Attachment 3 Pre-Construction Risk Assessment PCRA.pdf

Name:

Date:

Pre-Construction Risk Assessment (PCRA)

Manchester VAMC

1: Project Information 1.1: Project/WO Number * 1.2: Project Name *

1.3: Project COR/Lead Name (Last, First) *

1.4: Location

1.5: Building

1.6: Room(s)

1.7: Project Description *

1.8: Phases *

1.8.1: If yes, list phases with estimated start/stop dates below.

1.9: Start Date * 1.10: End Date *

2:

Infection Control

Pre-Construction Risk Assessment (PCRA) 1Continued on the next page.

2.1: Dust will be generated (i.e. from drilling, cutting, sawing, etc.) in or adjacent to patent care areas. *

2.1.1: If yes, complete ICRA and implement measures identified.

2.2: Work is being performed in a patient care area. *

2.2.1: If yes, complete ICRA and implement measures identified.

2.3: Construction area is greater than 110 ft2 and/or >3 ceiling tiles will be removed. *

2.3.1: If yes, complete ICRA and implement measures identified.

2.4: Contractor will be working in Low, Medium, or High Risk Infection Control Areas (as defined in ICRA). *

2.4.1: If yes, Infection Preventionist will complete the Tb screening tool for construction crew(s).

3: Life Safety (x6150 for help) 3.1: General construction, renovation, or significant repairs will take place in an occupied building. *

3.1.1: If yes, complete ILSM action items 6, 7, and 9.

Pre-Construction Risk Assessment (PCRA) 2Continued on the next page.

3.2: Egress pathways or exits will be blocked or partially obstructed by construction activities, partitions, or Infection Control measures. *

3.2.1: If yes, complete ILSM action items 1, 8, 10, and 11.

3.3: Smoke or fire walls will be breached where a temporary seal cannot maintain barrier integrity. Consult Fire and Smoke Barrier Diagrams. *

3.3.1: If yes, complete ILSM action items 2, 3, 7, 8, and 9.

3.4: Building emergency responder or fire equipment, fire hydrant, standpipe or connection blocked or obstructed, or removed from service. Note: This includes both interior and exterior access. *

3.4.1: If yes:

3.5: 17. Fire alarm, fire detection, and/or fire suppression systems will be impaired or shut down for more than four (4) hours. *

3.5.1: If yes, complete ILSM action items 3, 5, 6, 8, 9, 10, and 11.

3.6: 18. Will multiple ceiling tiles and/or hard ceilings will be removed for more than 4 hours? *

3.6.1: If yes, complete ILSM actions items 3, 5, 6, 8, 9, 10, and 11.

Pre-Construction Risk Assessment (PCRA) 3Continued on the next page.

3.7: 19. Will a temporary fire alarm system will be required? *

3.7.1: If yes, complete ILSM action items 3, 8 and 10.

3.8: 20. Will activities result in missing or severely compromised shaft or vertical opening, or compromised fire door? *

3.8.1: If yes, complete ILSM action items 2, 4, 7, and 9.

3.9: 21. It will be necessary to erect temporary construction partitions. *

3.9.1: If yes, Complete ILSM action items 1, 2, 4, 10, and 11.

3.10: 22. Penetrations in floors, ceilings, or fire walls. Consult Fire and Smoke Barrier Diagrams. *

3.10.1: If yes, obtain penetration permit. Ensure UL listed fire stop system is approved by Safety Office prior to use, and used.

3.11: 23. Will construction affect the safety of exterior grounds (i.e. walkways, roads, use of cranes, etc.? *

3.11.1: If yes, complete ILSM action items 2, 7, 9, and 11.

Pre-Construction Risk Assessment (PCRA) 4Continued on the next page.

3.12: 24. Work includes the storage of combustible or flammable materials. *

3.12.1: If yes, ensure that items are stored in accordance with Medical Center Safety Manual Chapter 20.

