Attachment - PCRA 36C261-24-AP-4955.pdf

VHA Pre-Construction Risk Assessment (PCRA)

PCRA Introductory Information and Instructions

Use this template as a baseline for performing facility Pre-Construction Risk Assessments (PCRA) for

Construction, Renovation, and Maintenance work (referred to as the “activity” in this document). The template provides minimum requirements for categorizing activity type(s) and safety risk to determine the level of precautions needed to prevent impact related to Construction, Renovation and Maintenance on patients, employees, and contractors.

Ensure that the activity statement of work and any drawings available are used for the PCRA assessment and included in the project file with the completed PCRA.

Communication and coordination of all types of activity with affected areas are to be included among the control measures. The development of communication and coordination plans must begin during the activity planning phase.

Facilities may customize this template to incorporate site-specific information and requirements.

NOTE: This VHA PCRA template pertains specifically to non-infection-related safety for Construction, Renovation, and Maintenance activities. It must be used in conjunction with the VHA Infection Control Risk Assessment (ICRA) for the activity, if required, which specifically addresses infection risks outside the scope of this PCRA.

PERMIT: See the last page of this document for a fillable permit form to be used for posting at the activity site.

Activity

Location:

Building 1, 3 Floor, OR, SPU, and PACU Spaces

Activity Name, Number, andlor Brief Description:

593-19-3 10- Replace Flooring in OR, PACU, and Special Procedures

Table I - Construction. Renovation, andlor Maintenance Activity Type and Control Measures

NOTE: If any of the bulleted criteria in a higher activity type pertains to the work that will be done (even if the other criteria are in a lower type), use the higher activity type for the VHA PCRA.

Controls defined in Table 1 for the activity must be in place before the activity begins and maintained until work is completed and the area is activated. Control measures for each activity must also include the control measures in the preceding row(s).

As the activity progresses, a full re-evaluation of remaining activity type and risk is required prior to changing the level of control measures.

Activity Type determined from Table 1: Large Scale (3 Individual Phases)

Activity Type and Description Control Measures

Inspectionlupkeep generally defined as follows: 1. Immediately replace any ceiling tile, close . Work can be completed in a single shift, not to exceed 10 access panels, etc., upon completion of work.

hours. 2. Site visits of construction area are required

. Patients, employees and/or visitors may be in the area weekly by member of multi-disciplinary team.

depending on the activity. Site visits will be documented on standard checklist.

. Work that does not create dust or debris.

3. Site specific safety plan, task hazard analysis, . Work that does not create vapors or fumes. and hazard communication required to be

. Removal of ceiling tile or access to mechanical or electrical provided by the contractor and approved where chase for visual inspection that will not impair fire safety a contact is in place. For internal work the systems_and_are_limited_to_1_tile_per_50_square_feet_with_limited

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Small scale Construction. Renovation and general maintenance/repair work, generally defined as follows:

• Prolonged work that may take longer than a single shift but not exceeding six months.

• Patients and employees are not to be in the area until activity is completed.

• Work that creates some noise and vibration due to power tool use.

• Selective demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements that may o disturb asbestos, lead or silica o create the potential for falling objects o create vibration and/or noise in excess of 80 dB(A) in surrounding areas.

o cause penetrations in fire or smoke barrier

• Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing that requires utility outages or work on the steam system that may require:

o LOTO o The use of compressed gas cylinders

• Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that require LOTO.

• Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit, a single device and the installation of ductwork, diffusers, and terminal units for an area that may require:

o Work on ladders o Rigging, hoisting or lifting of equipment or materials overhead

• Modification of existing fire alarm and suppression systems requiring system outages and ILSMs or obstruction of exits and or impact on corridors.

• Architectural, structural, or any other work that may cause vapors or fumes such as:

o Roofing work o Flooring work o Painting or other large-scale use of such substances.

