Attachment 4 - 668-22-106_PCRA_Pre-Construction Risk Assessment Checklist ver6.pdf
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- Solicitation number
- 36C26027R0014
About this file
This is a Pre-Construction Risk Assessment form for Project 668-22-106, titled "Correct Domestic Water Deficiencies Buildings 1 & 12," scheduled to begin October 1, 2026, with an estimated duration of 6 months at Buildings 1 and 12.
The assessment identifies multiple construction risks requiring mitigation. Fire and life safety concerns include pipe soldering activities requiring hot work permits submission to Safety; however, construction areas will not be separated by solid non-combustible smoke-tight partitions, triggering the need for an Interim Life Safety Measures (ILSM) plan. Contract compliance clauses will be included for risk enforcement. Construction activities will require utility shutdowns of various domestic water branches to safely remove piping deadlegs, with impact notifications to be sent as design progresses. Nuisance noise levels are anticipated in adjacent areas, with mitigation requiring that activities producing excessive noise in patient care areas be scheduled during off-hours. Facility-specific training is required due to work in biological areas. Known asbestos-containing material (ACM) disturbance is anticipated, with additional information to be provided at the 95% design phase. An Infection Control Risk Assessment (ICRA) plan has been submitted to the Infection Control Representative. Patient relocation is necessary in work areas and areas affected by domestic water outages, with detailed information forthcoming at 95% design completion. No trenching, radiographic examination, traffic control issues, NEPA assessment above categorical exclusion, air quality permits, stormwater permits, or hazardous chemical use are anticipated.
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R e v 6 P a g e 1 | 3
Pre-Construction Risk Assessment Project Number and Name: Planned Project Start Date:
Location of Construction: Estimated Duration:
Safety/Life Safety Risk Assessment-Safety officer should be involved in the design/planning of all projects
Y N 1. FIRE AND LIFE SAFETY IMPACTS
a. Will egress routes and exit signage from occupied areas remain unchanged? If no, ILSM is needed.
b. Will exit stairs remain unobstructed with appropriate fire protection? If no, ILSM is needed.
c. Will fire & smoke compartments remain intact & unchanged? If no, ILSM is needed.
d. Will fire alarm and detection systems remain functional & unimpaired; outages
<4 hours? If no, ILSM is needed.
e. Will fire suppression systems remain functional & unimpaired; outages <10 hours? If no, ILSM is needed.
f. Will construction area be separated by solid non-combustible smoke tight partitions? If no, ILSM is needed.
g. Will emergency access by Fire Department remain unobstructed? If no, ILSM is needed.
h. Will hot work be performed? If yes, submit hot work permit to Safety
2. SAFETY
a. Will a confined space work permit be required? If yes, submit permit
b. Will the project introduce other significant hazards? If yes, describe below
Additional Requirements and Description of Mitigation:
Construction Safety Specialist / Safety Specialist Signature: Date:
Y N 3. PHYSICAL SECURITY IMPACTS
a. Will the construction compromise security? If yes, describe necessary mitigation below
b. Will construction affect traffic control or cause road closures?
c. Do badging requirements exceed non-PIV level?
Additional Requirements and Description of Mitigation:
VA Police Signature: Date:
R e v 6 P a g e 2 | 3
Y N 4. CONTRACT COMPLIANCE
a. Will contract clauses be included for enforcement of identified risks? If no, describe necessary mitigation below
Y N 5. CONSTRUCTION ACTIVITY
a. Will there be any anticipated utility shutdowns? (Communications, electrical, heating/cooling, HVAC, medical gases, vacuum, water, sewer) If yes, describe necessary mitigation below and consider impact memo
b. Will there be nuisance noise levels for adjacent areas? If yes, describe necessary mitigation below
c. Will vibration levels affect operations of sensitive medical equipment? If yes, describe necessary mitigation below
d. Will construction require trenching?
e. Will radiographic examination be required of piping or structural steel? If yes, contact RPO
f. Will construction affect traffic control or cause road closures?
g. Will this contract complete work with a biological area such as a lab? If yes, Facility Specific Training required.
Additional Requirements and Description of Mitigation:
Project Manager Signature: Date:
Y N 6. ENVIRONMENTAL
a. Will the project require a NEPA assessment above a CATEX? Contact GEMS for a determination. CATEX #: If yes, submit draft NEPA to GEMS
b. Will the project require a permit from the Air Quality District? Contact GEMS for a determination. If yes, submit draft to GEMS
c. Will this project require a storm water permit? Contact GEMS for a determination. If yes, submit draft to GEMS
Y N 7. HAZARDOUS MATERIALS
a. Will this contract disturb known asbestos containing material (ACM)? Contact
Safety for a determination. If yes, describe necessary intervention:
b. Will contract require the use of hazardous chemicals? If yes, review by facility IH is required
GEMS Signature: Date:
R e v 6 P a g e 3 | 3
Y N 8. INFECTION CONTROL
a. Will this contract require an Infection Control Risk Assessment? If yes, ICRA shall be completed prior to construction start.
Additional Requirements and Description of Mitigation:
Infection Control Representative Signature: Date:
Y N 9. PATIENT SAFETY
a. Will project require additional monitoring for patient safety?
b. Will construction affect patient access?
c. Will patients need relocation during construction?
Patient Safety Signature: Date:
| Project Number and Name: 668-22-106 Correct Domestic Water Deficiencies Buildings 1 & 12 |
| Planned Project Start Date: 10/01/2026 |
| Estimated Duration: 6 Months |
| Date: |
| Date_2: |
| Date_3: |
| Date_4: |
| Date_5: |
| Date_6: |
| Location of Construction: Building 1, Building 12 |
| 2b: N |
| 2a: N |
| 1h: Y |
| 1g: Y |
| 1e: Y |
| 1d: Y |
| 1c: Y |
| 1b: Y |
| 1f: N |
| 1a: Y |
| 3a: N |
| 3b: N |
| 3c: N |
| 4a: Y |
| 5a: Y |
| 5b: Y |
| 5c: N |
| 5d: N |
| 5e: N |
| 5f: N |
| 5g: Y |
| 6a: N |
| 6b: N |
| 6c: N |
| 7a: Y |
| 7b: N |
| 8a: Y |
| 9a: N |
| 9b: N |
| 9c: Y |
| Additional Requirements and Description of Mitigation_Fire Life Safety: 1. h) Pipe soldering may occur, hot work permits to be submitted to Safety |
| Additional Requirements and Description of Mitigation_Physical Security Impacts: |
| Additional Requirements and Description of Mitigation_Contract Compliance & Construction Activity: 5. a) Various branches of domestic water will need to be isolated in order to safely remove piping deadlegs. Later design phases will contain more details of outage impacts. Impact notifications will be sent. |
5. b) While generally not a concern, any activities requiring excessive loud noises in patient care areas will be scheduled during off-hours.
| Additional Requirements and Description of Mitigation_Environmental & Hazardous Materials: 7. a) More information to come at 95% |
| Additional Requirements and Description of Mitigation_Infection Control: 8. a) ICRA plan submitted to Infection Control Representative |
| Additional Requirements and Description of Mitigation_Patient Safety: 9. c) Most parts to this project will take place within one work shift. Patients will need to be relocated in work areas and in some cases, areas that will be effected by domestic water outages. More information to come at 95% design. |
| CATEX #: |
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