Attachment 13 _Tuscaloosa PCRA.pdf

Tuscaloosa VA Medical Center Construction Risk Assessment

Tuscaloosa VA Medical Center Construction/Renovation Risk Assessment Package

Instructions: Project Managers or VA Supervisors will collaborate with Infection Control, Safety Office, and VA Police to complete the risk assessment package as part of managing the safe design and construction/renovation of the medical center environment. COTRs shall collaborate with Infection Control, the Safety Office, and the VA Police as necessary in the completion of these assessments. COTRs, Infection Control Coordinator, Safety Office staff, and VA Police will ensure all identified actions and control measures are implemented in their respective area of responsibility as long as the potential hazard exists.

The initial assessment should be completed in the design phase. Reassess as conditions change and prior to the beginning of each project phase. The assessments are conducted by the responsible program official using the attached risk assessment forms, and should be completed as follows:

1. NEPA Assessment:

a. Using NEPA Interim Guidance for Projects PG 18-17 determine the level of Environmental Impact of the project.

2. Vertical Environmental Impact Assessment:

a. Show the construction area and the functions/services located in adjacent areas, including floors above and below.

3. Horizontal Environmental Impact Assessment:

a. Using a current drawing of the area, show the construction area and surrounding patient/staff areas as indicated on the example provided.

4. Interim Life Safety Measures:

a. Evaluate each listed “Requirement or Deficiency” as related to the project’s impact on Life Safety components of the facility.

b. Provide a summary of required actions on the sheet provided.

5. Hazard Assessment and Exposure Controls:

a. Evaluate the potential for hazards during construction that may impact patients and staff. Indicate the required control measure for each hazard.

b. Provide a summary of the required control measures on the sheet provided.

6. Ceiling Mounted Patient Lift

a. During 50% and 100% Design Reviews, the COTR will verify that the patient lift design is in compliance with the requirements of VHA Directive 2005-019 Seismic Safety of VHA Buildings and VA Master Design Specification 3.05.041 Seismic Restraint Requirements for Non-Structural Components. The COTR will also ensure the requirements on the “Design Checklist for Ceiling Mounted Patient Lifts” are met.

b. Complete the “After Installation Checklist for Ceiling Mounted Patient Lifts”prior to permitting the equipment to be used for patient movement.

7. Infection Control Risk Assessment:

a. Determine and record the Location Group(s) that will be affected.

b. Determine and record the type of construction and magnitude of disruption.

c. Review the Infection Control Matrix using the Location and Type of Construction Groups (determined in steps a. and b.) and record the Class of Precautions associated with the project.

d. Complete the Infection Control Measures List and assign responsibility for each measure.

8. Approvals:

a. Upon completion of the risk assessment obtain approval signatures as applicable on the attached sheet. Ensure all signatures are complete prior to submitting to the Safety representative.

9. Contract Documents:

a. Include applicable risk assessment action items in the contract documents.

b. Provide the contractor’s superintendant with copies of the completed risk assessment and action plans.

c. File all risk assessment documents in the project file.

10. Daily Inspections:

a. Ensure the contractor conducts and documents daily construction site inspections.

11. Construction Site Inspection:

a. Each discipline (Infection Control, Safety Office, VA Police) shall inspect the construction site as applicable. All inspections will be documented.

12. Post Project Review:

a. Upon completion of the project conduct a review of risk assessment process.

b. Present the results to the Construction Safety Committee.

CONSTRUCTION RISK ASSESSMENTS AND HAZARD CONTROL APPROVALS

Project Title: Project Number:

Estimated Start Date: Estimated Duration:

Obtain the following approvals, in the order listed, as applicable:

1. VA Supervisor responsible for area under construction (Service Chief) Date

2. Infection Control Coordinator Date

3. VA Police Representative Date

4. Project Manager/COTR/Shop Supervisor Date

5. Assistant Chief, Engineering Service Date

6. Chief, Engineering Service Date

7. Safety and Emergency Management Service Representative Date

Other Date

Other Date

Tuscaloosa VA Medical Center Construction/Renovation Risk Assessment Package

Project Title: Project Number:

Location:

Date: Project Phase: Design Construction Final Pre-Con Other

Construction Start Date: Estimated Duration: Completion Date:

Scope of Work:

Note: The risk assessment process should begin in the design phase. Identified risk controls shall be incorporated into the technical plans and specifications as applicable. The risk assessment should be reviewed during all major phases of the project and risk controls updated as necessary.

