ATTACHMENT G - MEDICAL CENTER ENGINEERING SHUTDOWN SOP.docx

SOP 04-02

Attachment H

UTILITY OUTAGES AND SHUTDOWN PROCEDURES

SOP 04-02

Oscar G. Johnson VA Medical Center

Iron Mountain, MI 49801

Service Line(s):

Engineering

Signatory Authority:

Effective Date:

Chief, Engineering Service

February 23, 2021

Responsible Owner

Recertification Date:

Chief, Engineering Service

February 28, 2026

1. PURPOSE AND AUTHORITY

a. To establish procedures for full or partial utility system outages, shutdowns and service interruption on the campus due to commencement of construction, scheduled maintenance, and repairs.

b. Engineering Service personnel, both maintenance and project managers, shall provide a fourteen (14) day notice to affected Services, if possible. As much notice as possible will be given before shutdowns or outages in an emergency or urgent and compelling need. This policy applies to all personnel in Engineering Service.

2. PROCEDURES

A. Utility Shutdown Requests:

1. Contractor will submit a Utility outage request to the email group indicated on the top of the Utility Shutdown Request Form - Attachment A, a minimum of 14 days prior to the requested date, longer if significant impacts. Request will be submitted using the outage request form.

2. Contractor will submit a Medical Gas outage request to the email group indicated on the top of the Medical Gas Permit to Work Form – Attachment F, a minimum of 14 days prior to the requested date, longer if significant impacts. Contractor shall also submit appropriate medical gas certification cards for all individuals working on the medical gas system attached to the Attachment F. Request will be submitted using the permit to work form.

3. Upon receipt of shutdown request, for construction projects, the COR will update the shared utility shutdown calendar via Outlook. M&R Supervisor will review and invite the appropriate shop to the upcoming review meeting.

February 23, 2021 SOP 04-02

4. Engineering COR and M&R staff shall have weekly meetings to discuss and review all submitted shutdown requests. During this meeting, the group will perform an assessment of the shutdown utilizing the Utility Shutdown Assessment Matrix Form – Attachment B to classify if the shutdown is a Minor, Moderate or Major shutdown. The following procedures shall be followed according to its classification. For all fire system shut downs Electronics and M&R staff will utilize the internal “Fire System Utility Shut Down form” (attachment H) for communication of shut down details and notification purposes.

a. Minor Outages:

1) During the weekly assessment meeting, M&R Supervisor and COR reviews request and approves/disapproves.

2) If approved, Engineering COR returns “approved” request form back to Contractor. If determined not to be approved, COR notifies Contractor with determination, reasons and/or provides optional dates to perform shutdown.

3) COR notifies affected Services and Engineering staff of the upcoming shutdown via email the morning of the shutdown, or as applicable.

4) Contractor coordinates with M&R Supervisor and COR the day of shutdown. Both parties perform the required shutdown and Contractor conducts the required work.

5) After the work is complete, the contractor coordinates with the Maintenance and Repair Supervisor and/or COR to review work performed. If accepted by VA Engineering staff, M&R returns the system back to normal operation.

6) Maintenance and Repair Supervisor and/or COR electronically files completed Utility Shutdown Checklist Form – Attachment D and any associated correspondence.

b. Moderate Outages:

1) During the weekly assessment meeting, M&R Supervisor and COR reviews request, scope of work being performed and begins creating the areas of impact list and completes Utility Shutdown Impact List – Attachment C.

2) M&R Supervisor submits final impact list to the COR. M&R Supervisor and/or COR meets with affected Services Chief and/or Managers of the upcoming shutdown to review impacts and obtain approval.

3) If approved, Engineering COR returns “approved” request form back to Contractor. If determined not to be approved, COR notifies Contractor with determination, reasons and/or provides optional dates to perform shutdown.