3.13: 25. Will work involve installation of cables or hanging items (e.g. flex duct) near sprinkler pipe? *

3.13.1: If yes, inspect work area upon completion to ensure that nothing is hung from, or laying on sprinkler piping, valves, or hangers.

3.14: Sprinkler Lines

4: Safety (x6829 for help) 4.1: 26. Will hazardous materials be used? *

4.1.1: If yes, ensure that hazardous materials used by Medical Center staff are approved and entered into the online chemical inventory. Submit for approval here:

https://vhav05webrm.v05.med.va.gov/VISN1/608/EHS/?a=newform

Hazardous materials used onsite by Contractors must submit SDS to Medical Center Industrial

Hygienist for approval before Contractors may bring products on site. Attach SDS below.

4.2: 27. Disturbing, installing or removing building materials that may contain:

• Lead (i.e. non-latex paint, x-ray shielding materials, etc.)

• Asbestos (see asbestos survey, or consult with Supervisory Project Engineer, or Industrial Hygienist).

• Silica containing materials, such as drywall, joint compound, asphalt, rock (granite), concrete, grout, mortar, sand, etc.

• Bird or bat droppings.

• Mold. *

Pre-Construction Risk Assessment (PCRA) 5Continued on the next page.

27. Disturbing, installing or removing building materials that may contain:

• Lead (i.e. non-latex paint, x-ray shielding materials, etc.)

• Asbestos (see asbestos survey, or consult with Supervisory Project Engineer, or Industrial Hygienist).

• Silica containing materials, such as drywall, joint compound, asphalt, rock (granite), concrete, grout, mortar, sand, etc.

• Bird or bat droppings.

• Mold. continued *

4.2.1: If yes, establish written abatement plan that identifies appropriate engineering controls, work practices and procedures, monitoring requirements, and disposal/recycling requirements for the hazard(s).

4.3: 28. Working on elevations (i.e. roofs without guardrails, scaffolds, aerial lifts, etc.). *

4.3.1: If yes, establish appropriate fall protection plan, including appropriate rescue procedures.

4.4: 29. Entry into permit-required confined spaces (i.e. Building 1 steam tunnel, utility vaults, sewer and storm water manholes, etc.) *

4.4.1: If yes, ensure that Medical Center Staff follow procedures outlined in the Confined Space

Entry Program.

Contractors must have an established program. Complete Confined Space Entry Permit and submit to Medical Center Safety Office.

4.5: 30. Loud noise (i.e. have difficulty hearing the person standing next to you) or Vibration. *

4.5.1: If yes, ensure appropriate use of personal protection (i.e. hearing protection, anti-vibration gloves, etc.). Ensure that contractors have an established Hearing Conservation Program. Coordinate work activities with affected (i.e. adjacent) work areas to minimize disruption and ensure that occupants are not exposed to high levels of noise.

4.6: 31. Excavation or trenching. *

4.6.1: If yes, obtain Medical Center Excavation Permit prior to the start of work. Ensure that contractors have an excavation program, along with required Medical Center permit.

Pre-Construction Risk Assessment (PCRA) 6Continued on the next page.

4.7: 32. Cranes and/or heavy equipment. *

4.7.1: If yes, document inspections, operator qualifications, and ensure affected area is appropriately secured to prevent unauthorized personnel from entering hazard area.

4.8: 33. Work with hazardous energy sources (i.e. electricity, high pressure steam, pneumatic, hot water, etc.). *

4.8.1: If yes, ensure that contractors have established lockout/tagout programs. Review/develop equipment specific lockout/tagout procedures.

Coordinate shut downs with affected parties. If lockout/tagout is not feasible, complete Energized Electrical Work Permit.

4.9: 34. Material handling and rigging. *

4.9.1: If yes, confirm occupancy loading capacity of surrounding areas for material loading. Confirm rigging equipment is in good working condition, and clearly labeled and tested for load capacity.

4.10: 35. Welding or cutting. *

4.10.1: If yes, obtain hot work permit. Use local exhaust ventilation (i.e. smoke eater) for welding inside Medical Center. Identify and use proper PPE.