Prior to commencing work, the general contractor shall provide proof that an OSHA certified competent person (CP) [29 CFR 1926.32(f)] will maintain a presence at the worksite. An OSHA 30-hour training completion card is considered certification. Any other certification provided will be evaluated by the Project Manager and the Construction Safety Subcommittee in accordance with VA Directive 2011-036 to determine relevancy.

COR Signature:___________________________________________________________________________________

NEPA Risk Assessment to be completed utilizing NEPA Interim Guidance for Projects PG 18-17 http://www.cfm.va.gov/til/etc/NEPAGuidance.pdf

Project Title: Project Number:

Location:

Date: Type of Project: Operation and Maintenance Repairs/Renovation New Construction Lease Other

Construction Start Date: Estimated Duration: Completion Date:

Project Description:

Level of NEPA Analysis:

Categorical Exclusion

Environmental Assessment (EA) Needed

Environmental Impact Statement (EIS) Needed

Other Environmental Permits/Analysis Needed:

Project Impacts Would the proposed activity involve or generate any of the following?

Source Yes No Source Yes No Source Yes No Air Emissions including GHGs

Liquid Effluent RCRA or CERCLA Sites

Asbestos Petroleum Storage Wetlands Excess Noise Solid Waste Permit Modification Utility Modification Hazardous Waste Chemical Use/Storage Soil Disturbance Biological Resources Water/Well use Water Treatment Radioactive Waste Other:

Water Flow Modification

Mixed Waste

Determination I find the proposed project qualifies as a CATEGORICAL EXCLUSION with no extraordinary circumstances. Specify which CATEX:

I find that the proposed project MAY have a significant effect on the environment; therefore, an ENVIRONMENTAL ASSESSMENT (EA) will be prepared.

ENVIRONMENTAL IMPACT STATEMENT (EIS)

Project Manager:

GEMS Coordinator:

Building

Phase I

Tuscaloosa VA Medical Center Construction Risk Assessment g: _______

I: _______

Ve

___ Floor: _

___ Phase I ertical Envi

II: ______

ironmental

___ N/A: _

____ Phase l Impact B

III: _____

uilding Ass

______ Pha sessment se IV: ________

LEVEL 01 - ICRA PATIENT RISK

CATEGORIES

VA FORM 08-6231

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NORTH ARROW

5/27/2016 11:02:25 AM

SCALE: 1/16" = 1'-0"

Enter address here

COLUMBIA 03/16/2017 152

Canteen Pathology Lab

Chapel & Travel

Audiology Welcome Center

C&P

Lobby

Pharmacy

Urgent Care

Offices

Emergency Dental

Radiology

Mechanical

Mechanical

Retail

Retail Storage

Offices

Waiting Waiting Waiting

Waiting

= NEW SPEAKER/STROBE

= NEW STROBE DEVICE

= NEW SMOKE DETECTOR

= EXISTING FIRE ALARM PANEL

= NEW DUCT DETECTOR

= NEW CEILING-MOUNTED

SPEAKER/STROBE

= RISK GROUP 1

= RISK GROUP 2

= RISK GROUP 3

LEGEND & NOTES

= RISK GROUP 4

NOTE: This layout is to be used as guidance for determining the Infection Control Risk Assessment Risk Group Category for construction activities within the patient care buildings. Changes in space usage can and will alter the patient risk group from what is outlined here. The Project Coordinator is responsible for determining and verifying the actual patient risk group in vicinity of the construction project during the Risk Assessment development, in concurrence with Infection Control.

S V

Work Area vhatuaflynnz Text Box

SAMPLE HORIZONTAL IMPACT DRAWING

Completed form will be filed in the project file.

