ATTACHMENT PCRA Re-slurry and Re-stripe 08-26-26.pdf

PCRA 612A4-27-013 Re-slurry and Re-stripe

Safety Permit Request #661

Initiated by Lye SaechaoPre-Construction Risk Assessment (PCRA)

NorCal Submitted 8/14/2026

1: Project Information 1.1: Project Number

612A4-27-013

1.2: Project Name *

Re-slurry and Re-stripe 1.3: Project COR/Lead Name (Last, First) *

Lye Saechao 1.4: Campus * x McClellan 1.5: Building/s

1.6: Room/s

N/A 1.7: Project Description *

The purpose of this project is to reseal and restripe three (3) existing McClellan Clinic parking lots at building 98 and 88. Phasing includes closure of one entire lot at a time and reopen when re-seal and re-striping is cured. Alternate parking is planned at Building 911.

1.8: Phases * x Yes 1.8.1: If yes, list phases with estimated start/stop dates below.

Phase I: B88 Parking Lot, from 11/16/26 to 11/20/26.

Phase II: B98 North Parking Lot, from 11/27/26 to 11/31/26.

Phase III: B98 South Parking Lot, from 12/3/26 to 12/7/26.

1.9: Start Date *

11/02/2026

1.10: End Date *

12/31/2026

2:

Infection Control

Pre-Construction Risk Assessment (PCRA) 1Continued on the next page.

2.1: Dust will be generated (i.e. from drilling, cutting, sawing, etc.) in or adjacent to patent care areas. * x No

2.1.1: If yes, complete ICRA and implement measures identified.

2.2: Work is being performed in a patient care area. * x No

2.2.1: If yes, complete ICRA and implement measures identified.

2.3: Construction area is greater than 110 ft2 and/or >3 ceiling tiles will be removed. * x No

2.3.1: If yes, complete ICRA and implement measures identified.

3: Fire/Life Safety 3.1: General construction, renovation, or significant repairs will take place in an occupied building. * x No

3.1.1: If yes, complete ILSM action items 6, 7, and 9.

3.2: Egress pathways or exits will be blocked or partially obstructed by construction activities, partitions, or Infection Control measures. * x No

3.2.1: If yes, complete ILSM action items 1, 8, 10, and 11.

3.3: Smoke or fire walls will be breached where a temporary seal cannot maintain barrier integrity. Consult Fire and Smoke Barrier Diagrams. * x No

3.3.1: If yes, complete ILSM action items 2, 3, 7, 8, and 9.

3.4: Building emergency responder or fire equipment, fire hydrant, standpipe or connection blocked or obstructed, or removed from service. Note: This includes both interior and exterior access. * x Yes

3.4.1: If yes, notify appropriate emergency services (Local Fire Department). Take actions to provide alternate access points, if possible. (Must be approved by Safety Department)

Pre-Construction Risk Assessment (PCRA) 2Continued on the next page.

3.5: Fire alarm, fire detection, and/or fire suppression systems will be impaired or shut down for more than four (4) hours. *

3.5.1: If yes. complete ILSM action items 3, 5, 6, 8, 9, 10, and 11.

3.6: Will multiple ceiling tiles and/or hard ceilings will be removed for more than 4 hours? * x No

3.6.1: If yes, complete ILSM actions items 3, 5, 6, 8, 9, 10, and 11.

3.7: Will a temporary fire watch for the building or section be required? * x No

3.7.1: If yes, complete ILSM action items 3, 8 and 10.

3.8: Will activities will result in missing or severely compromised shaft or vertical opening, or compromised fire door? * x No

3.8.1: If yes, complete ILSM action items 2, 4, 7, and 9.

3.9: It will be necessary to erect temporary construction partitions. * x No

3.9.1: If yes, Complete ILSM action items 1, 2, 4, 10, and 11.

3.10: Will construction affect the safety of exterior grounds (i.e. walkways, roads, use of cranes, etc.? * x No

3.10.1: If yes, complete ILSM action items 2, 7, 9, and 11.

3.11: Work includes the storage of combustible or flammable materials. * x Yes

3.11.1: If yes, ensure that items are stored in accordance with OSHA/DOT/EPA & VANCHCS requirements.

3.12: List any other life safety concerns/deficiencies not identified above, and/or information relevant to fire/life safety.

4: Work Conditions 4.1: Will hazardous materials be used? * x Yes 4.2: Disturbing, installing or removing building materials that may contain:

Lead (i.e. non-latex paint, x-ray shielding materials, etc.)

Asbestos (see asbestos survey, or consult with Supervisory Project Engineer, or Industrial Hygienist).

