Attachment Q - ILSM and Hot Work Permit.pdf

VA LONG BEACH HEALTHCARE SYSTEM, Long Beach California

HEALTHCARE SYSTEM POLICY 003S-04

ISSUE DATE: January 2020

INTERIM LIFE SAFETY MEASURE (ILSM)

1. MAJOR POLICY CHANGES: Update the ILSM Assessment Form to ensure incorporation of the latest elements of performance for LS.01.02.01 of The Joint Commission (TJC) Standards Manuals, inclusive of life safety code deficiencies during periods of construction, renovation, and maintenance activities.

2. PURPOSE: To establish criteria for evaluating and determining when, and to what extent, implementing Interim Life Safety Measures are necessary and required, and to protect occupants when hospital identifies Life Safety Code (LSC) deficiencies that cannot be immediately corrected, or during periods of: construction, rehabilitation, renovation, scheduled and emergency maintenance activities.

3. POLICY: It is the Veterans Affairs Long Beach Healthcare System’s (VALBHS) policy to ensure the highest level of safety is attainable; anytime life safety protection components are impaired and meet the provisions of the Interim Life Safety Measures. As set forth by TJC, during: periods of construction, rehabilitation, renovation, scheduled and emergency maintenance activities. The need for an ILSM will be addressed during: 1.) All project(s), in the development stage. 2.) When deemed critical and in the event of an emergency, and evacuation. The ILSM will be continuously evaluated and maintained throughout the duration of the construction, rehabilitation, renovation, and maintenance phases. ILSMs apply to all VALBHS employees, visitors, and associated contractors; to include workers within the construction zone areas, and any adjacent areas that may be affected. Both interior and exterior areas are covered by this ILSM policy. The intent of the ILSM is to provide, situational awareness, and provisions to put in place compensating measures; when the requirements of the Life Safety Code cannot be immediately met.

4. DEFINITIONS:

a. Interim Life Safety Measures (ILSM) - A series of actions required to temporarily compensate for existing routes and/or hazards posed by existing Life Safety Code deficiencies.

b. Emergency Response Equipment or Systems - For purposes of this policy the emergency response equipment or systems consist of the fire alarm, fire suppression, fire notification, or fire protection systems; the compartmentalization of any facility, e.g. the fire or smoke doors, exit doors, fire or smoke door closures, exit stairwells, egress paths, and any device that support the fire or smoke doors; any other portion of the fire barriers, smoke barriers, and anything that affect the functional arrangement of the compartments.

c. Fire Watch – The assignment of a person or persons to an area for the express purpose of monitoring conditions that may contribute to fire hazards and the ability to initiate emergency fire response notification to the immediately affected building occupants, fire alarm activation, support facility fire response plan in conjunction with fire department; preventing a fire from occurring, extinguishing small fires and protecting the public from fire or life safety dangers.

d. Immediate – A quick response to an observed hazard that requires a deficiency be corrected as soon as humanly possible. If the deficiency is not corrected within a reasonable time in the same day, e.g. one business day then the ILSM assessment form is completed and presented following the procedures outlined in this policy and the NFPA 101 Life Safety Code 2015 edition.

HSP 003S-04

5. PROCEDURES:

a. Pre-construction Risk Assessment - Performed well in advance, before any work is performed to identify the potential risk the project may create for patients, staff; emphasizing on construction activities that may disrupt healthcare systems, impacting patient care and life safety. Giving the project team an opportunity to account and schedule probable ILSM action, and utility shut down request (SDR) consideration.

1) Infection Control Assessment - Coordinate with Engineering Contracting Officer

Representative (COR), to inspect and establish additional ILMS measures; as they relate to the PICRA (preconstruction risk assessment for construction and renovation) & ICRA (infection control risk assessment for construction and renovation) processing, ensuring optimal infection control condition. Meeting the requirements of Infection Prevention & Control Guidelines, Section One - 22.

b. ILSM Initiation - Engineering staff (i.e., Project Engineers, Unit Supervisors, Section Chiefs), Contracting Officer Representatives (CORs), Office and Information Technology and other respective staff shall initiate and prepare the ILSM Assessment Form prior to the construction or renovation or upon identification of a Life Safety Code deficiency because of construction, repair, or maintenance activities.

