FULL ICRA ILSM Tool (MCM 001S-03 Att B) 072420.pdf

Project Title: Project/WO#

Description:

Drawing Link:

COR/Frm/PM: Phone:

Ctr Rep: Phone:

Type Construction Activities Risk Service Area

Low Risk

Medium Risk

Type B

Small scale, short duration activities that create minimal dust.

Include, but are not limited to:

☐ Installation of telephone and computer cabling.

☐ Access to chase spaces using doors or hatches (not cutting).

High Risk

Type C

Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies.

Includes, but is not limited to:

☐ Sanding or cutting of walls or ceilings.

☐ Removal of floor coverings, ceiling tiles, and casework.

☐ New wall construction.

☐ Minor duct work or electrical work above ceilings.

☐ Major cabling activities.

☐ Any activity that cannot be completed within a single work shift.

Highest Risk

Low Med High Highest

Type A I I I II

Type B II II II III/IV

Type C II III III/IV III/IV

Type D III/IV IV IV IV

Class I

Class II

Class III

Cardiac Cath, EP Lab or Cardiology; Sterile Processing Service (SPS); All inpatient medical or surgical units; Care Units: PACU, MICU, SICU, TCU; Spinal Cord Injury (SCI); Negative pressure isolation rooms;

Outpatient chemotherapy or Oncology areas; Operating Rooms;

Endoscopy; Dialysis; Bronchoscopy; Pharmacy; Clinical Laboratories;

Other

Type D

Major demolition and construction projects.

Includes, but is not limited to:

☐ Activities that require consecutive work shifts.

☐ Requires heavy demolition or removal of a complete cabling system.

☐ New construction.

Risk Group

Const Type

2. Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area and wipe work surfaces with disinfectant.

3. Contain construction waste before transport in tightly covered containers. Tape may be used to ensure a tight cover.

4. Remove isolation of HVAC system in areas when work and area cleanup has been completed.

6. Complete all critical barriers, i.e., sheetrock, plywood, plastic, to seal area from non-work area or implement control cube method before construction begins.

7. Maintain Negative Pressure Ventilation (NPV) at 0.01” Water Column (WC) within the work site utilizing NPV machine.

8. NPV monitoring devices should be visible from outside the worksite and readings shall be documented daily or more often as needed. Keep tracking monitoring device and tracking log at outside of entrance at the site.

9. Contain construction waste before transport in tightly covered containers. Tape covering, unless using form-fitting solid lid.

5. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction.

6. Do not remove barriers from work area until completed project is thoroughly and inspected by COR, Safety and Infection Control.

10. Seal holes, pipes, conduits, and punctures. All above

Class IV

1. Execute work by methods to minimize dust dispersal from minor flooring or surface disruptions.

2. For visual inspection only, dampen ceiling tile with water spray before removing. Replace a ceiling tile immediately after inspection; do not leave unattended.

ICRA Classification

During construction, perform following daily: Upon completion, performed the following:

11. Construct anteroom and require all personnel to pass through this room to be vacuumed using a

HEPA vacuum cleaner before leaving work site OR they can wear cloth or paper coveralls that are removed each time they leave the work site.

12. All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area.

1. Clean up ceiling tile and flooring surfaces below with HEPA filtered vacuum or damp mop.

3. Provide active means to prevent dust from dispersing. Dust left on the floors, clothing and/or body is not allowed in order to prevent spreading and tracking. “Active means” are:

a. Vacuum attachments on tools with HEPA vacuum when generating dust, or

b. HEPA vacuuming immediately as the dust is generated.

c. Remove or isolate HVAC system in areas where work is being performed.

d. Water mist work surfaces to control dust while cutting.

e. Seal unused doors with duct tape.

f. Block off and seal all HVAC air vents.

g. Place +tacky mat at inside of entrance of work area and change frequently or when ineffective.

h. Wet mop and/or vacuum with +HEPA-filtered vacuum the work area before leaving the site.

Brooming is not sufficient.

4. Whenever transporting outside of construction site, wipe materials, equipment and work surfaces with EPA registered, unscented +disinfectant, which has manufacturer’s labeling as a bactericide, tuberculocide, virucide, and fungicide.

5. There shall be no standing, uncovered water during construction. This includes water in equipment drip pans and open containers within the construction areas. All accidental spills must be cleaned up and dried within 12 hours. Remove and dispose of porous materials that remain damp for more than 72 hours.

Infection Control Risk Assessment (ICRA)

JC BUILDING 2 WINDOW REPLACEMENT 657-19-110

Type A

Inspection and Non-Invasive Activities.

Include, but are not limited to:

☐ Removal of ceiling tiles for visual inspection limited to 1 tile per 50 square feet.

☐ Painting (but not sanding).