4.11: 36. Operation of gas powered equipment. *

4.11.1: If yes, the use of gas powered equipment inside buildings is not permitted. Ensure appropriate ICRA controls are in place. Avoid placing adjacent to building air intakes, windows, or louvers. Coordinate activities with affected areas.

Pre-Construction Risk Assessment (PCRA) 7Continued on the next page.

4.12: 37. Any hazard(s) to others not identified above, or information relevant to any of the identified hazards.

5: Security 5.1: Work impairs building security systems, locking systems, or alarms. *

5.1.1: If yes, work with Police and Clinical area impacted. Ensure alternate methods of assuring security are maintained and acceptable to both Police and Clinical areas. Fully brief contractor regarding compliance with all requirements.

5.2: Work performed in restricted access areas (i.e. Pharmacy, Armory, Warehouse, etc.) *

5.2.1: If yes, work with Police and Clinical area impacted. Ensure alternate methods of assuring security are maintained and acceptable to both Police and Clinical areas. Fully brief contractor regarding compliance with all requirements.

5.3: The contractor will store supplies and/or equipment on site. *

5.3.1: If yes, ensure that contractors are aware that they are responsible for their equipment and supplies. Contractors should 1) secure, 2) label/mark equipment (with company name or logo), and 3) maintain an inventory of equipment (including make, model, and serial number) and supplies.

Pre-Construction Risk Assessment (PCRA) 8Continued on the next page.

6: Utilities Shut Down 6.1: Normal Power *

6.1.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of electrical services. Ensure lock out / tag out is documented by the contractor or work group performing the work.

6.2: Emergency Power *

6.2.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of electrical services. Ensure lock out / tag out is documented by the contractor or work group performing the work.

6.3: Heating Ventilation Air Conditioning (HVAC) *

6.3.1: If yes, identify areas impacted by this shut down. Notify impacted parties. Identify lock out / tag out points for the isolation of all energy sources. Determine if temporary heat or cooling is required for the area. Ensure temporary services provided and that sufficient power and exhaust points are available.

6.4: Plumbing *

6.4.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of all energy sources. Notify impacted parties. Determine if temporary services are required for the area and provide those services.

Pre-Construction Risk Assessment (PCRA) 9Continued on the next page.

6.5: Medical Gas (oxygen, air, or vacuum) *

6.5.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of all energy sources. Notify impacted parties. Ensure clinical services have as much notice as possible to line up alternate sources and obtain additional tanks, pumps or compressors as needed.

6.6: Nurse Call *

6.6.1: If yes, identify areas impacted by this shut down. If necessary, follow guidelines in MCP 138-08 (Utility Management Program) for alternate methods to be used in a system outage.

6.7: Elevator *

6.7.1: If yes, provide advanced facility wide notice of and estimated length of time of outage.

6.8: Water *

6.8.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for system isolation for the work to be done. Notify impacted parties. Ensure clinical services have as much notice as possible to line potable water from other sources. Consult MCP 138-08 (Utility Management Program) for additional guidance and options to allow functionality during the outage.

6.9: Sewer *

6.9.1: If yes, identify areas impacted by this shut down. Review use of sanitary system in the area impacted. Develop contingency plans for the loss of use of the sanitary system for toileting, hand washing, and other uses. Coordinate work efforts with GEMS and Manchester Water Works.

Pre-Construction Risk Assessment (PCRA) 10Continued on the next page.

6.10: Telephone *

6.10.1: If yes, coordinate this work with the Chief Information Officer or designee.

6.11: Computer *

6.11.1: If yes, coordinate this work with the Chief Information Officer or designee.

6.12: PA System *

6.12.1: If yes, coordinate this work with Facility Service.

6.13: Water Tower *

6.13.1: If yes, identify lock out / tag out points for system isolation for the work to be done. Coordinate work efforts with GEMS and Manchester Water Works.

6.14: Roof Drains *

6.14.1: If yes and work is widespread, coordinate with GEMS to assess compliance with Stormwater permit.

