FAA Form 3900-18 04.16.2013.pdf

Pre-Construction Environmental and Occupational Safety and Health Checklist

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 1 of 8

INSTRUCTIONS FOR COMPLETING FAA FORM 3900-18

Section A. Purpose. FAA Form 3900-18, Pre-Construction Environmental and Occupational Safety and Health (EOSH) Checklist, is intended to be used to review construction, installation, and maintenance activities involving construction prior to commencement of work that potentially has EOSH impacts on NAS operations and employees. The organization that directly manages the construction project is responsible for completing the checklist. They shall coordinate with the appropriate District Office prior to commencement of the project. Actual work on the project (i.e., construction) may not be initiated prior to completion and review of the checklist. The form must be used, as appropriate, during critical phases of the work (e.g., during a mandatory pre-construction meeting). Emphasis should be placed on using this checklist as a tool to assess as well as reassess hazards as the work progresses.

1. Responsibilities: Responsibility for submitting the checklist may fall on several individuals depending on the work being performed.

a. For example, the District Office Manager will be responsible for District Office projects.

b. The engineer for Engineering Services projects.

c. The FMP manager for Field Maintenance Program (FMP) projects.

d. For turnkey projects managed by Headquarters organizations, the Headquarters program office will be responsible for submitting the checklist.

Section B. Work Summary Information. The individual/organization initiating the checklist will complete this portion of the checklist.

1. District Office: Name of the District Office.

2. Work Location: City, State, Airport, building, room within building.

3. Facility: Facility type, associated runway, facility ID.

4. Work Description: Provide a concise statement as to the nature of the work to be accomplished. Example:

Asbestos abatement of the control room attic.

5. Originator of Work: This is the individual/organization responsible for initiating the work (e.g., project engineer, senior engineer, technical support office).

6. Planned Start Date: Provide the expected start date of the work.

7. Expected Completion Date: Provide the expected completion date of the work.

8. Contractor Contact: Provide the name and telephone/pager number for a contractor representative who has the authority to make decisions and implement stop work/change orders. If the work is being accomplished by an FAA employee(s) or FAA contract employee(s), provide the name, organization, and telephone/pager number of the on-site lead (e.g., work order carrier, etc.).

9. Project/Design Representative: Provide the name for the designer of the work (e.g., Engineering Services project engineer, District Office engineer, Headquarters program manager for turnkey projects).

10. COTR/Specialist: Provide the name, organization, and telephone/pager number of the on-site lead (e.g., COTR, work order carrier).

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 2 of 8

11. District Office EOSH Contact: Provide the name and telephone/pager number of the person responsible for the occupational safety and health/environmental program for the District Office (e.g., SECM, District Office OSH Professional).

12. Facility Representative: Provide the name and telephone number for an ATO representative at the facility who has the authority to make decisions for facility management.

Section C. Evaluation: The District Office Manager or designee will determine whether the work will have a potential EOSH impact to NAS operations. The District Office Manager or designee must sign and date this section. If there is an impact (yes), complete the checklist. If there is no impact, proceed to Section I, Distribution of Copies, for distribution only.

Section D. Facility Procedures: The individuals/organization performing the work, and their contractors, along with the facility POC, must review all applicable facility specific procedures and plans.

1. Asbestos Contingency Plan: Determine the responsibilities of the personnel doing the work in the event of an incident that requires implementation of the asbestos contingency plan.

2. Hazard Communications: The personnel performing the work must be made familiar with the facility hazard communication program. Information such as material safety data sheets (MSDS) must be shared between the facility and the personnel performing the work.

3. Lockout/Tagout (LOTO): The work must be performed in accordance with the facility LOTO program.

Determine if the facility LOTO procedures require equipment to be locked out/tagged out by an FAA technician, or if the personnel performing the work will be allowed to LOTO the equipment.

4. Energized Work Permits: Applicable FAA facility, District Office, or regional energized work permits must be submitted by the individuals/organization performing the work, signed and posted at the work site. General note:

All work permits should be included in this document (e.g., hot work permit, welding, cutting, brazing).

5. Emergency Plans: Describe the responsibilities, including the points of contact, in the event of an incident that requires implementation of the facility Occupant Emergency Plan.