CONTRACTOR CONSTRUCTION/RENOVATION AREA ILSM INSPECTION

Week Of:

Project Title/Number: ____Location: ____________

1. Means of egress is clear in construction area:

MON TUE WED THU FRI SAT SUN

2. Accesses for fire department and emergency services are clear:

MON TUE WED THU FRI SAT SUN

3. Fire detection/Sprinkler systems operational:

MON TUE WED THU FRI SAT SUN

Note: If system is impaired ensure a temporary, but equivalent, system is provided. Temporary systems to be tested monthly. Describe temporary system(s) provided:_____________________________________________________________________.

4. Construction partitions are being maintained as a 1 hour fire barrier, all penetrations firestopped at the end of each day:

MON TUE WED THU FRI SAT SUN

5. Good housekeeping practices are being used in construction area. Flammables and combustible fire load is being kept to a minimum:

MON TUE WED THU FRI SAT SUN

6. Buildings, grounds, and equipment are being maintained in a safe manner (pay special attention to excavations, construction areas, and construction storage):

MON TUE WED THU FRI SAT SUN

7. The “No Smoking Policy” is being enforced throughout the project area:

MON TUE WED THU FRI SAT SUN

8. Job site fire extinguishers and other additional fire fighting equipment (if necessary) in place and inspected:

MON TUE WED THU FRI SAT SUN

9. Deficiencies and appropriation corrective actions to be listed here:

10. Inspector’s Initials: MON TUE WED THU FRI SAT SUN

Form Completed By:

Interim Life Safety Measure (ILSM) Evaluation for Construction/Renovation Projects

Project Name: Date: Project Manager (COTR):____________________________________ Safety Staff Member: _______________________________________

Instructions: Use this evaluation to identify and implement activities to protect occupants during construction and renovations and during periods when the building and/or construction area does not meet the applicable provisions of the Life Safety Code. This evaluation is to be updated throughout the project to identify code deficiencies that cannot be immediately corrected and the ensuing special measures to be taken to compensate for increased life safety risk. Check all conditions that apply and add any other identified deficiencies and additional special measures:

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Building/area egress routes blocked or altered. This applies to the construction area as well as surrounding areas.

Egress routes for all personnel (including construction workers) must be maintained at all times.

List blocked egress route locations: 1. Provide alternate means of egress.

Personnel in the area shall be given additional training when alternative egress routes are designated. Signage shall be posted identifying the location of the alternate means of egress or exit to everyone affected.

2. Exits in affected area(s) shall be inspected daily.

3. Conduct one additional fire drill per shift per quarter in the affected area.

Required

Required

Required

N/A

N/A

N/A

Obstructed or altered access to emergency services and for fire, police, and other emergency forces.

List access routes blocked: 1. Provide and mark alternate access routes.

2. Inspect routes daily.

Required

Required

N/A

N/A

Fire alarm, detection, and/or suppression systems out of service. Each outage will be assessed based on duration, location, building occupancy, existing fire barriers, and type of system out of service to determine necessary measures.

Compliance with the applicable chapter of the LSC required.

List each system out of service:

List each temporary system required:

1. Provide temporary, equivalent alarm and detection systems.

2. Inspect and test temporary systems monthly. The completion date of the test shall be documented.

3. Fire alarm, detection, and suppression system outages > 4 hours in a 24-hour period require a fire watch and fire dept. notification.

Fire watch shall be documented.

4. Conduct one additional fire drill per shift per quarter in the affected area.

Required

Required

Required

Required

N/A

N/A

N/A

Evaluation Criteria: Deficiency Description and Location: ILSM required to compensate for increased life safety risk:

Temporary construction separation requirements (see attached “Construction Partition Evaluation Criteria”)

List project separation requirements and locations:

Inspect partitions daily. Ensure all smoke tight and fire barrier features are in place at the end of each workday.

Required N/A

Additional fire-fighting equipment:

Minimum requirement for all projects = properly maintained fire extinguisher every 75 ft. Assess all construction work and require other equipment based on criteria contained in NFPA 241.

List all additional fire fighting equipment:

1. Fire Extinguisher(s) 2.

3.

4.

1. Contractor to provide equipment and properly train all personnel in the use of all additional fire fighting equipment. Training shall be documented. Equipment shall be properly maintained.

2. Provide additional fire fighting equipment and training to medical center staff.

Required

Required N/A

Hot Work: evaluate all stages of construction to determine the type of hot work to be conducted.