Silica containing materials, such as drywall, joint compound, asphalt, rock (granite), concrete, grout, mortar, sand, etc.

Bird or bat droppings.

Mold. * x No

4.2.1: If yes, establish written abatement plan that identifies appropriate engineering controls, work

Pre-Construction Risk Assessment (PCRA) 3Continued on the next page.

practices and procedures, monitoring requirements, and disposal/recycling requirements for the hazard(s).

4.3: Working on elevations (i.e. roofs without guardrails, scaffolds, aerial lifts, etc.). * x No

4.3.1: If yes, establish appropriate fall protection plan, including appropriate rescue procedures.

4.4: Entry into permit-required confined spaces (i.e. steam tunnel, utility vaults, sewer and storm water manholes, etc.) * x No

4.4.1: If yes, ensure that Medical Center Staff follow procedures outlined in the Confined Space

Entry Program.

Contractors must have an established program. Complete Confined Space Entry Permit and submit to Medical Center Safety Office.

4.5: Loud noise (i.e. have difficulty hearing the person standing next to you) or Vibration. * x Yes

4.5.1: If yes, ensure appropriate use of personal protection (i.e. hearing protection, anti-vibration gloves, etc.). Ensure that contractors have an established Hearing Conservation Program.

Coordinate work activities with affected (i.e. adjacent) work areas to minimize disruption and ensure that occupants are not exposed to high levels of noise.

4.6: 35. Welding or cutting. * x No

4.6.1: If yes, obtain hot work permit. Use local exhaust ventilation (i.e. smoke eater) for welding inside Medical Center. Identify and use proper PPE.

4.7: 36. Operation of gas powered equipment. * x Yes

4.7.1: If yes, the use of gas powered equipment inside buildings is not permitted. Ensure appropriate ICRA controls are in place. Avoid placing adjacent to building air intakes, windows, or louvers. Coordinate activities with affected areas.

4.8: 37. Any hazard(s) to others not identified above, or information relevant to any of the identified hazards.

Parking lot asphalt sealer will consist of fibrated chemical type asphalt base binders and fillers.

5: Security

Pre-Construction Risk Assessment (PCRA) 4Continued on the next page.

5.1: Work impairs building security systems, locking systems, or alarms. *

5.1.1: If yes, work with Police and Clinical area impacted. Ensure alternate methods of assuring security are maintained and acceptable to both Police and Clinical areas. Fully brief contractor regarding compliance with all requirements.

5.2: Work performed in restricted access areas (i.e. Pharmacy, Armory, Warehouse, etc.) * x No

5.2.1: If yes, work with Police and Clinical area impacted. Ensure alternate methods of assuring security are maintained and acceptable to both Police and Clinical areas. Fully brief contractor regarding compliance with all requirements.

5.3: The contractor will store supplies and/or equipment on site. * x Yes

5.3.1: If yes, ensure that contractors are aware that they are responsible for their equipment and supplies. Contractors should 1) secure, 2) label/mark equipment (with company name or logo), and 3) maintain an inventory of equipment (including make, model, and serial number) and supplies.

6: Utilities Shut Down 6.1: Normal Power * x No 6.1.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of electrical services. Ensure lock out / tag out is documented by the contractor or work group performing the work.

6.2: Emergency Power * x No 6.2.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of electrical services. Ensure lock out / tag out is documented by the contractor or work group performing the work.

6.3: Heating Ventilation Air Conditioning (HVAC) * x No 6.3.1: If yes, identify areas impacted by this shut down. Notify impacted parties. Identify lock out / tag out points for the isolation of all energy sources. Determine if temporary heat or cooling is required for the area. Ensure temporary services provided and that sufficient power and exhaust points are available.

Pre-Construction Risk Assessment (PCRA) 5Continued on the next page.

6.4: Plumbing *

6.4.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of all energy sources. Notify impacted parties. Determine if temporary services are required for the area and provide those services.

6.5: Medical Gas (oxygen, air, or vacuum) * x No 6.5.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for the isolation of all energy sources. Notify impacted parties. Ensure clinical services have as much notice as possible to line up alternate sources and obtain additional tanks, pumps or compressors as needed.

6.6: Nurse Call * x No 6.6.1: If yes, identify areas impacted by this shut down. If necessary, follow guidelines in MCP 138-08 (Utility Management Program) for alternate methods to be used in a system outage.

6.7: Elevator * x No

6.7.1: If yes, provide advanced facility wide notice of and estimated length of time of outage.