Pre-Construction Risk Assessment (PCRA) 11Continued on the next page.

6.15: Storm Drains *

6.15.1: If yes, coordinate work efforts with GEMS to assess compliance with stormwater permit.

6.16: Hydrants *

6.16.1: If yes, coordinate work efforts with Maintenance and Repair, Safety, and, if necessary, Manchester Water Works.

6.17: Legionella Control: Will any building areas with point of use plumbing fixtures (sinks, showers) be closed for 3 days or more? *

6.17.1: Legionella

7: Environmental (x6241 for help)

7.1: NPDES *

7.1.1: If yes, file Notice of Intent (NOI) to obtain NPDES Stormwater Construction General Permit from EPA. Prepare Stormwater Pollution Prevention Plan (SWPP). Provide copies to GEMS.

7.2: Will there be any changes existing building appearance, architectural, or historic features (i.e. windows, doors, walls, roofs, etc.) or addition of new structures?

7.2.1: If yes, submit project notification to State Historic Preservation Office. Compliance with NHPA Section 106. Review with GEMS.

Pre-Construction Risk Assessment (PCRA) 12Continued on the next page.

7.3: Waste *

7.3.1: If yes, manifest is required for hazardous waste. GEMS Manager is the generator signatory.

Provide GEMS copies of asbestos waste manifests.

Report construction waste/recycling volumes.

7.4: Staging waste storage containers. *

7.4.1: If yes, containers must be covered when not in use/overnight. All containers must be at least 35 feet from the building.

7.5: Potential discharge from Stormwater runoff or connections. *

7.5.1: If yes, use of temporary environmental controls for runoff, availability of spill kits. Report spills to GEMS Manager.

7.6: Sewer system discharge (including any addition of equipment with drainage needs). *

7.6.1: If yes, notification of changes to facility wastewater discharge must be made to the City of Manchester. Contact GEMS Manager to assess compliance with Wastewater Permit.

7.7: Will fuel burning equipment be added or removed? (ex. temporary or permanent generators, boilers, heater, etc.) *

7.7.1: If yes, contact the GEMS Manager to assess compliance with Air Permit.

Pre-Construction Risk Assessment (PCRA) 13Continued on the next page.

7.8: Refrigerant *

7.8.1: If yes, document reclamation and certified recycling for removal. Provide specifications on new equipment, including refrigerant charge volume, to GEMS.

7.9: Tanks *

7.9.1: If yes, design of new fuel storage tanks > 55 gallons and associated piping must be approved by NHDES and have permit for installation and registration. Also, must be added to VAMC SPCC Plan. Contact GEMS.

Any storage tanks <55 gallons require secondary containment, grounding, proper labeling, and must be covered. This is for TEMPORARY or PERMANENT tanks.

7.10: Water Distribution *

7.10.1: Water NHDES

8: Other 8.1: Close or limit access to parking lots or roadways. *

8.1.1: If yes, complete Life Safety Assessment, and if necessary implement Interim Life Safety Measures. Ensure compliance with MUTCD standards when working in roadways.

8.2: Noxious or unusual odors. *

8.2.1: If yes, identify what steps are to be taken to minimize impact.

Pre-Construction Risk Assessment (PCRA) 14Continued on the next page.

8.3: Special communications with outside agencies will be required. Consider VSOs, SHPO, EPA, NHDES, local historical groups, city agencies, etc. *

8.3.1: If yes, identify any special communications that will need to be completed before, during, or after the project.

8.4: Eyewash *

8.4.1: If yes, ensure that equipment locations and specifications are approved by the Medical Center Industrial Hygienist prior to installation.

8.5: Relevant Attachments (e.g. maps)

Pre-Construction Risk Assessment (PCRA) 15Continued on the next page.

Name:

Date:

Pre-Construction Risk Assessment (PCRA)

Manchester VAMC

1: Amendment Description:

* = required field

Pre-Construction Risk Assessment (PCRA) 16This form was generated by LEAF on 3/28/2024