List hot work tasks/locations:

1.

2.

3.

4.

1. Obtain Hot Work Permit in accordance with medical center procedure/project specifications.

2. Provide additional fire fighting equipment.

3. Provide fire watch in accordance with NFPA 241. Documentation required.

4. Additional requirements for hot work operations and fire prevention precautions, including permits and fire watches, shall be in accordance with NFPA 51 and 51B as applicable. List other requirements:

1.

2.

3.

4.

Required

Required

Required

Required

Required

N/A

N/A

N/A life safety risk:

Smoking prohibited in all buildings and in and near construction areas.

Applicable to all projects. Strict enforcement of no smoking policy. Required

Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

Applicable to all projects. Accumulations of combustible waste material, dust, and debris shall be removed from the construction area and the immediate vicinity at the end of each work shift or more frequently as necessary for safe operations.

Required

Fire/smoke barrier penetrations.

Determine if construction will require the penetration of existing fire and/or smoke barriers.

List locations of project fire/smoke barriers required to be maintained for the duration of the project:

1. Floor and ceiling barriers.

2.

3.

4.

All barrier penetrations shall be properly sealed at the end of each work shift. Sealing methods shall be in accordance with VA specifications.

Required N/A

Increased hazard surveillance is required when any Life Safety Code deficiency is identified during period of construction.

Required for construction in occupied buildings.

List LSC deficiencies:

1.

2.

3.

4.

Increase surveillance of building(s), grounds, and equipment, giving special attention to construction areas and storage (lay down locations), excavation, and field offices as applicable.

Required N/A

Construction occurring adjacent to occupied areas of the building.

List ILSMs implemented for this project:

1.

2.

3.

4.

Department specific education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety. This is the responsibility of the area Supervisor with assistance from the COTR and Safety Office.

Required N/A life safety risk:

During construction the building’s structural or compartmental fire safety features (fire zones) are impaired or altered.

List features impaired:

1.

2.

3.

4.

Medical Center workers in the affected building will be trained to compensate for impaired structural or compartmental fire safety features (fire zones). This is the responsibility of the COTR and Safety Office.

Required N/A

Construction Partition Evaluation Criteria:

The VA Fire Safety Design Manual:

C. Separate all occupied areas from demolition, renovation, or construction activities by temporary smoke-tight construction partitions of gypsum board or other approved non-combustible or limited-combustible material. Partitions shall be full height, extending through suspended ceilings to the floor slab or roof deck above and shall be one-hour fire rated, unless sprinklers are installed and are operational on both sides of the temporary partition whereupon the partition may be permitted to terminate at the ceiling in accordance with NFPA 241.

Note: This requirement is due to the inherently greater potential for fire or hazardous materials incidents associated with the combustibles and operations of demolition/construction. This risk is made worse by the likelihood of compromised fire protection systems and fire/smoke resistant construction. This does not obviate the need to provide other protective measures to contain dust and debris as specified by VAMCS 01010 section 1.6(D)(5). Sprinklers are considered to be operational when they are installed in accordance with NFPA 13 (spacing, protection, distance from the ceiling, etc.) and there is a sufficient automatic water supply.

NFPA 101 Chapter 4

4.6.10 Construction, Repair, and Improvement Operations.

4.6.10.1* Buildings, or portions of buildings, shall be permitted to be occupied during construction, repair, alterations, or additions only where required means of egress and required fire protection features are in place and continuously maintained for the portion occupied or where alternative life safety measures acceptable to the authority having jurisdiction are in place.

4.6.10.2* In buildings under construction, adequate escape facilities shall be maintained at all times for the use of construction workers.

Escape facilities shall consist of doors, walkways, stairs, ramps, fire escapes, ladders, or other approved means or devices arranged in accordance with the general principles of the Code insofar as they can reasonably be applied to buildings under construction.

A.4.6.10.1 Fatal fires have occurred when, for example, a required stair has been closed for repairs or removed for rebuilding, or when a required automatic sprinkler system has been shut off to change piping.

A.4.6.10.2 See also NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations.

