Attachment 11 - 636-130 PCRA LAB_executed.pdf

Pre-Construction Risk Assessment (PCRA)

PCRA 7/15/2024 Page 1 of 8 Owner: Occupational Safety & Health

PCRA Introductory Information and Instructions

This template is a baseline for facility Pre-Construction Risk Assessments (PCRA) for Construction, Renovation, and Maintenance work (referred to as the “activity” in this document). This PCRA 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. In house activities may not have a COR, for purposes of this form, the COR may be a supervisor who is in-charge of the work being performed (e.g.

Carpenter Shop Supervisor).

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.

PERMIT: The last page of this document is a fillable permit form to be used for posting at the activity site.

Activity Number:

Activity Name:

Location of project/activity (Construction, Renovation/Maintenance):

Contractor or Shop Performing Activity:

Activity COR: Primary COR Phone #:

Secondary COR: Secondary COR Phone #:

Activity CSO: Primary CSO Phone #:

Start Date (Estimated): Completion Date (Estimated):

Description of Project / Activity:

Note:

1. This PCRA must be updated if the Project/Activity or Environmental conditions change from the original scope of work.

2. An E-alert is required to notify VA employees of potential hazards and controls prior to the start of each project phase.

3. The Risk Assessment must be performed prior to the project going out for bid per VHA Directive.

PCRA 7/15/2024 Page 2 of 8 Owner: Occupational Safety & Health

Elements to be reviewed: SMEs must indicate any specific items in the comment area that needs to be included into the permit.

Life Safety Yes No Will the fire alarm detection system be out of service for more than 4hrs?

(Interim Life Safety Measures must be implemented)

Will the fire sprinkler system be out of service for more than 8hrs?

Will any Fire/Smoke walls be breached?

Will egress pathways (exit doors, corridors) be closed or reduced?

Will emergency access by the fire department be obstructed?

Will any work being conducted result in open flames, (cutting torch or sparks)?

(Hot work must be issued)

Will sprinkler systems be compromised?

Note: Partitions must separate all occupied areas from demolition, renovation, or construction activities when sprinkler systems are compromised. Partitions shall be from the floor slab to the roof deck above and shall be fire rated in accordance with NFPA 241.

Emergency Management Yes No Will normal business operations or patient care be interrupted?

Will there be any anticipated utility shutdowns?

Comments:

Emergency Mgr/Life Safety (AHJ) Signature:

GEMS Yes No

Was an Environmental Evaluation (NEPA form) completed?

Were Environmental Specs included? (01 57 19, 01 74 19, 01 81 13)

Environmental Protection Specialist

PCRA 7/15/2024 Page 3 of 8 Owner: Occupational Safety & Health

Industrial Hygiene Yes No Does the project involve hazardous chemicals or chemicals with strong odors?

Will asbestos or lead paint be disturbed? (Specific specs must be included)

Were asbestos/lead abatement specs added?

Will a third party be conducting air sampling?

Industrial Hygiene

Safety Yes No Is VA Master Safety Specification 01 35 26 added to ensure a “Accident Prevention Plan” is provided by the contractor?

Requirement included to ensure all workers on the construction site have a minimum of OSHA 10-hour safety training?

Requirement included to ensure all required Competent Persons complete OSHA 30-hour safety training (within the past 5 years)?

Will scaffolding be used on the project?

Will work be performed on surfaces 4 feet or greater above the ground or a lower level?

If yes, a fall protection method(s) is required.

Will excavation/trenching be conducted with this project?

Will confined spaces be accessed or created during this project?

Will a crane be used with this project? If yes, lift permit must be completed ahead of time.

Safety

PCRA 7/15/2024 Page 4 of 8 Owner: Occupational Safety & Health

Patient Safety Yes No Does this project involve a patient care area?

Will there be noise or vibrations generated that will impact a department adjacent to, above, or below the construction area? (If so, these departments must be notified)

Will the project affect any Critical clinical alarms? (medical gas, wander guard system, nurse call systems, medication delivery systems, patient monitoring systems)

Patient Safety

Police Yes No Will the construction compromise security?

Will there be any work performed after normal business hours?

Does contractor have correct Security?

Note: The construction area must be secured at all times to prevent unauthorized entry into the construction area.

Police

Infection Prevention and Control Yes No Is an ICRA required in addition to this Activity?

Consult Infection Prevention and Control regarding the ICRA and the need for control measures. If yes, see ICRA.

PCRA 7/15/2024 Page 5 of 8 Owner: Occupational Safety & Health

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 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 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.

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 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 & vibration due to power tool use.

• Selective demo/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

All control measures in the row above and the following:

1. Hazard communication chemical inventory and SDSs 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.

PCRA 7/15/2024 Page 6 of 8 Owner: Occupational Safety & Health 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 equipment / 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 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

Large-scale construction, renovation, or maintenance generally defined as follows:

• Work exceeding 6 months in duration.

• Patients / employees not allowed in until activity is completed

• 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

• Installation of 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.

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

2. Dust control plan

3. Pollution prevention plan

4. Dig safe paper work

5. Crane lift plan:

- Crane placement, swing & load evaluation

6. Fall protection plan

7. Confined entry plan

PCRA 7/15/2024 Page 7 of 8 Owner: Occupational Safety & Health

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.

• 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).

Affected Adjacent Areas 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.

Pre-Construction Risk Assessment (PCRA) Permit

PCRA – April 2024 Owner: VA Occupational Safety & Health Department

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 VA Activity manager: Activity start date VA Contact phone number: Completion date Contractor or VA Shop Lead Permit expiration date

Activity Type:

Activity Type Control measures to be in place for the duration of the activity (Control Measures include all those in and above the checked “Activity Type”)

Inspection/ Upkeep

1. Site specific safety plan, activity hazard analysis (AHA), and hazard communication (w/ SDSs) required and provided by the contractor or shop lead and approved by VA OSH department.

2. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

3. Must address identified hazards and controls that will be implemented to ensure minimal impact patients, employees, contractors and facility.

4. Communication and coordination plan for all affected areas

5. Secure site at all times to prevent unauthorized entry into the construction/activity area by unauthorized personnel

6. Site Inspection at the completion of work (pre-occupancy inspection)

Small-scale

All control measures in the row above and the following:

1. Construction area site visits documented w/ standard checklist; required weekly by member of multi-disciplinary team

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 the procedures

5. Partitions are in place when the sprinkler system is compromised, per NFPA 241

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. No live electrical work; exception must be in writing per VHA Directive 1028; exception provided/approved

8. Confined space entry plan - in place and staff trained

Signatures below indicate that all required info from above SMEs in the PCRA have been included into this permit.

*Location of all applicable AHAs, plans (safety, dust, pollution, etc.) and SDSs; shall be identified on the permit & made available to all workers.

Additional requirements:

Infection Control Risk Assessment (ICRA) required for the Activity? Yes No Project COR/Shop Lead Signature Occupational Safety & Health rep Signature Chair, Construction Safety Committee Signature