6.8: Water * x No 6.8.1: If yes, identify areas impacted by this shut down. Identify lock out / tag out points for system isolation for the work to be done. Notify impacted parties. Ensure clinical services have as much notice as possible to line potable water from other sources. Consult MCP 138-08 (Utility Management Program) for additional guidance and options to allow functionality during the outage.

6.9: Sewer * x No 6.9.1: If yes, identify areas impacted by this shut down. Review use of sanitary system in the area impacted. Develop contingency plans for the loss of use of the sanitary system for toileting, hand washing, and other uses. Coordinate work efforts with GEMS and Manchester Water Works.

6.10: Telephone * x No

6.10.1: If yes, coordinate this work with the Chief Information Officer or designee.

6.11: Computer *

Pre-Construction Risk Assessment (PCRA) 6Continued on the next page.

6.11.1: If yes, coordinate this work with the Chief Information Officer or designee.

6.12: Water Tower * x No

6.12.1: If yes, identify lock out / tag out points for system isolation for the work to be done.

Coordinate work efforts with GEMS and Manchester Water Works.

6.13: Roof Drains * x No

6.13.1: If yes and work is widespread, coordinate with GEMS to assess compliance with

Stormwater permit.

6.14: Storm Drains * x No

6.14.1: If yes, coordinate work efforts with GEMS to assess compliance with stormwater permit.

6.15: Hydrants * x No

6.15.1: If yes, coordinate work efforts with Maintenance and Repair, Safety, and, if necessary, Manchester Water Works.

7: Environmental

7.1: NPDES *

x No

7.1.1: If yes, file Notice of Intent (NOI) to obtain NPDES Stormwater Construction General Permit from EPA. Prepare Stormwater Pollution Prevention Plan (SWPP). Provide copies to GEMS.

7.2: Disturb area with 100 feet of wetlands or water body. * x No

7.2.1: If yes, must comply with Wetlands Protection Act. May need to file Notice Of Intent or

Determination of Applicability. Contact GEMS.

7.3: Waste * x No

7.3.1: If yes, manifest is required for hazardous waste. GEMS Manager is the generator signatory.

Report construction waste/recycling volumes.

7.4: Staging waste storage containers. * x Yes

7.4.1: If yes, containers must be covered when not in use/overnight. All containers must be at least

35 feet from the building.

Pre-Construction Risk Assessment (PCRA) 7Continued on the next page.

7.5: Potential discharge from Stormwater runoff or connections. *

7.5.1: If yes, use of temporary environmental controls for runoff, availability of spill kits. Report spills to GEMS Manager.

7.6: Sewer system discharge (including any addition of equipment with drainage needs). *

7.6.1: If yes, notification of changes to facility wastewater discharge must be made to the City of

Manchester. Contact GEMS Manager to assess compliance with Wastewater Permit.

7.7: Air emissions (including fuel burning equipment). * x Yes

7.7.1: If yes, contact the GEMS Manager to assess compliance with Air Permit.

7.8: Refrigerant * x No

7.8.1: If yes, document reclamation and certified recycling for removal. Provide specifications on new equipment, including refrigerant charge volume, to GEMS.

7.9: Petroleum Fuel Storage (temporary or permanent) * x Yes

7.9.1: If yes, design of new fuel storage tanks > 55 gallons and associated piping must be approved by NHDES and have permit for installation and registration. Also, must be added to

VAMC SPCC Plan. Contact GEMS.

Any storage tanks <55 gallons require secondary containment, grounding, proper labeling, and must be covered. This is for TEMPORARY or PERMANENT tanks.

7.10: Legionella * x No

7.10.1: If yes, notify Housekeeping that flushing of the area will be required prior to reopening/commissioning.

7.11: Tie-In * x No

7.11.1: If yes, notify M&R Supervisor and/or Infection Control to coordinate flushing/testing requirements before tie-in.

8: Other 8.1: Close or limit access to parking lots or roadways. * x Yes

Pre-Construction Risk Assessment (PCRA) 8Continued on the next page.

8.1.1: If yes, complete Life Safety Assessment, and if necessary implement Interim Life Safety

Measures. Ensure compliance with MUTCD standards when working in roadways.

8.2: Noxious or unusual odors. * x Yes 8.2.1: If yes, identify what steps are to be taken to minimize impact.

All work is to be completed outdoors and at a distance from buildings. Odors should dissipate fairly easily and quickly.

8.3: Special communications with outside agencies will be required. Consider VSOs, SHPO, EPA, NHDES, local historical groups, city agencies, etc. * x No 8.3.1: If yes, identify any special communications that will need to be completed before, during, or after the project.

* = required field

Pre-Construction Risk Assessment (PCRA) 9This form was generated by LEAF on 8/14/2026