6. Impacts to Fire Alarm and Suppression Systems: Identify the Fire Alarm and Suppression System and instructions to avoid unintentional impact to it. If the work involves intentional impact to the Fire Alarm and Suppression System, determine what coordination has to be done to ensure no disruption of the NAS. Determine what interim life safety measures will be required during the project.

7. Confined Space Entry: Describe the facility procedures used in and around confined spaces. In addition, describe specific procedures for permit-required confined space in and around where the work will take place.

8. Work at Heights: Describe procedures for working at elevated surfaces (catwalks, towers, roofs) that may require fall protection procedures or equipment.

9. Restricted Areas Due to OSH Concerns: Describe those areas of the facility that have restricted access due to safety and health hazards (e.g., asbestos regulated areas, noise).

10. Bloodborne Pathogens: Describe the facility procedures for dealing with emergency first aid situations and other trauma situations.

11. Other: The personnel performing the work should be made familiar with other facility programs, procedures, and requirements.

Section E. Activity Hazard: The individuals/organization performing the work, and their contractors, along with the facility POC, must identify potential OSH hazards that may be encountered during the accomplishment of the work. Determine the possibility of causing disruption of NAS operations.

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 3 of 8

1. Asbestos: Determine if known or assumed asbestos containing material will be impacted by this work.

2. Chemical, Gas, Fumes, Dust, Radiation: Determine if any products or methods will be used that may cause odors or vapors (from chemicals volatizing or biological agents), fumes (from welding or burning), excessive dust (e.g., sanding, grinding), or radiation (e.g., heat sources, light sources such as lasers, ionizing radiation sources such as X-ray equipment).

3. Storage of Hazardous Materials: Determine if substances that exist at the facility may be impacted and what substances may be brought into the facility, which may have an impact on the facility and/or occupants.

4. Impact on HVAC System: Determine whether the environmental control elements of the facility may be impacted by the accomplishment of the work.

5. Equipment Removal/Installations: Determine if work activities will cause disturbance of excessive dust, e.g.

disturbance of equipment, which has been in place for a long time.

6. Fire Protection: Determine if work activities will impact fire protection systems and procedures at the facility (e.g., blocking egress, removing fire stopping, impacting fire rated barriers).

7. Impact to Integrity of Fire Alarm/Suppression System: Identify the Fire Alarm and Suppression System and instructions to avoid unintentional impact to it. If the work involves intentional impact to the Fire Alarm and Suppression System, determine what coordination has to be done to ensure no disruption of the NAS. Determine what interim life safety measures will be required during the project.

8. Lead Exposure: Determine if activities will expose FAA/contract employees to lead dust, lead fumes or other exposure to lead from known or assumed lead containing material during the construction project.

9. Electrical Safety: Determine if work activities will expose FAA employees to electrical safety hazards (e.g., open electrical panel doors, exposed energized conductors, energized work).

10. Noise: Determine if work activities will expose FAA employees to excessive noise.

11. Walking Working Surfaces: Determine if work activities will expose FAA employees to tripping, slip and fall hazards, e.g. open panels in a raised floor, uneven floors, raised or loose carpeting, stairs, wet floors, etc.

12. Work Above Equipment/People: Determine if work activities will expose FAA employees to objects dropped from above.

13. Water Quality/Sanitation: Determine if work activities may cut off or contaminate the facility’s potable water system.

14. Cranes/Rigging/Hoisting: Determine if work activities will expose FAA employees to hazards associated with rigging, hoisting and cranes.

15. Lighting: Determine if work activities will create insufficient lighting for FAA employees.

16. Machinery and Mechanized Equipment: Determine if work activities may expose FAA employees to hazards such as being struck by, caught in, or injured by machinery and mechanized equipment.

17. Excavation: Determine if work activities performed near facilities may cause catastrophic failure of a NAS facility.

18. Other: Other work activities that may impact NAS operations and employees.

Section F. Site Safety and Health - Controls. Ensure that measures and controls to address applicable site safety and health risks (e.g., through discussions, available site safety plans, or other applicable documents)

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 4 of 8 have been identified. If a hazard has been identified in Section E, Activity Hazard, briefly describe the controls to be used.

1. Identify issues/hazards in Section E, Activity Hazard.

2. “Has this been addressed in the site safety plan?” – The purpose of this column is to review the site safety plan for the work with regard to any hazards identified in Section E, Activity Hazard.