4) COR notifies affected Services and Engineering staff of the upcoming shutdown via email 24-hours prior to the scheduled shutdown. The day of the scheduled shutdown, M&R Supervisor and/or COR, notifies affected services by phone or in-person as a reminder.

5) Contractor coordinates with M&R Supervisor and COR the day of shutdown. Both parties perform the required shutdown and Contractor conducts the required work.

6) After the work is complete, the contractor coordinates with the Maintenance and Repair Supervisor and/or COR to review work performed. If accepted by VA Engineering staff, M&R returns the system back to normal operation and verifies system is running properly.

7) Maintenance and Repair Supervisor and/or COR electronically files completed Utility Shutdown Checklist Form – Attachment D and any associated correspondence.

c. Major Outages:

1) During the weekly assessment meeting, M&R Supervisor and COR reviews request, scope of work being performed and begins creating the areas of impact list and completes Utility Shutdown Impact List – Attachment C.

2) M&R Supervisor submits final impact list to the COR. M&R Supervisor and/or COR requests a meeting be scheduled by the Emergency Manager with Emergency Management committee and other applicable staff to review and discuss impacts, determine any mitigating procedures and obtain approval. Committee members shall sign Major Utility Shutdown Review Form – Attachment E, acknowledging shutdown and appropriate contingencies. If approved by the Committee, COR shall route Major Utility Shutdown Review form to the Associate Director, or designee for final approval.

3) If approved, Engineering COR returns “approved” request form back to Contractor. If determined not to be approved, COR notifies Contractor with determination, reasons and/or provides optional dates to perform shutdown.

4) Procedures Prior to the Day of a Major Outage:

a) COR or M&R Supervisor to generate a correspondence email that will be distributed by the Front office for review by the Chief Engineer, or designee. The email shall include the type of outage/shutdown, location and areas of impact, duration, start date and time, completion date and time, and contact information for the engineering staff responsible for the coordination of the shutdown. Approved correspondence will be routed to the “ELT Secretaries” email group for all employee distribution.

b) COR or M&R Supervisor shall write overhead announcements to be read by the AOD (if applicable). Overhead announcements are to be reviewed by the Chief Engineering Service or M&R Supervisor, or designees.

c) Review completed Major Utility Shutdown Review Form – Attachment E with the Chief Engineering Service or M&R Supervisor, or designees.

5) Procedures the Day of a Major Outage:

a) Engineering CORs are required to be present for utility outages on their projects to coordinate with the contractor and hospital. M&R Maintenance Staff will be present for outages related to utilities and service contracts they are the COR for and for shutting down all utilities for the Contractor.

b) Pre-outage Meeting - a prescheduled meeting, usually 30-45 minutes prior to the outages start time with the COR, M&R staff, Bio Med (if applicable) and contractors performing the work to review the schedule and timeline of the work to be performed.

c) Ensure contractor has paper copy of outage.

d) Distribute radios if needed.

e) If after house, meet with AOD and have him/her check with critical areas and sign the Utility Shutdown Checklist Form – Attachment D that it is OK to precede with outage.

f) Initiate the overhead announcements to the hospital (if applicable). COR to provide a paper copy of the announcements to police and the AOD.

g) Stay with AOD until 15-30 minutes after outage has begun to ensure no problems and provide AOD contact information.

h) Keep in contact with contractor during the outage. For long outages, hourly contact should be maintained.

i) 15-30 minutes prior to completion of the outage, report to the AOD's office and initiate overhead announcements the outage is coming to an end.

j) Once service is restored, remain with AOD for 5-10 minutes in case there are issues.

k) Do NOT release the contractor(s) until all issues have been resolved and all services restored, tested and there are no alarms. Complete Utility Shutdown Checklist Form – Attachment D.

l) Engineering COR (Project manager or maintenance staff) are to notify Assistant Chief of Engineering, M&R Supervisor and the Chief Engineering Service the outage was concluded successfully or if there were any issues with the outage.

m) M&R Supervisor and/or COR electronically files completed shutdown forms and associated correspondence.

d. Medical Gas Interruption/Shutdown

1) All maintenance, repair, and construction work on the piped medical gas and medical vacuum systems that will affect the quality, quantity, and continuity of the gas or vacuum will require a Medical Gas Permit-To-Work (Attachment F). The Facility’s plan shall include the following procedures prior to work beginning:

· The affected medical staff and facility administration is appropriately in communication prior to any work on the pied medical gas and vacuum systems.

