Attachment 6 - 583-22-509 ILSM.pdf

ILSM Evaluation

The purpose of the following determination matrix form is to screen for the need of measures.

An answer of "yes" to any of the below items will require ILSM's and a full assessment. This form is applicable to construction related risks and identified Life Safety Code deficiencies.

Project/LS Deficiency: 583-22-509 Renovate Auditorium & C1202 Location: Bldg.1Auditorium & C1202

Question/Condition

Will construction activities or renovation occur in any hospital building that poses increased fire risk, hot work, or increased combustible loads?

Will construction or renovation activities occur adjacent to occupied areas?

Will hot work be performed in any area (outside approved shop areas}?

Will barrier to isolate any type of work, and that obstruct exits, be required?

Will any exits be taken out of service, closed, or impaired?

Are there inoperable exit signs?

Will exits be obstructed and require excessive travel distance to an approved exit?

Will sprinkler or fire detection systems be impaired?

Will components of the sprinkler system (e.g., fire pump, flow switches, tamper switches, or related alarm system} be affected?

Are any barriers or fire/smoke walls impaired?

Are any fire rated doors or required barrier doors impaired?

Will ceiling tiles be removed?

Are any fire alarm components, panels, detection devices, or monitoring system impaired?

Are any fire protection components, including dampers, doors, and control devices impaired?

Will any condition change fire load (e.g., storage of combustibles} in un-approved areas?

Will a life safety code requirement by deficient?

_X __ Yes, answered to any, proceed to Assessment Form.

YES NO

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

___ No to all, no ILSMs required. This form must be retained for the life of the project.

Completed by: Ja�es w_allace O /JJ,,,,, � Engmeermg tJ / -

Approved by: �rc,._ '1¢++-er'I ::O=??== Safety Office

Date: 02/15/2022

INTERIM LIFE SAFETY ASSESSMENT TOOL - CONSTRUCTION AND RENOVATION

Date: 02/15/2022 Evaluator: James Wallace Approval:

Engineering

Description of PROJECT/PHASE: 583-22-509 Upgrade Auditorium & C1202 Approval: --5

Safety Management

Life Safety Deficiency

Life Safety Code Deficiencies as a Result of Construction ILSM Administrative Action Required

Construction Condition Yes No 1 2 3 4 5 6 7 8 9 10 11 12 13 14

1. Renovation and construction adjacent to occupied areas. X

X X X X X

2. Renovation and construction on an unoccupied floor.

X

3. Adding an addition to an existing and occupied building.

Other Conditions (these measures are added to the above construction condition measures).

1. Partially blocking or obstructing exit pathway with barrier or other project condition.

2. Removing an approved exit.

X X

3. Rerouting internal patient/staff/visitor traffic flows.

4. Rerouting exterior access to the hospital.

5. Part of the fire alarm system is disabled or impaired.

6. Fire alarm system out of service >4 hours in a 24-hour period. X X X

7. Sprinkler system out of service > 10 hours in a 24-hour period.

8. Other system (halon, kitchen hood, etc.) out of service One fire alarm zone out of service >4 hours in a 24-hour period.

9. Contractor will be performing hot work.

10. Other condition.

INTERIM LIFE SAFETY ASSESSMENT TOOL - LIFE SAFETY CODE DEFICIENCY

Date: 02/15/2022 Evaluator: James Wallace Approval:

Engineering

Description of Life Safety Code Deficiency: 583-22-509 Upgrade Auditorium & C1202 Approval:

Safety Management

Life Safety Deficiency

Existing Life Safety Code Deficiencies or Conditions ILSM Administrative Action Required

Code Deficiencies Yes No 1 2 3 4 5 6 7 8 9 10 11 12 13 14

1. Lacking code required smoke barrier or fire wall.

2. Minor penetrations in smoke barrier or fire wall.

3. Major penetrations in smoke barrier or fire wall.

x

4. Damaged or inoperable fire rated door component.

5. Damaged or inoperable smoke compartment door component.

6. Hazardous area not properly protected.

7. Excessive travel distance to an approved exit.

8. Lack of a required exit sign or inoperable exit sign.

Fire Protection Systems Yes No

1. Fire alarm system out of service >4 hours in 24-hour period.

2. Sprinkler system out of service > 10 hours in 24-hour period.

3. Loss of or limited (one compartment) smoke detection.

4. Trouble alarm: water flow or tamper switch.

5. Trouble alarm: smoke, heat, or duct detector.

6. Trouble alarm: other initiating device.

x x x

7. Other system (halon, kitchen hood, etc.) out of service.

8. Other system component.

Other Condition

INTERIM LIFE SAFETY REQUIREMENTS MATRIX

Project: Upgrade Auditorium & C1202 Signature: / Date:

Life Safety Deficiency

Existing Significant Life Safety Code Deficiencies or Conditions

ILSM Administrative Action Required as a Result of Construction

The following measures will be implemented when monitoring systems are impaired >4 hours

Code Deficiencies Yes No 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Maintenance or Repairs Yes No

1. Fire alarm system out of service >4 hours.

2. Sprinkler system out of service >4 hours.

X x

3. One fire alarm zone out of service >4 hours.

4. A few sprinkler zones out of service >4 hours.

5. Other system (halon, kitchen hood, etc.) out of service.

X X X

All Other (See John Piwowarski)

Risk Score Yes / No / NA=Not applicable

Interim Life Safety Measures (ILSMs) for Construction

Evaluation Date: 02/15/2022

Description of PROJECT/PHASE: Upgrade Auditorium & C-1202 583-22-509

Start Date:07/01/2022 End Date: 09/30/2022

Measure Measure Required Action '1 All that No.

apply 1 If smoke detection or alarms A fire watch shall be conducted using the X are out of service 4 or more hospital form. An individual will be assigned hours in 24-hour period and/or to conduct rounds and document fire watch if sprinkler system is out of every 30 minutes.

service more than 10 hours in

24-hour period. If fire watch is required in construction area, the fire watch will be conducted by the

A Fire watch is implemented contractor during hours of construction.

and the Fire Department is contacted. Notification and Fire The fire department must be notified.

Watch times are documented.

Notification to the fire department must be documented.

2 Signs for alternate exits Signs for alternate exits are posted in posted. affected areas.

3 Inspect exits in affected areas All exits in affected area are inspected daily.

on a daily basis. The inspection is documented. Inspection must be completed 7 days/week.

4 Provide temporary but Smoke or heat detection is provided in equivalent fire alarm and affected area.

detection systems for use when the fire system is impaired.

5 Additional firefighting Additional fire extinguishers are installed in X equipment must be provided, the affected area. The fire extinguishers are tagged with annual inspection and checked monthly. The fire extinguishers must be mounted off the floor.

6 Use temporary construction Construction barriers are installed to contain X partitions which are smoke the entire work area. In accordance with tight, non-combustible or of NFPA 241, the barrier must be 1-hour fire limited-combustible material rated with 45-minute door. If the area is fully that shall not contribute to the sprinkler protected, the barrier may be development or spread of fire. smoke tight with fire resistant poly-sheeting.

7 Increase surveillance Perform inspection of the affected area at X implemented for buildings, least daily using the hospital's approved grounds, and equipment with surveillance form.

special attention to construction areas, storage excavation, and field offices.

Interim Life Safety Measures (ILSMs) for Construction

Measure Measure Required Action /All that

8 Enforce storage and debris Excess storage or materials is prohibited in X removal practices. the affected area. If construction, the contractor will be instructed to limit staging and storing supplies in the work area.

9 Additional training for Provide and document training for fire X personnel on firefighting extinguishers installed in the affected area.

equipment.

10 Additional fire drill per shift per Safety Staff: Perform an additional fire drill quarter each quarter for the affected area and adjacent areas.

11 Inspect and test temporary Inspect and document testing of temporary systems monthly. Ensure the systems installed to detect fire and smoke.

completion date is

12 Conduct organization wide Safety Staff: Conduct and document safety education programs to education for employees. The education promote awareness of fire must address awareness for the deficiencies safety building deficiencies, identified, construction hazards and ILSM construction hazards, and measures. The education must be provided temporary ILSM measures organization wide.

implemented.

13 Train personnel to compensate Safety Staff: Conduct training for employees for impaired structural or in affected area. The training must cover any compartmentalization features methods to compensate for the identified of fire safety. impairment, compartmentalization feature issue or fire safety issue.

14 Hot work permit is required. Implement hospital hot work permit program.

ADDITIONAL COMMENTS:

If fire alarm system is out of service for more than 4 hours, or sprinklers are disabled for more than 10 hours, contractor shall provide a fire watch to check the area every 30 minutes until the system(s) are restored.

If ceiling tiles are out of place for more than 10 hours or more than 4 hours when no workers are present, contractor shall provide a fire watch to check the area every 30 minutes until the tiles are replaced.

