more than 4 hours in a 24-hour period.

The activity includes Hot Work

The activity includes large quantities of combustible materials, flammable materials, or generation of large amounts of dust and debris.

Access to the area by emergency forces will be impaired

Will non/limited combustible partitions be required?

[ ] ILSM is required* [ ] ILSM are not required*

* A yes answer to any of the above criteria may require that an ILSM be initiated. Use the following check sheet to denote the interim life safety measures appropriate for the issue/work which compromises life safety. Periodic inspections of other aspects of an ILSM shall be completed during the pendency of the ILSM. All forms will be maintained by the COR with copies in the project file.

If an ILSM is not required, provide the completed assessment only to the safety manager for review.

Maintain a copy in the project file.

Work:

Comments:

Reviewed by:___________________________________________ Safety Manager Date:___________

Approved by:___________________________________________ Chief Facilities Management Date:________

Interim Life Safety Measures Check Sheet to be implemented

Project Name: _________________________ Log Number: _________________________

Place a check mark in each applicable ILSM activity as determined by an assessment of the risks identified in the Assessment Work Sheet.

#1 INSPECTIONS / SURVEILLANCE

Increased surveillance of buildings, grounds, and equipment: shift / daily / other:

Means of exiting construction areas inspected daily Implementation of Fire Watch Not applicable

#2 ACCESSIBILITY

Maintenance of escape/egress routes from construction areas Maintenance of access to emergency services for emergency equipment, fire alarm pull stations, Fire

Department connections (internal & external) Alternate EXIT signs posted YES NO NA Not applicable

#3 EQUIPMENT – LIFE SAFETY

Temporary fire alarm, detection, suppression system in place Monthly testing and inspection of temporary systems Provide additional firefighting equipment in project area Provide additional firefighting equipment in adjacent areas Not applicable

#4 COMMUNICATIONS

Notification to Municipal Fire Department (or applicable emergency forces group) Not applicable

#5 CONSTRUCTION MATERIALS / PRACTICES

Partitions smoke tight and constructed of noncombustible or limited combustible materials Prohibition of smoking throughout building and in and near construction areas Implement appropriate storage practices Implement appropriate housekeeping practices Implement appropriate debris removal practices Not applicable

2 fire drills per shift per quarter throughout Hospital (one additional drill beyond requirement of

EC.5.30).

2 fire drills per shift per quarter in areas adjacent to project (one additional drill beyond requirement of EC.5.30)

More than 2 fire drills per shift per quarter throughout Hospital. If yes, how many_________ More than 2 fire drills per shift per quarter in areas adjacent to project. If yes, how many_______ Not applicable

# 6 FIRE DRILLS

Additional training for staff in immediate area Additional training for staff throughout hospital Additional training for incident response team Training to promote awareness of fire-safety building deficiencies, construction hazards, ILSM Training on changes in physical environment (egress routes) Training on firefighting equipment Training on compensating for impaired structural or compartmentalization features of fire safety Not applicable

Other measures:____________________________________________

Comments: _________________________________________________

Prepared by: ______________________

Reviewed by:___________________________________________ Safety Manager Date:___________

Approved by:___________________________________________ Chief, Facilities Management Date:________

#7 TRAINING

I have read and understand the requirements of this Pre-Construction Risk Assessment and will comply with its requirements.

SIGNATURES:

Project COR

Infection Control

Chief of Police & Law Enforcement

GEMS Coordinator

Chief Engineer

Date:

Union Safety Officer

Safety Manager

Chair – Construction Safety Committee

Contractor

Other as Applicable

Date:

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