Attachment 5 - PCRA 668-22-105 Upgrade AHU 9 and 15.pdf

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:

1h. Submit hot work permit to Safety prior to performing hot work.

5f. A crane will lift both the temporary AHU and the new AHUs to their locations. The crane will be placed near the ambulance entrance causing a temporary closure of the loop.

9c. Potential IB needed for reduction of available beds.

CATEX #: