Attachment 9 - Pre-Construction Risk Assessment (PCRA) - MTZ Parking Structure.pdf
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Pre-Construction Risk Assessment (PCRA) VA Northern California Health Care System
Attachment A Policy Statement 138-56 March 1, 2019
Pre-Construction Risk Assessment
Project Name: Planned Project Start Date:
Project Number:
PM / COR P.O.C.: P.O.C. extension:
Location of Construction: Estimated Duration:
Safety/Life Safety Risk Assessment-Safety officer should be involved in the design/planning of all projects
Y N FIRE AND LIFE SAFETY IMPACTS
Will egress routes and exit signage from occupied areas remain unchanged? If No, ILSM is needed.
Will exit stairs remain unobstructed with appropriate fire protection? If No, ILSM is needed.
Will fire & smoke compartments remain intact & unchanged? If No, ILSM is needed.
Will fire alarm and detection systems remain functional & unimpaired; outages <4 hours?
If No, ILSM is needed.
Will fire suppression systems remain functional & unimpaired; outages <10 hours? If No, ILSM is needed.
Will construction area be separated by solid non-combustible smoke tight partitions? If No, ILSM is needed.
Will emergency access by Fire Department remain unobstructed? If No, ILSM is needed.
Will hot work be performed? If Yes, submit hot work permit to Safety
Will the project introduce other significant hazards? If Yes, describe below
Y N CONSTRUCTION ACTIVITY
Will there be any anticipated utility shutdowns? (Communications, electrical, heating/cooling, HVAC, medical gases, vacuum, water, sewer)
If Yes, describe necessary mitigation below
Will there be nuisance noise levels for adjacent areas? If Yes, describe necessary mitigation below Will vibration levels be affect operations of sensitive medical equipment? If Yes, describe necessary mitigation below
Y N PHYSICAL SECURITY IMPACTS
Will the construction compromise security? If Yes, describe necessary mitigation below
Y N CONTRACT COMPLIANCE
Will contract clauses be included for enforcement of identified risks? If Yes, describe necessary mitigation below
Y N ENVIRONMENTAL
Will the project require a NEPA assessment? Contact GEMS for a determination. If Yes, submit draft NEPA to GEMS
Will the project require a permit from the Air Quality District? Contact GEMS for a determination. If Yes, submit draft to GEMS
Will this project require a storm water permit? Contact GEMS for a determination. If Yes, submit draft to GEMS
Y N HAZARDOUS MATERIALS
Will this contract disturb known asbestos containing material (ACM)? Contact Safety for a determination. If Yes, describe necessary intervention:
Will this contract complete work with a biological area such as a lab? If Yes, Facility Specific Training required.
Will contract require the use of hazardous chemicals? If Yes, review by facility IH is required
Y N INFECTION CONTROL
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:
Construction Safety Specialist / Safety Specialist Signature: Date:
Infection Control Representative Signature: Date:
VA Police Signature: Date:
Project Section Manager Signature: Date:
| Safety/Life Safety Risk Assessment-Safety officer should be involved in the design/planning of all projects |
| Y |
| N |
| FIRE AND LIFE SAFETY IMPACTS |
| Y |
| N |
| CONSTRUCTION ACTIVITY |
| Y |
| N |
| Y |
| N |
| Y |
| N |
| Y |
| N |
| Y |
| N |
| Project Name: Construct Parking Structure Replacing Expiring Lease |
| PM COR POC: Hari Kushwaha |
| POC extension: 925-372-2529 |
| Location of Construction: MTZ campus-AB5,AB6 and AB7 |
| Estimated Duration: 400 days |
| Additional Requirements and Description of Mitigation: This Project Includes the following: |
Demolish Bldgs AB5,AB6 and AB7, Construct Parking Structure Replacing Expiring Lease.
The Project is not connected to any existing Bldgs, and located approximately 200 meters from TBI and CREC(B20). A diagram showing the location of the construction site is enclosed for reference.
1-The construction area will be fenced out .
2-During the demolition activities water will be sprayed to keep the dust down.
| Project Number: 612-165 | |
| Date1_af_date: 1/21/2021 | |
| 2020-06-25T10:28:43-0700 | |
| GARRETT S. OLVERA 1014406 |
| 2020-06-25T12:17:39-0700 | |
| JEFFREY S. DAILEY 459086 |
| 2020-06-25T10:53:31-0700 | |
| George Ponce 362482 |
| 2020-07-10T09:27:16-0700 | |
| Jonathan L. Bassignani 326635 |
| Date6_af_date: 6/25/20 |
| Date7_af_date: |
| Date8_af_date: 6/25/20 |
| Date9_af_date: 7/10/20 |
| Check Box1: Yes |
| Check Box2: Off |
| Check Box3: Yes |
| Check Box4: Off |
| Check Box5: Yes |
| Check Box6: Off |
| Check Box7: Yes |
| Check Box8: Off |
| Check Box9: Yes |
| Check Box10: Off |
| Check Box11: Yes |
| Check Box12: Off |
| Check Box13: Yes |
| Check Box14: Off |
| Check Box15: Yes |
| Check Box16: Off |
| Check Box17: Off |
| Check Box18: Yes |
| Check Box19: Yes |
| Check Box20: Off |
| Check Box21: Off |
| Check Box22: Yes |
| Check Box23: Off |
| Check Box24: Yes |
| Check Box25: Off |
| Check Box26: Yes |
| Check Box27: Off |
| Check Box28: Yes |
| Check Box29: Yes |
| Check Box30: Off |
| Check Box31: Off |
| Check Box32: Yes |
| Check Box33: Yes |
| Check Box34: Off |
| Check Box35: Off |
| Check Box36: Yes |
| Check Box37: Off |
| Check Box38: Yes |
| Check Box39: Off |
| Check Box40: Yes |
| Check Box41: Yes |
| Check Box42: Off |
| Text43: |
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