c. Mandatory ISLM Action - When a fire alarm system is out of service for more than 4 hours out of a 24-hour period, or a fire suppression system is out of service for more than 10 hours, out of a 24-hour period; in an occupied building. The Facility Officer of the Day (FOD), COR or Chief of Facility Operations will immediately notify Chief of Engineering Service, the Chief of Occupational Safety and Emergency Service (OSEMS), and Executive Management.

d. Required ILSM Assessment Criteria - When Life Safety Code deficiencies cannot be immediately corrected or during periods of periods of construction, rehabilitation, renovation, scheduled and emergency maintenance activities; the following shall be implemented using the ILSM Assessment Checklist (Attachment A). The Life Safety Standards will be evaluated on all construction projects or deficiencies using the following criteria:

1) Pre-ILSM Evaluation - Prior to any work being performed, OSEMS in concurrence with the appropriate Engineering staff supervisor or Contracting Officer Representative (COR), shall use the ILSM checklist to evaluate all reasonably potential construction project life safety deficiencies, to determine the extent of provision to put in place as required to effectively compensate for deficiencies.

2) Shutdown Requests (SDR) - COR, Resident Engineer (RE), or equivalent, must coordinate and schedule in advance, with affected stakeholders, prior to isolating, securing, or disabling of: fire alarm, fire suppression, or utility systems. At minimum, compliance with the General Safety requirements specification 01 35 26 is required, and fire alarm system impairments procedures shall comply with NFPA 72. OSEMS must be notified before SDR, and immediately when SDR is complete; when impairment is fully restoration.

e. ILSM Checklist (Attachment A) - An assessment tool used to evaluate LSC deficient situations, to determine if the degree of deficiency warrants ILSM action, and to determine what specific provisions and compensating measures are required to minimize the effects of the LSC deficiency. Where a process that contributes to LSC deficiency is identified, and the deficient elements are compared to the provisions, to determine what appropriate activity to implement. If there are LSC deficiencies, an ILSM assessment will be completed for the following:

1) Prior to all construction, rehabilitation renovation, or schedule of maintenance activities.

2) Projects which may compromise fire alarm and suppression systems.

3) Projects that may compromise means of egress or affect any fire protection component.

f. ILSM Notifications

1) The Chief of OSEMS and Engineering are immediately informed, of any emergency ILSM action. The FOD initiates after hours ILSM implementation and provides notification to the local Long Beach Fire Department; who is the authority having jurisdiction (AHJ).

g. Implement Applicable Provisions & Compensating Action

1) The COR and OSEMS shall ensure scope of work life safety deficiencies are fully captured on the ILMS assessment, to include understanding of all applicable provision to be put I place, before approval is proved.

2) As necessary, resulting from ILSM assessment: OSEMS and the project COR shall provide and schedule awareness briefings, orientations, meetings related to ILSM hazards. Conduct additional training to promote awareness of building deficiencies, applicable provisions, substitutions and alternative or temporary egress path; construction hazards, and temporary measures implemented to maintain fire safety, to affected personal. Especially during construction, rehabilitation, renovations and emergency maintenance.

3) The COR shall utilize Attachment D: ILSM Map Plan, as a template; for the purposes of effectively posting ILMS conditions in affected areas. Incorporating the latest building drawings, the map plan must delineate alternative available emergency evacuation exit egress paths and location; and/or intermediate compensating action measure, for affected occupants. Print color ILSM map plan on minimum dimension of 11 X17. Each ILSM submission, requires new map submittal, to capture any changes and updates; to ensure most current egress identification. The reverse side of checklist can be used to convey prior ILSM other than map conditions.

4) If the map plan drawing piece can’t be captured legibly, on a one page as indicated above;

at minimum post: 1. Fully Approved and signed ILMS checklist only (attachment A). 2. The building drawing map plan that delineates: identified locations of alternative exits, and or acceptable immediate life safety compensating measure.