· Alternative supply or adjustments in patient care arrangements are in place prior to system interruption, including monitoring, as appropriate, of the work being performed and the alternate arrangements in use.

· All work on piped medical gas and vacuum systems is performed by competent individuals holding appropriate qualifications for the work.

2) Engineering COR and M&R staff shall have weekly meetings to discuss and review all submitted shutdown requests. During this meeting, the group will perform an assessment of the shutdown utilizing the Utility Shutdown Assessment Matrix Form – Attachment B to classify if the shutdown is a Minor, Moderate or Major shutdown. Procedures A.3.A, A.3.B and A.3.C shall be followed according to its classification.

3) The affected portions of the system are to be correctly tested in accordance with NFPA 99 2021 5.1.12 and 5.1.13 and demonstrated to be acceptable for patient use. See Attachment G.

d. Fire Systems Utility Shut down form usage: For all fire system shut downs; Electronic or Suppression. The Engineering Electronics and M&R staff will utilize the internal “Fire System Utility Shut Down form” (attachment H) for the communication of shut down details and notification purposes.

1) The form shall be posted within Engineering until the shut-down is completed and then filed.

3. ASSIGNMENT OF RESPONSIBILITIES

A. Chief, Engineering Service: Responsible for the oversight and implementation of this policy.

B. Maintenance and Repair Supervisor: Responsible to ensure all maintenance staff are trained on this policy and comply.

C. Assistant Chief, Engineering Service: Responsible to ensure all projects section staff are trained on this policy and comply.

D. Work Leaders and Maintenance Shops: Responsible to understand with this policy and ensuring outage requests are submitted by contractors and staff, pre-outage checklists are complete, and outages are properly coordinated to ensure the safety of staff, Veterans, visitors and contractors.

E. Engineering CORs (Project Managers and Maintenance Staff): Responsible to understand and comply with this policy and ensuring outage requests are submitted by contractors, pre-outage checklists are complete, and outages are properly coordinated to ensure the safety of staff, Veterans, visitors and contractors.

F. Responsible Facility Authority (RFA): Responsible for the implementation of the piped medical gas and vacuum system requirements of, but not limited, to NFPA 99 2021, ASSE 6000 2018, CGA E-10 2018 and ANSI/CGA M-1 2018 for the health care facility including all medical gas, support gas and vacuum systems.

4. DEFINITIONS

A. Minor Interruptions/Shutdown: Expected to last no more than four hours and affects no more than one utility service. No risk to patients or staff.

B. Moderate Interruption/Shutdown: Utility for which there is a risk of injury to patients or staff if it should fail.

C. Major Interruption/Shutdown: Utility for which there is a risk of serious injury or death to a patient or staff member if it should fail.

D. Medical Gas Interruption/Shutdown: Any interruption or Shutdown of the Patient Medical Gas or Medical Support Gas Systems. Systems include Oxygen, Medical Vacuum, Medical Air, Non-Medical Air, Dental Vacuum, Carbon Dioxide, Nitrous Oxide and Nitrogen. Medical Gas Interruption/Shutdown: Any interruption or Shutdown of the Patient Medical Gas or Medical Support Gas Systems. Systems include Oxygen, Medical Vacuum, Medical Air, Non-Medical Air, Dental Vacuum, Carbon Dioxide, Nitrous Oxide and Nitrogen.

5. REFERENCES

None.