All control measures in the row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. Where construction, Renovation and maintenance are done in an accredited facility, and ILSM assessment is required to be done and ILSMs put into place in accordance with TJC LS.01 .02.01 and the local facility policy including Fire watch if necessary. Staff is trained and the ILSM is verified regularly

3. Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

Daily inspections of the site are to be conducted by the General Contractor or shop supervisor and documented on their daily log.

exposure time (not to exceed an hour for each tile) within the shop involved must work with Safety to ensure shift. proper precautions are in place.

• Minor interior updates (e.g., replacing floor or ceiling tiles, 4. Must address identified hazards and controls carpentry work to include hanging signage, and painting with that will be implemented to ensure minimal hand tools) that do not create vibration or noise. impact to patients, employees, contractors and

Limited building system maintenance that does not require facility.

Lock Out Tag Out (LOTO) such as plumbing on potable 5. Communication and coordination plan for all systems limited to faucet replacement, steam trap replacement affected areas etc. and electrical work such as replacement of bulbs, receptacles, or switches.

6.

Large-scale construction, renovation, or maintenance All control measures in the two rows above and generally defined as follows: the following Activity Hazard Analyses and

• Work exceeding 6 months in duration. Control Plans (check all that apply):

1. Excavation safety plan in place

• Patients and employees are not to be in the area until activity is completed.

2. Dust control plan in place 0

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• Excavation or heavy equipment use taking place 3. Pollution prevention plan in place Li o Dig safe required utility location 4. Dig safe paper work in place Li o Trench safety 5. Crane lift plan in place LI o Dust control plan a. Crane placement o Equipment exhaust, Noise, Vibration b. Crane swing

• Confined space entry required (permit required or not) c. Crane load evaluation

• Requires crane work 6. Fall protection plan in place and staff trained Li o General crane work 7. Confined entry plan in place and staff trained Li o Lift over buildings

• Includes elevated work o Roof work, fall protection o Window work, scaffolding and fall protection o Odor control

• Welding, cutting or use of torches requiring burn permits

• Demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC that may o require asbestos, lead or silica abatement o create the potential for falling objects o create vibration and/or noise in excess of 90 dB(A) in surrounding areas.

o cause breaches to fire or smoke barrier

• The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work that requires transport of significant materials through building and up elevators i.e., weight limits of floors and elevators

• Plumbing work requiring LOTO and system shutdown and startup such as the installation of:

o new medical gas systems, o steam/heating hot water, condensate systems, o Potable water and sanitary drainage, multiple sinks, showers and toilets including associated plumbing.

• Electrical work such as installation of electrical feeders, distribution panels, conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc. requiring LOTO and system isolation.

• Installation of fire alarm and suppression systems requiring outages of those systems and ILSMs or closure of exits/corridors

• Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls requiring lifting and support of equipment and systems.

Table 2. Affected Adjacent Area Assessment

In addition to the minimum precautions noted above for the Activity Type, it is critical that the activity be coordinated with the areas adjacent to the activity to ensure operations in those areas are not disrupted or impacted. List the adjacent areas in Table 2 below and develop activity-specific coordination plans and associated communication plans with each area to address activity work that could impact or disrupt the operation of the areas, in general as follows:

• If adjacent area is vacant (e.g., work outside, construction of new building, etc.):

o Coordination is typically not necessary other than potentially traffic flow and pedestrian access.

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• If adjacent area is non-continuously occupied (e.g., areas where outpatient care is provided, employee health, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., conduct work after hours).

• If adjacent area is occupied continuously (e.g., areas where inpatient care is provided, residential areas such as Community Living Centers, etc.):

o Develop a list of activities that will potentially impact or disrupt the operation of the area (e.g., work involving noise, vibration or exit obstruction) and meet with POC to coordinate execution of work in a way that mitigates the impact (e.g., move affected party temporarily).

Area Service(s)IType(s) of Point of Contact POC Contact Construction

Area(s) (POC) Information plan

(e.g., OR, Unit/Ward, corn mu nicated

Sterile Processing, to POC?