5) All ILSM postings must be laminated or incased and posting in the affected areas.

h. Approval

1) Written approval and coordination with respective personnel, as indicated on the ILSM

Assessment Form (attachment A), in order of 1 -5; shall be completed prior to final approval submission to the Chief of OSEMS, or designee.

i. Monitoring & Compliance - The Project COR is responsible for inspecting the work site during daily activities on the facility during construction project, during tour of duty, and weekend or holidays when the contractor(s) are required to work those days. All inspections shall be documented in the provided. The ILSM is a living document and shall be continuously updated as project progress or conditions change.

1) Monitor hot work operations and ensure process and documentation is compliant with facility’s hot work permitting procedures, with properly trained fire watch (Attachment C).

2) All fire alarm components, detection and suppression systems shall be kept clean and maintained in working order. If a smoke detector is authorized to be covered, it must be uncovered at the end of each workday. If a temporary system is required, prior written notification and approval shall be given and obtained from Chief, Engineering Service or designee. The temporary system must comply with all current codes and be inspected and tested at least monthly. Initiate a fire watch when a fire alarm system is out of service for more than 4 hours out of a 24-hour period, or a fire suppression system is out of service for more than 10 hours, out of a 24-hour period; in an occupied building. For construction related fire alarm systems that are observed inoperable or impaired, the contractor is required to provide a fire watch.

i. Increased surveillance is implemented with a fire watch. Form Attachment B, shall be used to document fire watch monitoring activities.

ii. Contractor fire watch personnel must be competent by proof of specialized fire watch training, not limited to, but inclusive of: fire prevention, familiar with affected areas of building occupants, VALBMC Fire Response Plan, fire department notification techniques, and they should understand each fire safety situation for public education purposes. Contractors will provide and document fire watches within the scope of their works or projects using Attachment B or equivalent form that must contain, at a minimum all required areas to monitor. The log of actions shown on Attachment B will be utilized to document the fire watch monitoring activities.

j. Fire watch can be assigned to anyone cognizant of the conditions of the ILSM and the ability to recognize life safety hazards. The FOD, VA Police and those trained by OSEMS, may provide fire watches during emergencies, off-shifts, weekends, and holidays. ILSM Closeout – Before project completion, turnover and return to occupancy/full use, COR must verify that all ILSM life safety deficiencies have been corrected.

6. RESPONSIBILITITIES:

a. Occupational Safety and Emergency Management Service (OSEMS)

1) The Chief of OSEMS will notify the Long Beach Fire Department when a fire alarm system is out of service for more than 4 hours out of a 24-hour period, or a fire suppression system is out of service for more than 10 hours, out of a 24-hour period, in an occupied building. The Fire & Life Safety PM will conduct one additional fire drill per shift (tour of duty) per quarter.

2) Chief of OSEMS or designee, is responsible for assisting the COR, M&O (the Chief of

Maintenance & Operations) to evaluate projects with anticipated ILSM action, as necessary to determine the extent of the life safety deficiencies, hazards, and reasonable concurred provision(s) to compensate, using the ILSM checklist and developed mitigating procedures for implementation.

If an ILSM is found to be necessary for the project, the COR will generate, process, implement, enforcement, and maintain documented ILSM.

3) The Chief of OSEMS or designee is responsible for reviewing the ILSM assessment checklist evaluation, to ensure with the requirements of applicable codes, standards, and regulations are met.

4) The Chief of OSEMS or designee is responsible for final review and approval the ILSM evaluations, and is responsible for ensuring the implementation, enforcement, and documentation complies with this policy.

5) The Chief of OSEMS is responsible for ensuring employees understand the ILSM program and carrying out timely notification to the Authority Having Jurisdiction (AHJ); through alarm activation and phone call.

6) The Chief of OSEMS will maintain ILSM documentation and ensure reporting of ILSMs to the Construction Safety Committee and Environment of Care Council.

b. Engineering Service

1) The Chief of Engineering will Initiate a fire watch if a fire alarm system is out of service for more than 4 hours out of a 24-hour period, or a fire suppression system is out of service for more than 10 hours, out of a 24-hour period, in an occupied building. Implement Fire watch and documented using form Attachment B.