6. REVIEW

This SOP will be reviewed at minimum at recertification and including when there are changes to the governing document, VHA Handbook 1101-11(2). This review is documented on the OGJMC Quality Management SharePoint site (see https://dvagov.sharepoint.com/sites/iro/Policy/default.aspx). NOTE: This is an internal VA Web site that is not available to the public.

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of February 2026. In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

Arthur G. Ontto, P.E., CHFM Chief, Engineering Service NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: SOPs are available at: https://dvagov.sharepoint.com/sites/iro/Policy/default.aspx NOTE: This is an internal VA Web site that is not available to the public.

Attachments:

Attachment A: Shutdown Request Form Attachment B: Utility Shutdown Assessment Matrix Form Attachment C: Utility Shutdown Impact List Attachment D: Utility Shutdown Checklist Form Attachment E: Major Utility Shutdown Review Form Attachment F: Medical Gas Permit to Work Attachment G: Medical Gas Installation Testing Checklist Attachment H: Fire System Utility Shut Down

Attachment C

ILSM Measures required: Y / N (see attached if required) Shut down impact list / Risk Assessment:

UTILITY Shutdown Checklist - Oscar G. Johnson VA Medical Center COR: ________________________________________________________________________________ PROJECT: ____________________________________________________________________________ CONTRACTOR: ________________________________________________________________________ SHUTDOWN DATE: ____________________________________________________________________ SHUTDOWN TIME: _____________________________________________________________________ SHUTDOWN DURATION: ________________________________________________________________

1. Affected UTILITY: __ _____ _______________________________________________________

2. Affected SERVICES: ______________________________________________________________

call

Shut Down Protocol

STANDARD GROUP:

1 - Notify AOD 5 Minutes prior to shut down start

2- Follow up with AOD to verify OK to proceed with utility shut down

3 - Proceed with shutdown.

4 – Notify AOD ready to return utility to service, provide 5 minutes for AOD to verify OK to Proceed.

5 – Follow up with AOD to verify OK to proceed with returning utility into service

6 – Follow up with AOD to verify no issues present post shut down.

IMPACT GROUP:

COR: Notifications completed: ____________________________________________________ Date: _________________ Shutdown Start time: _________________________ Date: _________________ Utility Returned to Service: ____________________ Date: _________________

_________________________________ Date: _____________ Approved__/__Disapproved Chief, Engineering Service (or designee)

** Fill in the information requested and return to Chief, Engineering Service (or designee) at completion of work

the utility service.

____________________________________________ cc: Affected Services M & R Supervisor (Date)

Department of Veterans Affairs Memorandum Request for FIRE SYSTEM(S) - Utility Shutdown

Vendor/Contractor: _____________________________

Utility: ____ Fire Alarm System ____ Suppression System

Main Drain Test Required: Yes / No Work Order#_________________________________

Shut Down: a.m. /p.m. Date:

Utility Returned to Service: a.m. /p.m Date:

1. Area(s) Affected:

2. Monitor Points: _________

3. Purpose:

4. Notification: Check off pre- and post when completed.

SimplexGrinnell Central Monitoring 1-800-274-3932 Account # 210-7008

Safety Manager x32750

VA Police Service x32030 or pager 3##911

M&R Foreman x32220 or cell 906-282-1353

Boiler Plant x32250/32240

Electronics Shop x32299 or cell 906-221-4154

IM Fire Department 774-0622

VA Plumbers – 32215/32216 or cell 906-239-6112/906-239-9709

Emergency Mgmt. Coordinator x33834

Eng. Secretary x32200

Simplex Monitoring Impact:

Requestor: _____________________________

Approved/ Disapproved

Chief, Engineering Service (or designee)

Fill in the information requested and return to Chief, Engineering Service (or designee) at completion of work.

THIS NOTICE MUST BE POSTED OUTSIDE THE ENGINEERING OFFICE

Reviewed/RevisedMarch 16, 2018 image1.emf image2.png image3.emf image4.emf image5.emf