3. “Description of Controls” – The purpose of this column is to very briefly describe the controls in place for addressing each hazard.

Section G. Site Walk-Through: Following review of all applicable facility procedures, activity hazards and applicable control measures, the personnel performing the work must participate in a walk-through of the area of the facility where the work will be accomplished, led by a facility representative. The purpose of the walk-through is to allow the personnel performing the work to be introduced to the facility and the potential hazards as referenced in Sections E and F. It also allows the personnel performing the work to become familiar with the facility with respect to the work being done and awareness of the method of implementation of the various emergency plans. The time, date, and personnel present for the walk-through must be recorded in Section G.

Section H. Review Information. This form should be reviewed by those individuals identified below, as appropriate, during design of the project, during pre-bid conferences, prior to the beginning of work (preferably at or prior to the pre-construction conference) and periodically throughout the completion of the project.

1. Originator: This is the individual/organization responsible for initiating the work (e.g., project engineer, senior engineer, technical support office) or the organization directly managing the day-to-day activities in the construction project.

2. Contractor/Installation Crew Lead/Specialist: These are the individuals performing the work who have the authority to make decisions and implement stop work/change orders. If the work is being accomplished by an FAA employee or an FAA contract employee, the employee should sign the form and provide a routing symbol and platform title.

3. District Office Manager or designee: This person must be the District Office Manager or designee. The designee may be the Contracting Officer’s Technical Representative, SSC Manager, or other party.

Section I. Distribution of Copies: The form must be signed and copies forwarded to the individuals identified below.

1. District Office Manager.

2. SECM (Safety and Environmental Compliance Manager) or District Office EOSH Professional.

3. Engineering Services EOSH (Environmental and Occupational Safety and Health) Coordinator.

4. Engineering Services Manager.

5. Engineering Services Project Engineer.

6. Contracting Officer.

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 5 of 8

Section A. Purpose This checklist is intended to review construction, installation and non-routine maintenance activities, prior to commencement, that potentially have occupational safety and health related impacts on NAS operations and employees. This tool must be used, as appropriate, during critical phases of the work (e.g., the pre-construction meeting, prior to commencement of work, etc.). Emphasis should be placed on using this checklist as a tool to assess as well as reassess hazards as the work progresses.

The purpose of this section is to provide a brief description of the construction project and/or specific maintenance tasks, and identify key personnel responsible for project completion. Fill in the requested site-specific information. Indicate if this work will occur in or adjacent to an occupied space (e.g., equipment room, ATCT cab, etc.). Note: Provide further explanation of activities on additional sheets if necessary.

Section C. Evaluation

The purpose of this section is for the District Office Manager or designee to determine if there is a potential safety and health impact to NAS operations from the construction and/or specific maintenance project based on the information provided in Section B. The sections below describing potential impacts to NAS operations are to be completed by the organization managing the construction project or large-scale maintenance task. The District Office Manager or designee must sign and date below. If there is no impact, proceed to Section I.

Is there a potential safety and health hazard that will impact NAS operations?

________ Yes

(Checklist to be returned to the organization managing the construction project for completion.)

________ No

Name (typed or printed)

Signature Date

Section B. Work Summary Information

1. District Office:

2. Work Location:

3. Facility:

4. Work Description:

5. Planned Start Date: ___________________

6. Expected Completion Date: ___________________

7. Contractor Contact: Name: Phone:

8. Project/Design Representative: Name: Phone:

9. COTR/Specialist: Name: Phone:

10. District Office OSH Contact: Name: Phone:

11. Facility Representative: Name: Phone:

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 6 of 8

Section D. Facility Procedures

Review site-specific FAA procedures and considerations with the contractor/installer/specialist. For example, discuss when or how during the work, emergency plans will be required and/or used .

NOTE: Think about your work and its potential hazards. Consider sensitive NAS operations and all facility personnel that may be impacted by your work. As an example, construction activities with potential for impacting asbestos materials in or near sensitive operations could result in incidents that may disrupt NAS operations.

Section E. Activity Hazard Note: Provide further explanation of potential hazards, locations, etc. below and attach additional sheets if necessary.

Facility Procedures Reviewed?