2) The Chief of Engineering or designee is responsible for review and approval of the ILSM assessment checklist evaluation form, received by the COR, RE, and facilities M&O; to ensure the requirements of applicable codes, standards, and regulations are met and maintained

3) The Chief of Engineering or designee shall ensure the facility fire alarm notification system and suppression systems operate consistently and are inspected as required. Temporary fire alarm system equipment, or equivalent will be tested and inspected monthly, and shall be available as back up when the fire alarm system is impaired; the ILSM checklist (Attachment A) shall be reviewed by the Chief Engineer with approval signature. Affected supervisors and employees will be notified and will post the ILSM in the immediate area affected.

4) The Chief of Engineering or designee will ensure exits are unobstructed for egress. Provide access and post ILSM signage, identifying the location of alternative exits to everyone affected. Provide alternate access for emergency services. Ensure construction partitions are smoke tight and non-combustible temporary fire rated barrier materials that will not contribute to the development and spread of fire.

5) The Chief of Engineering will coordinate and have final approval of all utility shut down requests (SDR).

6) All necessary documentation will be maintained in the Engineering project files and will be readily available for inspections or upon request. Ensure that the copies of completed ILSM Assessment Forms and fire watches are provided to the OSEMS.

c. Construction Site Maintenance

1) Temporary construction partitions shall be built of non-combustible or limited combustible materials and be smoke-tight.

2) The respective PE, or Maintenance and Operation M&Os, and COR and/or Section Chiefs will evaluate the need for ILSM through the duration of the project.

3) Construction hazards may require additional firefighting suppressing equipment such as fire extinguishers. Contractors are responsible for providing and maintaining additional and appropriate fire extinguishers at the construction sites.

d. Inspections

1) Patient care areas will be inspected daily, and non-patient care areas inspected on a regular schedule by the COR throughout the duration of the project.

2) The COR and the Construction Safety Committee will inspect the construction sites under

ILSM for the removal of all excess debris, proper storage of construction materials, cleanliness, and proper removal of debris and combustibles.

3) The Chief of OSEMS will provide oversight of all Interim Life Safety Measures.

e. Training

1) OSEMS shall provide education and orientation to VALBHS staff and in conjunction with the

COR, for contractors, during the pre-construction phase, for special instruction(s), VALBMC policy and permits, and validate compensating measures for any special life safety impairment, to functional or compartmentalization features of the Healthcare System, when applicable.

2) Additional training shall be provided for firefighting equipment, such as fire extinguisher.

3) Is provided to VALBHS staff to promote awareness of existing Life Safety Code deficiencies, construction hazards, and ILSMs.

f. Forms

1) Attachment A: ILSM Assessment Checklist

2) Attachment B: Fire Watch Actions/Log

3) Attachment C: VALBHS FLS, Hot Work Permit

4) Attachment D: VALBHS ILSM Map Plan

7. REFERENCES:

a. The Joint Commission, Life Safety Chapter, LS.01.02.01 Life Safety, most current edition

b. NFPA 101, Life Safety Code, 2018 edition

c. VA Master Specification, General Safety 01 35 26.

d. DVAHC Long Beach, CA - Infection Prevention & Control Guidelines, Section One - 22.

8. RESCISSION: HEALTHCARE SYSTEM POLICY 003S-04, Interim Life Safety Measures (ILSM), JANUARY 05, 2018.

9. REVIEW AND FOLLOW UP RESPONSIBILITY: This policy will be reviewed annually by the Policy

Coordinator and Construction Safety Committee and reported to the Environment of Care Council (EOC). This policy will be recertified and reissued on or before TBD.

10. POLICY COORDINATOR: The Facility Chief of Occupational Safety and Emergency Management

Service (OSEMS), is responsible for the contents of this document.

Walt C. Dannenberg Medical Center Director

ATTACHMENTS:

A – ILSM Assessment Form, Revision January 2020.

B – Fire Watch Actions/Log, January 2020.

C – VALBHC FLS, Hot Work Permit, Revision January 2020.

D – ILSM Map Plan.