NFPA 241 Chapter 8

8.6.2 Temporary Separation Walls.

8.6.2.1 Protection shall be provided to separate an occupied portion of the structure from a portion of the structure undergoing alteration, construction, or demolition operations when such operations are considered as having a higher level of hazard than the occupied portion of the building.

8.6.2.2 Walls shall have at least a 1-hour fire resistance rating.

8.6.2.3 Opening protectives shall have at least a 45-minute fire protection rating.

8.6.2.4* Nonrated walls and opening protectives shall be permitted when an approved automatic sprinkler system is installed.

A.8.6.2.4 Construction tarpaulins would not be considered appropriate barriers or opening protectives.

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ILSM Implementation List

Project Name: Date: Project Manager or VA Supervisor:

Instructions: List all “required” actions from the above ILSM evaluation.

1. Applicable to all projects: Contractor to provide and maintain fire extinguishers and other fire-fighting equipment, on-site.

2. Applicable to all projects: Strict enforcement of no smoking policy.

3. Applicable to all projects: Storage, housekeeping, and debris removal practices will be conducted to ensure the building’s flammable and combustible fire load is reduced to the lowest feasible level.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Hazard Assessment and Exposure Controls

Project Name: Date: Project Manager or VA Supervisor:

Instructions: Identify potential hazards and required control measures. See attached list for sample control measures.

Hazard: Concern? Control Measure(s): Remarks:

Asbestos Containing Material (ACM)

Yes No

Dust Yes No Also see Infection Control Risk Assessment

Moisture/Water Leaks Yes No

Vapors/Fumes Yes No

Hazard: Concern? Control Measure(s): Remarks:

Noise Yes No

Vibration Yes No

Air Pressure Relationships Yes No

Traffic Flow Yes No

Proximity to HVAC intakes Yes No

Utility Outages Yes No Minimize impact to the medical center. Ensure proper notifications are made. COTR to ensure compliance with Engineering Specification requirements for utility outages.

Hazard: Concern? Control Measure(s): Remarks:

Security Systems Yes No

Ceiling-Mounted Patient Lifts

Yes No Lift systems shall be evaluated and inspected in accordance with Patient Safety Alert #AL 10-07. Utilize the attached “Design Checklist for Ceiling Mounted Patient Lifts” and “After Installation Checklist for Ceiling Mounted Patient Lifts.”

Ensure specification 11 73 00 is included in the construction specifications. All required tests and inspections must be documented.

Other (describe): Yes No

Lead Based Paint or Elemental Lead:j j j j j

Yes j j j j j

No j j j j j vhacmsbrownj2 Rectangle vhacmsbrownj2 Rectangle vhacmsbrownj2 Rectangle

Serial #: ____________________

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Facility: Manufacturer:

Model:

COMPLETE

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

Serial Number: EE Number:

Work Order:

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts The commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Lift Location:

VAMC Contact:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

Verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.

NOTES:

Installation

Ceiling Mounted Patient Lifts If not applicable check here:

PASS FAIL

PASS FAIL

COMPLETE

Rails/Tracks and End Stops

NOTES:

Lift Unit and Straps

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light) Inspection and verification of all emergency functions of the lift unit.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

Confirm track is clean and clear of all debris. (Use manufacturer’s recommended cleaning materials to avoid damage to the motor case and other components.)

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

Verification that the lift unit charges properly.

Perform operational test to verify lift functionality.

NOTES:

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Post-Installation

NOTES:

Verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

Verification that all manufacturer specified end stops or docking gates are properly installed.

PASS FAIL

2 Verify that training and competency are documented prior to release for use with patients.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

COMPLETE

COMPLETE

Full extension and inspection of lift strap for loose threads or frays.

Verification of any “soft start” or “soft stop” features and that lifting speed does not exceed 2.5 inches per second with “zero” load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

NOTES:

NOTES:

Training

NOTES:

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Load Testing

NOTES:

Manuals

DATE:

DATE:

DATE:

SIGNATURE:

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in place to provide ongoing training on the proper use of ceiling mounted lifts.

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the installing contractor shall release the ceiling mounted lift installation to VA representative.

SIGNATURE:

TITLE:

VA Representative After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the installing contractor prior to releasing the ceiling mounted lift into service to ensure completion of all requirements.