Completed by Date:

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E e ng

Approved by: Date: Z/ S iZS/_Z_-) Safety Officer

ILSM PERMIT

Effective on: 01 July 2022

Interim Life Safety Measures are in effect for the following areas:

Auditorium and C1202

Reason: Construction near occupied spaces, replacement of ceiling tiles, and relocation od sprinkler heads.

Requirements: Measures 1, 5, 6, 7, 8, and 9

Signature & Title of Project Engineer/COR Date *Project Engineer/COR will post this completed document at the job site.

'1/1 5 f'LOZL.

Signature of Safety Manager Date

~y~Z z n ure of Supervisory or Chief Engineer Date

Definitions:

Compartmentalization — the concept of using various building components (for example, fire-rated walls and doors, smoke barriers, fire-rated floor slabs) to prevent the spread of fire and the products of combustion so as to provide a safe means of egress to an approved exit. The presence of these features varies, depending on the building occupancy classification.

Fire Watch — The assignment of a person or persons to an area for the express purpose of notifying the fire department, the building occupants, or both of an emergency; preventing a fire from occurring; extinguishing small fires; or protecting the public from fire or life safety dangers.

Evaluation Date: 02/15/2022 Description of DEFICIENCY:

Start Date: 07/01/2022 End Date: 09/30/2022

Measure Measure Required Action 1 All that

1 If smoke detection or alarms A fire watch shall be conducted using the X are out of service 4 or more hospital form. An individual will be assigned hours in 24-hour period and/or to conduct rounds and document fire watch if sprinkler system is out of every 30 minutes.

service more than 10 hours in

24-hour period. If fire watch is required in construction area, the fire watch will be conducted by the

A Fire watch is implemented, contractor during hours of construction.

and the Fire Department is contacted. Notification and The fire department must be notified.

Fire Watch times are documented. Notification to the fire department must be

2 Signs for alternate exits Signs for alternate exits are posted in posted affected areas.

3 Inspect exits in affected areas All exits in affected area are inspected daily.

on a daily basis. The inspection is documented. Inspection must be completed 7 days/week.

4 Provide temporary but Smoke or heat detection is provided in equivalent fire alarm and affected area.

detection systems for use when the fire system is impaired.

5 Additional firefighting Additional fire extinguishers are installed in X equipment provided, the affected area. The fire extinguishers are tagged with annual inspection and checked monthly. The fire extinguishers must be mounted off the floor.

6 Use temporary construction Construction barriers are installed to contain X partitions which are smoke the entire work area. In accordance with tight, non-combustible or of NFPA 241, the barrier must be 1-hour fire limited-combustible material rated with 45-minute door. If the area is fully that shall not contribute to the sprinkler protected, the barrier may be smoke development or spread of fire. tight with fire resistant poly-sheeting.

7 Increase surveillance Perform inspection of the affected area at X implemented for buildings, least daily using the hospitals approved grounds, and equipment with surveillance form.

special attention to construction areas, storage, evacuation, and field offices.

8 Enforce storage and debris Excess storage or materials is prohibited in X removal practices the affected area. If construction, the contractor will be instructed to limit staging and storing supplies in the work area.

9 Additional training for Provide and document training for fire X personnel on firefighting extinguishers installed in the affected area.

equipment.

10 Additional fire drill per shift per Safety Staff: Perform an additional fire drill quarter. each quarter for the affected area and adjacent areas.

11 Inspect and test temporary Inspect and document testing of temporary systems monthly. Ensure the systems installed to detect fire and smoke.

Measure Measure Required Action i All that completion date is

12 Conduct organization wide Safety Staff: Conduct and document safety education programs to education for employees. The education must promote awareness of fire address awareness for the deficiencies safety building deficiencies, identified, construction hazards, and ILSM construction hazards, and measures. The education must be provided temporary ILSM measures organization wide.

implemented.

13 Train personnel to Safety Staff: Conduct training for employees compensate for impaired in affected area. The training must cover any structural or methods to compensate for the identified compartmentalization features impairment, compartmentalization feature of fire safety. issue or fire safety issue.

14 Hot work permit is required. Implement hospital hot work permit program.

ADDITIONAL COMMENTS:

If fire alarm system is out of service for more than 4 hours, or sprinklers are disabled for more than 10 hours, contractor shall provide a fire watch to check the area every 30 minutes until the system(s) are restored.

If ceiling tiles are out of place for more than 10 hours or more than 4 hours when no workers are present, contractor shall provide a fire watch to check the area every 30 minutes until the tiles are replaced.

Completed by Date: )S~-oZ~-

E ee ng

Approved by: Date: `L` 15 kc L Safety Officer