Attachment A

VA LONG BEACH HEALTHCARE SYSTEM

INTERIM LIFE SAFETY MEASURE (ILSM) ASSESSMENT CHECKLIST

WHAT (brief description of deficiency): __ WHERE (areas affected):

Building(s) #: Floor(s): Room(s)#:

FIX (corrective action planned):

WORK (description to be performed): _ _ PERMITS (in conjunction with): Hot work Above the Ceiling & Penetration Energized Work Permit N/A TIMELINE Implementation Date/Time: Completion Date/Time:

Deficient Life Safety Conditions (as a result of any construction / rehabilitation) YES NO N/A If YES, implement ILSM & applicable PROVISIONS

A Existing EXITS are obstructed. 3, 5, 9, 10, 12, 13, 14

B Emergency responders’ access is limited or impaired. 3,4, 5, 9, 12, 14

C Disruption of FIRE ALARM SYSTEM is greater than 4 hours in a 24-hour period. 2, 4, 5, 6, 7, 9, 13, 14, 15

D Disruption of FIRE SUPPRESSION SYSTEM is greater than 10 hours in a 24-hour period. 1, 2, 6, 7, 9, 10, 12, 13, 14,15

E Temporary construction partitions are erected. 8, 9, 10, 12, 13, 14

F Fire and smoke compartments will not remain intact. 9, 10, 12

G Demolition in construction area that generates major amounts of debris 7, 8, 9, 10, 12

H Doors locked against egress. 3, 4, 8, 9, 11, 12

I Fire exit stairs discharge improperly. 3, 7, 8, 10, 13

J Greater than 150 feet travel distance to an approved exit. 8, 9, 13

K Lack of two remote exits. 7, 8, 9, 10, 12

L Nonconforming building construction material. 6, 8, 9, 10, 11, 13,15

M Improperly protected vertical openings 8, 9, 12

N Penetrations in fire/smoke barriers. 7, 8, 9, 10, 11

O Corridor walls do not extend to the structure 8, 9, 11, 12

P Major renovation of an occupied floor. 3, 4, 5, 6, 8, 9, 11, 12,15

Q Replacing or repairing fire alarm system (out-of-service). 3, 4, 7, 8, 9, 11

R Replacing or repairing sprinkler system (out-of-service) 2, 5, 6, 7, 9, 10, 13,15

S Significantly modifying smoke or barrier walls. 5, 8, 9, 11, 12

T Blocking off an approved exit 3, 4, 5, 9, 12, 13

U Disconnecting alarm devices 4, 5, 7, 8

V Other (specify):

PROVISIONS: To put in place, to effectively COMPENSATE Life Safety Deficiency that cannot be immediately corrected.

1. Ensure the Chief of OSEMS provides notification to LB Fire Department (or other emergency response group, e.g., VA Police), when a fire alarm (FA) or fire suppression (FS) system is out of service more than 4 hours (FA) or 10 hours (FS), in a 24-hour period: in an occupied building (notification is documented).

2. Initiate a fire watch when: a fire alarm system is out of service for more than 4 hours, w/in a 24-hour period, or a fire suppression system is out of service more than 10 hours in a 24-hour period in an occupied building. Utilize Attachment – B (VALBMC Fire Watch Action Log), to document Fire watch / times.

3. Ensure access and post signage identifying the location of alternative exits to everyone affected.

4. Ensure alternate access for emergency services.

5. Inspect exits in affected areas on a daily basis.

6. A temporary but equivalent fire alarm and detection systems shall be provided when a fire system is impaired. Ensure fire alarm and detection systems are in good working order.

7. Provide additional firefighting equipment. Write type and location of firefighting equipment:

8. Ensure temporary construction partitions are smoke tight or made of noncombustible or limited-combustible materials that will not contribute to the development and spread of fire.

9. Smoking is NOT allowed at VALBMC. Increase surveillance of: buildings, grounds, & equipment storage; w/ extra attention to construction areas, excavations, & temp field offices.

10. Enforce storage, housekeeping, and debris-removal practices that reduce the building’s flammable and combustible fire load to the lowest feasible level.

11. Provide additional training to those who work in the hospital on the use of firefighting equipment.

12. Conduct one additional fire drill (tour of duty) per quarter.

13. Conduct education to promote awareness of building deficiencies, construction hazards, and temporary measures implemented to maintain fire safety.