COMPLETE

SIGNATURE:

TITLE:

TITLE:

COMPLETE

Hazard Control Measure List

Project Name: Date: Project Manager or VA Supervisor:

Instructions: List all identified hazard controls from the assessment above.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Noise:

SAMPLE Hazard Control Measures (If used, modify as necessary for the specific hazard)

Asbestos:

a. Appropriate VA and state asbestos removal, control, monitoring, and clean-up incorporated into the project specifications.

b. VA to hire independent Industrial Hygienist to inspect and clear area for occupancy in accordance with VA standards.

c. Project area will be encased with spray-applied hard surface encasement material.

d. Provide mini containments under negative air in public areas.

e. Sealed gypsum board barrier will be constructed to isolate the construction area from the public.

f. Transite panels will be removed, which is considered Class B removal.

Dust:

a. Sealed gypsum board barrier will be constructed to isolate the construction area from the public.

b. Trash carts will be covered when transported through the building.

c. Provide negative air machine exhausted to outside.

d. Provide mini containments under negative air in public areas.

e. Provide negative air machine in space as air scrubber.

f. Provide walk off mats at entrances to work area.

g. Perimeter barrier will be constructed above the ceiling to isolate the construction area with other areas above the ceiling.

Moisture Water Leaks

a. Contain any water from core drilling activities.

b. Dike any floor penetrations to minimize risk of leaks from construction zone.

Vapors/Fumes:

a. Use of products with low Volatile Organic Compounds (VOCs).

b. Provide negative air in construction zone exhausted to outside, away from HVAC intakes.

c. Seal work area with airtight barrier.

d. Use of combustion engine and propane powered equipment prohibited in buildings. Ensure use outdoors is away from HVAC intakes.

e. Properly seal any floor penetrations in accordance with fire-stopping specifications to minimize risk of fumes from construction zone migrating to other areas of the building.

f. Shut down or modify operation of air handler to minimize infiltration of fumes from outside.

g. Use charcoal and/or HEPA filters on HVAC outside air intakes to protect interiors spaces from dust or fumes.

a. Schedule demolition work after normal work hours, to extent possible.

b. Cut all metal outside the building.

Vibration:

a. Schedule demolition work after normal work hours, to extent possible.

b. Coordinate with occupants in surrounding areas to explain the work occurring.

Air Pressure Relationships:

a. Provide negative air during asbestos abatement.

b. Provide negative air during construction.

c. Seal off supply and exhaust Heating, Ventilation and Air-Conditioning (HVAC) registers.

d. Provide anti room under negative pressure at entrance to project zone.

Traffic Control:

a. Access construction area via exterior door.

b. Schedule delivery of large quantities of material and demolition haul out after hours.

Open Outside Walls:

Construct temporary outside wall to limit the infiltration of wind, air and temperature differences into the project site.

Impact to Levels Above and Below:

a. Coordinate with occupants in surrounding areas to explain the work occurring.

b. Follow asbestos protocol when doing under floor work.

c. Vacate areas when doing below floor work off of the catwalk.

Proximity of Air Intakes:

Shut down air handlers to reduce infiltration of fumes from exterior activities such as painting, gasoline powered engines, roofing operations, equipment, etc.

Lead Based Paint or Elemental Lead:

Appropriate VA, federal and state requirements for removal, control, monitoring, and clean-up incorporated into the project specifications.

a.

INFECTION CONTROL RISK ASSESSMENT/IMPLEMENTATION

PROCEDURES:

A. Determine Location Group based upon work location:

B. Determine Work Type:

Work Type A: Inspections and Non-Invasive Activities. Includes, but is not limited to, removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet, painting (but not sanding) wall covering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Work Type B: Small scale, short duration activities which create minimal dust. Includes, but is not limited to, installation of telephone and computer cabling, access to chase spaces, cutting of walls or ceiling where dust migration can be controlled.

Work Type C: Any work which generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies. Includes, but is not limited to, sanding of wall for painting or wall covering, removal of floor coverings, ceiling tiles and casework, new wall construction, minor ductwork or electrical work above ceilings, major cabling activities, and any activity which cannot be completed within a single work shift.