Administrative,_etc) *

OR, SPU, PACU Crystal Sandoval 702-863-6874 Yes crystal.sandoval@va.gov

Activity Area** Donna Rau 725-500-3352 donna.rau@va.gov

Area Above NA (Maintenance NA Space)

Area Below SPS Raymond Miles 702-513-4634 Yes raymond.milesva.gov

Waiting area/Hallway Crystal Sandoval 702-863-6874 Yes (OR) crystal.sandoval@va.gov

Adjacent Area I Donna Rau 725-500-3352 donna.rau@va.gov

Office/Cath Lab Crystal Sandoval 702-863-6874 Yes (OR/Cardiology) crystal.sandovalva.gov

Adjacent Area 2 Richel Burog 702-409-8491 richel.burogcva.gov

Office/Hallway (Medical Crystal Sandoval 702-863-6874 Yes Services) crystal.sandoval@va.gov

Adjacent Area 3 Donna Rau 725-500-3352 donna.rau@va.gov

Adjacent Area 4 NA (Exterior Wall) NA

* There may be more than one Service/type of area for each row. List all. The information entered on this table must be used in the ICRA if required.

** List the area(s) in which the construction/renovation/maintenance activity will occur.

Infection Control Risk Assessment (ICRA)

Consult with Infection Prevention and Control regarding the assessment of potential infection risks associated with the activity and the need for control measures. See VHA Directive 7715 and the VHA ICRA Template for more information.

Is an ICRA required for the Activity? Yes No EJ

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Pre-Construction Risk Assessment (PCRA) Permit This oaae must be posted at the entrance to the project area, or other desiqnated area

Unique permit number:

Project manaqer Contact phone number Contractor or lead shop

Activity Type

Inspection/Upkeep

Small-scale

Large-scale

*The location of all Activity Hazard Analyses and Control Plans (excavation, dust, pollution, shall be identified on this permit and shall be made available to all workers on the job.

etc.) as applicable

702-241-9729

Location and brief description of 593-19-310 - Replace Flooring in OR, PACU, and Special Procedures construction/renovation/maintenance Mariorie Winemiller I Project start date 1 Apr 2025

I Completion date

Activity Type Inspection/Upkeep, Small-scale, or Large-scale) Large Scale (3 Phases, separated by 1 month each)

Permit expiration date 1 31 Dec 2025

31 Dec 2025

Control measures to be in place for the duration of the activity (Check the box for the Activity Type to indicate the Control Measures)

1. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

2. Site visits of construction area are required weekly by member of multi-disciplinary team. Site visits will be documented on standard checklist.

3. Site specific safety plan, task hazard analysis, and hazard communication required to be provided by the contractor and approved.

4. Must address identified hazards and controls that will be implemented to ensure minimal impact patients, employees, contractors and facility.

5. Communication and coordination nlan for all affected areas All controlr’ in th row above and the following:

1. Hazard communication chemical inventory required to be provided by the contractor and approved.

2. ILSMs in place and staff trained on situation

3. Hot Work or burn permits in place and staff trained

4. LOTO procedures in place and staff trained on their use

5. Site visits will be reviewed using the criteria in standardized guide.

6. Daily inspections of the site are to be conducted by the General Contractor and documented on their daily be.

All controJ mcI.r in both rows above and the following Activity Hazard Analyses and Control Plans as applicable (check all that apply):

1. Excavation safety plan in place LI

2. Dust control plan in place

3. Pollution prevention plan in place

4. Dig safe paperwork in place LI

5. Crane lift plan in place LI

a. Crane placement

b. Crane swing

c. Crane load evaluation

6. Fall protection plan in place and staff trained LI

7. Confined entry plan in place and staff trained LI

Additional requirements:

Is an Infection Control Risk Assessment (ICRA) required for the Activity? Yes No 0 Digitally signed by PAOLO

Infection Prevention and Control signature: PAOLO CARLO CUBELO CARLO CUBELO

Date: Date: 2024.0R.l 407:01:42 -0700

Project Manager signature MARJORIE WINEMILLER Digitally signed bYMARJORIE WINEMILLER Date Date: 2024.08.13 15:43:08 -0700

DateSafety Officer signature tDate Chair, Construction Safety Committee signature

VHA-PCRA-2023-1 .0