14. Train those who work in the affected areas and construction personnel to compensate for impaired structural or compartmental fire safety features.

15. Inspects and tests temporary systems monthly. Document completion dates of tests.

Signatures of Persons Implementing (sign/date):

1.Initiator/COR: 2. General Contractor Competent Person:

3. Project Section/Unit Supervisor: 4. Chief/M&O

5. APPROVED by (Chief of ENGINEERING): Date:

6. FINAL APPROVAL (Chief of OSEMS): Date:

Revised January 2020

Attachment B VA Long Beach Medical Center

. FIRE WATCH ACTION LOG

Initiator: Date: Phone#:

Reason for the fire watch (example: Loss of: Fire Alarm >4 hr. w/in 24 hr., fire suppression >10 hr. w/in 24 hr., hot work, obstructed exit, etc.):

Applicable HOT WORK Permit Approved and Posted? Yes No N/A

Are there Combustible or flammable materials in the area, that can contribute to a potential fire hazard (ex: O2 in use/stored, flammable gas, ventilation systems, excessive combustibles materials/boxes, etc.)? Yes No If yes, how is potential fire contributor/hazard mitigated?

Potential ignition sources in the area to monitor (ex: hot work, grinding, sparks, welding, torch cutting, etc.)?: None

Fire Alarm / Suppression System Status Is fire alarm , detection , and fire suppression systems operational? Yes No If no, component down

If NO, is a temporary equivalent system provided in place, in lieu of impairment? Yes No Specify

Has LBFD been notified by the OSEMS Chief? Yes No N/A Date: Time: Notified LBFD POC:

Is the temporary equivalent or system(s) provided, inspected and/or tested monthly? Yes No N/A

Applicable interim life safety measures are compliant? Yes No N/A If NO, what corrective action taken to for non-compliance/or to mitigate? __

FIRE WATCH MONITORING LOG

Building(s): Floor(s): Room(s):

Frequency of the fire watch: 4 Hr. , 8 Hr. , 24 Hr. , Other Hr.

Fire Watch 1 (print, first/last): Fire Watch Trained to fulfill Duties? Yes No

Fire Watch 2 (print, first/last): Fire Watch Trained to fulfill Duties? Yes No

Fire Watch 2 (print, first/last): Fire Watch Trained to fulfill Duties? Yes No

DATE (Month/Day/Yr:

TIME 7

A

A

A

A

A

P

P

P

P

P

P

P

P

P

P

P

P

A

A

A

A

A

A

A

1. Ensure free and unobstructed exits.

2. Access maintained to emergency services and for fire, police, and other emergency forces.

3. Enforce storage, housekeeping, and debris removal practice that reduce the building’s flammable and combustible fire load to the lowest feasible level.

4. Other or N/A :

INITIAL OF PERSON CONDUCTING FIRE WATCH.

Submit a copy of the completed form to the OSEMS office, at the end of day/shift, or upon termination of fire watch; whichever comes first. Any discrepancies shall immediately be reported to initiate corrective action, to the: 1.) Designated COR Service or HCG Supervisor. 2.) The Chief or designee, of Occ. Safety & Emergency Mgmt. Service (OSEMS).

Use back of this sheet for additional comments. Revised January 2020

Attachment C VA Long Beach Healthcare System (VALBHS)

Hot Work Permit

This permit requests must be submitted through the Fire & Life Safety PM, or Safety designee; 48 working hours in advance, before the start of any work. For emergency permit requests, call (562)826-8000 or ext. 3153.

Govt. or GC Requestor: Date of Request:

COR/Requester’s HCG/Shop: Phone#:

Est. start of work – Date: Time: Est. Compl. of work -Date: Time:

A. AFFECTED WORK AREA

Building(s) #: HCG/Service/Clinic:

Floor(s): Room(s)#: Other:

Scope of work to be performed:

B. PROVISIONS

Fire Watch Required? YES NO Is there an active ILSM Fire Watch *See NFPA 51B Figure A5.6.1, w/minimum 60 minutes post hot-work fire monitoring. Use VALBHC Fire Watch Action/Log att. B to document.