Work Type D: Major demolition and construction projects. Includes, but is not limited to, activities which require consecutive work shifts, require heavy demolition or removal of a complete ceiling system, and new construction.

C. Determine Interim Measure Class:

LOCATION

GROUP 1

LOWEST

LOCATION

GROUP 2

MEDIUM

LOCATION

GROUP 3

MEDIUM HIGH

LOCATION

GROUP 4

HIGHEST

1) Office areas

2) Engineering

3) Environmental services

1) At patient care units (example:

Cardiac, Rehab., ultrasound)

2) Outpatient areas

1) Emergency Room

2) Radiology/MRI

3) Post-anesthesia

Care unit

4) Intensive Care

Units

5) Nuclear Medicine

6) Admission/Dischar ge area

7) PT – tank areas

8) Cafeteria

9) Echocardiography

10) Laboratories

11) Dialysis

12) Central sterile supply

13) Oncology

14) Cardiology

1) Operating Rooms;

Sterile Processing

2) Intensive Care units

3) Cardiac Catheterization

4) Anesthesia areas

5) All endoscopy areas

6) Pharmacy

CONSTRUCTION

ACTIVITY→ TYPE

“A”

TYPE

“B”

TYPE

“C”

TYPE

“D”

RISK LEVEL

Group 1 I II II III/IV

Group 2 I II III IV Group 3 I III III/IV IV

Group 4 III III/IV III/IV IV

Interim Measure Class I

1. Execute work by methods to minimize raising dust from construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

3. Cleanup and disposal as appropriate.

Interim Measure Class II

1. Provide active means to prevent air-borne dust from dispersing into atmosphere, including water mist work surfaces to control dust while cutting.

2. Seal unused doors with masking tape.

3. Block off and seal air vents.

4. Cleanup and disposal as appropriate.

Interim Measure Class III

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

2. Complete all critical barriers before construction begins or implement control cube method.

3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration filter as required on a per project basis.

4. Contain construction waste and during transport in appropriate container.

5. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work areas.

6. Place dust mat at entrance and exit of work area.

7. Clean construction area before leaving work area daily.

Interim Measure Class IV

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

2. Complete all critical barriers before construction begins per project basis.

3. Maintain negative air pressure within work site utilizing HEPA equipped air filtration units as required on a per project basis.

4. Seal holes, pipes, conduits, and punctures appropriately.

5. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using an HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave the work site as required per project basis.

6. All personnel entering work site are required to wear appropriate protective clothing as required by the area.

7. Provide adhesive/carpet walk-off mats at entrance to work area within the anteroom.

Replace used mats with new mats in accordance with manufacturer’s recommendations and/or as needed.

8. Do not remove barriers from work area until completed project is inspected by the VAMC’s Safety and Infection Control Departments, COTR, and thoroughly cleaned.

9. Provide appropriate clean up daily.

10. Wet mop area with disinfectant as required.

11. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

12. Contain construction waste before and during transport in appropriate covered containers.

D. Document infection control measures to be implemented on attached form. List contractor, service line or individual responsible for implementation.

E. Obtain appropriate approvals.

F. Review and implement all required interim measures with the Contractor’s Project Managers and personnel performing work.

G. Complete Infection Control Permit and ensure it is posted outside the work site entrance at all times.

INFECTION CONTROL MEASURES

Location Group:

Work Type:

Interim Measure Class:

Infection Control actions to be implemented:

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

Responsibility for implementation:

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

Tuscaloosa VAMC Infection Control Construction Permit

Location of Construction: Project Start Date:

Project Coordinator: Estimated Duration:

Contractor Performing Work: Permit Expiration Date: when finished Supervisor: Constr.Supervisor phone:

YES NO CONSTRUCTION ACTIVITY TYPES YES NO PATIENT RISK GROUP

TYPE A: Inspection, non-invasive activity GROUP 1: Least Risk TYPE B: Small scale, short duration, moderate to high levels GROUP 2: Medium Risk

TYPE C: Activity generates moderate to high levels of dust, requires greater 1 work shift for completion

GROUP 3: Medium/High Risk

TYPE D: Major duration and construction activities Requiring consecutive work shifts

GROUP 4: Highest Risk

CLASS I 1. Execute work by methods to minimize raising dust from construction operations.