Notes Yes N/A

1. Asbestos Contingency Plan

2. Hazard Communications (e.g. MSDSs)

3. Lockout/Tagout

4. Work Permits (e.g., Asbestos, Lead, Hot Work)

5. Emergency Plans (e.g., Occupant Emergency Plan)

6. Impacts to Fire Alarm and Suppression Systems

7. Confined Space Entry

8. Work at Heights

9. Restricted Areas Due to OSH Concerns

10. First Aid/Bloodborne Pathogens

11. Other

Potential Hazardous Exposures and/or Activities Consider Sensitive NAS Operations:

Potential for Exposure/Release/ Incident Description of Hazard

Yes No

1. Asbestos (e.g., tiles & insulation)

2. Chemical, Gases, Fumes, Vapors, Mist, Dust, Radiation

a. Painting/Solvent/Adhesive/Sealant

b. Grinding/Sanding/Cutting/Welding/Soldering

c. Indoor Air Quality Control (e.g., biological agents, mold, odors, CO2)

3. Storage of Hazardous Materials (e.g., flammables, compressed gas)

4. Impact on HVAC System

5. Equipment Removal/Installation

6. Fire Protection (e.g. blocked egress, fire barrier penetration)

7. Impact to Integrity of Fire Alarm/Suppression System(s)

8. Lead Exposure (e.g., lead-based paint)

9. Electrical Safety

a. Work on Live Electrical Systems

b. Temporary Wiring

10. Noise

11. Walking/Working Surfaces (e.g., tripping hazards, work at heights)

12. Work Above Equipment/People

13. Water Quality/Sanitation

14. Cranes/Rigging/Hoisting

15. Lighting

16. Machinery and Mechanized Equipment (e.g., operator training and certification and equipment certification)

17. Excavation

18. Other

FAA Form 3900-18 (03/13) Electronic Version (PDF) Page 7 of 8

Section F. Site Safety and Health - Controls After reviewing the potential hazards in Section E, ensure that measures and controls to address applicable site safety and health risks (e.g., through discussions, available site safety plans, or other applicable documents) have been identified. If a hazard has been identified in Section E, briefly describe the controls to be used.

Note: Provide further explanation of controls below and attach additional sheets if necessary.

Potential Hazardous Exposures and/or Activities

Identified as a hazard in Section

E?

Has this been addressed in site safety plan?

Description of Controls

1. Asbestos (e.g. tiles & insulation)

2. Chemical, Gases, Fumes, Vapors, Mist, Dust, Radiation

a. Painting/Solvent/Adhesive/Sealant

b. Grinding/Sanding/Cutting/Welding/Soldering

c. Indoor Air Quality Control (e.g., biological agents, odors, CO2)

3. Storage of Hazardous Materials (e.g., flammables, compressed gas)

4. Impact on HVAC System

5. Equipment Removal/Installation

6. Fire Protection (e.g., blocked egress, fire barrier penetration)

7. Impact to Integrity of Fire Alarm/Suppression System(s)

8. Lead Exposure (e.g., lead-based paint)

9. Electrical Safety

a. Work on Live Electrical Systems

b. Temporary Wiring

10. Noise

11. Walking/Working Surfaces (e.g., work at heights, tripping hazards)

12. Work Above Equipment/People

13. Water Quality/Sanitation

14. Cranes/Rigging/Hoisting

15. Lighting

16. Machinery and Mechanized Equipment (e.g., operator training and certification and equipment certification)

17. Excavation

18. Other

Section G. Site Safety Walk-Through

Time/date of site walk-through with appropriate personnel (e.g., System Support Center Manager, SECM, District Office representative, contractor, COTR).

Time Date Personnel

Name Organization Name Organization Name Organization

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Section H. Review Information

The appropriate FAA point of contact and the contractor/installation crew lead/specialist sign below to document discussion of the items on this form.

Completed By: Date

1. Originator (Project Engineer or Resident Engineer):

2. Contractor/Installation Crew Lead/Specialist, and company name:

Reviewed By: Date

1. District Office Manager or Designee:

Section I. Distribution of Copies

This form must be forwarded to the following: Name/Routing Symbol

1. District Office Manager

2. SECM/District Office OSH Professional

3. Engineering Services EOSH Coordinator

4. Engineering Services Manager

5. Engineering Services Project Engineer

6. Contracting Officer (if contractor resources perform the construction work)