Will this work result in fire/smoke wall, floor, or ceiling penetrations?

If yes, complete the corresponding Above the Ceiling/Penetration Permit, and ICRA.

YES NO

Prior to requesting hot work permit:

The designated competent person or M&O Supervisor has conducted a pre-inspection of equipment, site and ensured workers performing the hot work/fire watch, are properly trained. YES NO

Before the start & During any hot work process:

The designated competent person or M&O Supervisor shall inspect the work area and confirm all precautionary measures are in place; to prevent IIP and fire: IAW with OSHA and NFPA 51B/241, etc. ACKNOWLEDGED (see reverse of permit)

Acknowledgments/Approvals (print, sign, date):

General Contractor (GC): Date:

Actual Start of work - Date: Time: Actual Compl. of work - Date: Time:

GC Supervisor Phone#: 24-HR Emergency Phone#:

*By signing, signee acknowledges and is responsible for compliance with OSHA, IBR CONCENSUS STANDARDS and VHA requirement, for all work processes performed to support hot work; while at VALBMC. Signee has read and understood reverse page information this permit.

1. Approved Disapproved : Date:

(Project Engineer: COR)

2. Approved Disapproved : Date:

(Section Chief/Shop Supervisor or RE)

3. Approved Disapproved : Date:

(Life Safety Officer)

4. Permit Expiration Date: Time:

(Life Safety Officer)

5. Quality Assurance: Date:

(GC & COR)

*Inspection of: 1.) completed hot work and 2.) Immediate/adjacent hot work areas. Revised January 2020

The VALBMC expectation is full cooperation in complying with our efforts to maintain optimal life safety condition. To mitigate potential ignition sources, or factors that may contribute to the development or spread of fire; throughout our facility. Providing a safe environment for our: a. patients, b. staff, c. students, and d. visitors.

I. General contractors, vendors and VA staff performing short/long term work, that requires aspects of permit, at the VA Long Beach

Healthcare System shall:

1) Obtain fully approved Hot Work Permit; prior to the commencement of any work.

2) Requests must be submitted to OSEMS 48 working hours prior to the start of any work. Permits are valid for 24 hours. On a case-by-case basis, the maximum length of any permit is 1 working week.

3) Must specifically include all work areas affected and thorough scope of work, for operation.

4) Ensure a copy of valid permits, are conspicuously posted at all work location; and readily available for inspection/verification, upon request.

5) Upon completion of hot work and after CG/COR’s final Q&A inspection. Permit is to be returned to the Safety Service’s Fire and Life

Safety PM to be filed: a.). Permit, b. Activity Hazard Analysis (AHA), c. SDS & MFG. Specifications (where applicable).

II. COMPLIANCE PRECAUTIONS: 1.) All Hot work processes are subject to applicable general safety, local policies & federal standards; and related environmental responsibility. 2.) Control, maintain and assure permanent record of any hot work operations. 3.) Ensure general safety precautions are addressed, such as, but not limited to:

PRECAUTIONS:

• Sprinkler in service (or appropriate measure in place/ILSM). Cutting and welding equipment maintained in approved manufacturing operating condition.

Utilities properly secured (ex: oxygen, LP gas, etc.). LOTO, energy controls as appropriate. PPE (ex: FR rated, eye light shielding, respirator, etc.). Requestor and applicable GC conforms to VALBMC policies and procedures. Contractors are responsible for maintaining their own company policy(s), for all work processes to support hot work; and provide the FLSPM with a copy of each.

WITHIN 35 FT. OF HOT WORK [see NFPA 51B A5.6.1(1)(a)-(b)]:

• Floor swept clean of combustibles. Combustible materials or flammable liquid. NO combustible materials or flammable liquids. Combustibles and flammable liquids protected with approved covers, guards, shielding and lockers. ALL wall and floor openings covered.

WORK ON WALLS OR CEILINGS:

• Covers suspended beneath work to collect sparks. Construction noncombustible and without combustible coverings. Any fire wall, ceiling, door penetrations shall be sealed with approved rated materials. Comply and file VALBMC: Above the Ceiling & Penetration Permit.