2. Immediately replace any ceiling tile displaced for visual inspection.

3. Use control cube for ceiling access when >1 ceiling tile removed.

4. Clean work area immediately after task completion.

CLASS II 1. Provide active means to prevent air-borne dust from dispersing into atmosphere

2. Water mist work surfaces to control dust while cutting.

3. Seal unused doors with duct tape.

4. Block off and seal all air vents.

5. Place dust mats at entrance and exits of work areas.

6. Wipe work surfaces with approved disinfectant.

7. Contain construction waste before transport in tightly covered containers.

8. Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area.

9. Remove or isolate HVAC system in areas where work is being performed.

CLASS III

1. Remove or Isolate HVAC system in area where work is being done to prevent contamination of the duct system.

2. Complete all critical barriers to seal area from non work area before construction begins.

3. Maintain negative air pressure within work site 24/7, utilizing HEPA equipped air filtration units; with filter changes as needed.

6. Vacuum work area with HEPA filtered vacuums.

7. Wet mop with disinfectant.

8. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

9. Contain construction waste before transport in tightly-covered containers.

Date 4. Do not remove barriers from work area until completed project is thoroughly cleaned with hospital-approved disinfectant by Housekeeping, and approved by Project Coordinator.

10. Cover transport receptacles or carts. Tape covering.

Wipe off cart and wheels with approved disinfectant before transporting debris.

Initial

Class IV

1. Isolate HVAC system in area where work is being done to prevent contamination of duct system.

2. Complete all critical barriers or implement control cube method before construction begins.

3. Maintain negative air pressure within work site 24/7, utilizing HEPA equipped air filtration units; with filter changes as needed.

4. Seal holes, pipes, conduits, and punctures appropriately.

5. Construct anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site or they can wear cloth or paper coveralls that are removed each time they leave the work site.

6. All personnel entering work site are required to wear shoe covers; changed each time exiting work area.

7. Do not remove barriers from work area until completed project is thoroughly cleaned with approved disinfectant by Housekeeping and approved by Project Coordinator.

8. Vacuum work area with HEPA filtered vacuums.

9. Wet mop with disinfectant.

10. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

11. Contain construction waste before transport in tightly covered containers.

12. Cover transport receptacles or carts. Tape covering.

13. Remove or isolate HVAC system in areas where work is being done.

Date

Initial

Additional Requirements: Adhesive walk-off mats required at entrance to and exit from work areas for Class III and Class IV projects.

� YES � NO 2-step tuberculosis skin testing (TST) documentation is required for this project involving occupied rooms.

� YES � NO N-95 respirator fit-testing documentation is required for projects involving occupied airborne isolation rooms.

TB risk assessment: Per CDC criteria Dorn VAMC is low risk and although not required (except as listed above), all construction workers are encouraged to have 2-step tuberculosis skin testing (TST).

Date Initials : ___________ Exceptions/Additions to this permit Date

Initials are noted by attached memoranda

Permit Request By: Permit Authorized By:

Date: Date:

POST-CONSTRUCTION ASSESSMENT

PROJECT:

LOCATION:

PROJECT TYPE:

PROJECT START(NTP) DATE:

PROJECT COMPLETION DATE:

Has a final walk through been completed with all affected parties/end users?

NA (N/A for in-house projects)

Yes No

Air quality:

Review comments:

Additional action taken:

Infection control:

Review comments:

Additional action taken:

Utility requirements:

Review comments:

Additional action taken:

Noise and vibration:

Review comments:

Additional action taken:

Physical security:

Review comments:

Additional action taken:

Emergency procedures:

Review comments:

Additional action taken:

General comments:

Submitted by:

Obtain the following approvals, in the order listed, as applicable:

1. Assistant Chief, Engineering Service Date

2. Infection Control Coordinator Date

3. VA Police Representative Date

4. Safety and Emergency Management Service Representative Date

5. Chief, Engineering Service Date

Other Date

Other Date

1. Project Manager/COTR/Shop Supervisor Date

Untitled

Schedule work after normal hours, to extent possible.