WORK ON ENCLOSED EQUIPMENT (TANKS, CONTAINERS, DUCTS, BOILERS, ETC.)

• Combustibles moved away from the opposite side of walls. Equipment cleaned of all combustibles. Containers purged of flammable vapors. Contractors are responsible for implementing all aspects of permit-required confined space program. To include: air monitoring, rescue, fall protection, etc.

FIRE WATCH (where applicable see NFPA 51 A5.6.1)

• Have available approved fire extinguisher on work site. Trained in the use of the equipment, documentation using VALBHC Fire Watch Action/Log attachment

B of ILMS HSP; and ability to in sounding the fire alarm.

FIRE & SMOKE ALARM SYSTEMS

• Before any life safety impairments, ensure ILSM process HSP 003-04 is adhered to, and adequate pre-coordination with stakeholders to support any shut down requests (SDR), or life safety deficiency; is afforded prior to the start of any work or SDR.

III. General contractor scope of work shall include job specific Job Safety Analysis (JSA), to mitigate and address identified risk (ex: PACM, ILSM, Fall Protection, Electrical Safety, etc.). Attach AHA to permit request for VALBMC Fire & Life Safety Program Managers review.

IV. 1.) Requestor ACKNOWLEDGE ALL (I, II, III): 2.) G.C. ACKNOWLEDGE ALL (I, II, III):

Attachment D

Building: Building 126, 2nd floor, Area Function: Main Lobby Entrance

Occupancy: Ambulatory Occupancy NFPA 101 Life Safety Code 3.3.188.1 (current use) & Life Safety Drawings.

Deficiency: Install Diverter for Pneumatic Tube System at corridor outside of waiting room. Dental waiting door and corridor portion will be closed and inaccessible. Travel distance to nearest exits will not be obstructed.

How will it be corrected: Evacuation routes have been marked to reflect the path the travel to alternate egress.

Projected Start Date: April 01, 2020

Projected Completion Date: May 01, 2020

Actual Completion Date: TBD

ILSM action to be taken

1. Laminated/encased, signage and/or directional signs are posted to indicate exit egress doors and exit routes.

2. Aisles and doors shall remain clear and unobstructed at all times.

3. Using Service/HCG supervisors or their designees shall inspect at the beginning and at the end of each shift to ensure that exit doors and egress paths are unobstructed and clear at all times.

4. The AOD/FOD shall be notified and perform and document fire watch hour after normal business hours and weekend shifts.

5. Using Service/Activity supervisors and managers shall ensure that employees, Veteran and guest, and volunteer are aware of the present condition.

6. Using Service/Activity supervisors and managers shall adjust emergency procedures and evacuation accordingly and educate staff members.

Any questions regarding this ILSM may be directed to the Fire & Life Safety Program Manager (562) 676-2236, the Chief, Engineering

Service at Ext. 1-3774 or the Occupational Safety & Emergency Management Service (OSEMS), at Ext. 1-5464.

North

OSEMS FLS PM: Milton Burnside Chief Engineer: Anthony Streletz

DATE ISSUED: April 01, 2020 NOTE: This sign shall remain posted in conspicuous locations and/or within the vicinity of the life safety deficient area and shall only be removed by authorized personnel: COR & OSEMS; and when the condition no longer exists or has been abated.

VA Long Beach Healthcare System

Interim Life Safety Measures (ILSM)

Fire Prevention and Life Safety Management

Intent: Interim Life Safety Measures (ILSM) is administrative or operational actions taken to temporarily reduce the hazards posed by existing Life Safety Code

(LSC) 101 deficiencies or construction activities. Implementation of ILSM is required in or adjacent to all construction areas and throughout buildings with existing LSC deficiencies. ILSM apply to all personnel, including construction workers, and must be implemented upon project development, and continuously enforced and kept current through project completion. ILSM are intended to provide a level of life safety comparable to that described in VALBHS Interim Life

Safety Measures Policy and applicable occupancy chapters of the LSC. Each ILSM action must be documented through written policies and procedures. Subject to revision to promote optimal conditions. Except as stated, frequencies for inspection, testing, training, and monitoring and evaluation must be established by the organization.

EXIT

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Area of work