☐ Wall covering, electrical trim work, minor plumbing, and activities that do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Office areas; Out Doors; Electrical or Mechanical Rooms; Social Work;

Retail Store; Stage, Recreation, Theater; Stairwells; Conference

Rooms; Other

Physical and Occupational Therapy; Outpatient Clinics; Waiting

Rooms; Sleep Lab; Mental Health (outpatient only); Prosthetics /

Orthotics; Domiciliary; Other

REMOVE AND REPLACE 1,089 WINDOWS THROUGHOUT BLDG. 1 A AND B WINGS

MIKE GOMEZ

Emergency Room; Kitchen or Food Preparation / Dining / Canteen;

Echocardiography; Radiology/MRI; Respiratory Therapy; Nuclear

Medicine; Senior Mental Health (In Patient or Senior); Community

Living Center (CLC); Clean Supply; Other

Project Title: Project/WO #

Care Units: PACU, MICU, SICU, TCU

Care Units: PACU, MICU, SICU, TCU

Care Units: PACU, MICU, SICU, TCU

Care Units: PACU, MICU, SICU, TCU

Care Units: PACU, MICU, SICU, TCU

Care Units: PACU, MICU, SICU, TCU

NO

Plastic Walls

NO

YES

NO

YES

YES

IP Signature

Not Required for Class I or

Class II

Highest Risk

- using hard walls must use door with door closer and lock; otherwise, plastic walls may use zipper door.

Is there a risk of compromising structural integrity (e.g., wall, ceiling, etc.) due to potential of water damage?

Identify the areas surrounding the project area, assessing potential impact.

Unit Below

Unit Above

East

West

North

South

Risk Group:

Risk Group:

Risk Group:

Risk Group:

Risk Group:

Risk Group: Highest Risk

Identify impact issues (probable disruptions/outages, and describe their corresponding corrective actions).

Identify containment measures:

MODERATE NOISE EXPECTED; DAYTIME WORK + MANUAL MEANS USED

ALL HVAC OPENINGS TO BE ISOLATED FROM WORK AREAS USING CRITICAL BARRIERS

ICRA - Operations Steps

JC BUILDING 2 WINDOW REPLACEMENT 657-19-110

- boundary shared with public or patient care areas must have hard walls.

Highest Risk

Highest Risk

Noise:

HVAC:

Highest Risk

Highest Risk

Is the work area in or adjacent to an isolation room?

Identify containment issues with the project team: traffic flow, housekeeping, and debris removal (if not on dwg).

Also, Insert any EXCEPTIONS or ADDITIONS to above items here.

Does this work remove any of the following from service?

-isolation/negative airflow rooms?

-hand hygiene sinks?

-clean or soiled utility rooms ?

Consult with Infection Prevention staff for mitigating action

ALL ASBESTOS/LEAD CONTAINING WINDOW REMOVAL TO BE PERFORMED WITHIN NEGATIVE PRESSURE CONTAINMENT SYSTEM (SEE OPTIONS 1 - 6 OF DESIGN PLANS). WHEN

FIXED INTERIOR CONTAINMENT SYSTEM USED FOR ABATEMENT, GC MAY RE-USE CLEARED CONTAINMENT SYSTEM FOR WINDOW INSTALL; OTHERWISE GC WILL INSTALL

REQUIRED ISOLATION CUBE SYSTEM WITHIN ROOMS IAW IP PERMIT REQUIREMENTS AND USE ROOM DOOR FOR PHYSICAL BARRIER TO PATIENT AREAS OR SHALL CONSTRUCT

SHEETROCK BARRIER WITH DOOR IF NOT WITHIN ISOLATED ROOM.

Does the work need to be performed during patient-care hours?

Barrier Types:

zipper door

Note: Renovation/construction area

- shall be isolated from the occupied areas during const. and shall be negative with respect to surrounding areas.

N/A

N/A

N/A

Plumbing:

Potable Water:

Electrical:

X I n f e c t i o n P r e v e n t i o n R e p r e s e n t a t i v e

X P M / C O R / S h o p R e p r e s e n t a t i v e

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

D. TEMPORARY PARTITIONS: Will construction involve the use of temporary fire or smoke partitions or barriers?

Will temporary fire protection systems be required as part this project/repair?

H. FIRE DRILLS: Does the project warrant additional fire drills within the affected areas?

Required Actions: If the life safety features of a particular area are adversely impacted by construction, then the frequency of fire drills must be increased to two per shift per quarter for healthcare/lodger occupancies. Adverse impacts would include blocked fire exits, impaired fire alarm or sprinkler systems, or major compromises in fire or smoke barriers or compartments.

Specific Actions (confirm with Safety Dept):

Interim Life Safety Measures (ILSM)

JC BUILDING 2 WINDOW REPLACEMENT 657-19-110

Specific Actions (confirm with Safety Dept):Required Actions: An alternate means of access must be designated and the St.

Louis City (JC)/St. Louis County (JB) Fire Department and VA Police must be notified by the Safety Office of the alternative.

C. FIRE PROTECTION: Does the project/repair have the potential of impairing existing fire alarm, detection, or suppression systems?

Required Actions: If the fire load of a particular area is significantly increased over normal due to construction, additional firefighting equipment (such as fire extinguishers) will be required. If any of this additional firefighting equipment is of a different type than that already available in the affected area, training in the use of this equipment for staff or contractor personnel is required.

Specific Actions (confirm with Safety Dept):

F. SMOKING POLICY: Will variance to existing medical center smoking policy be permitted?

E. ADDITIONAL FIRE FIGHTING EQUIPMENT AND TRAINING: Does the area affected by the project warrant placement of additional fire protection equipment?

Will additional firefighting training be required by affected personal?

Required Actions: If construction/repair involves major breaches in fire or smoke barriers, the contractor must erect temporary walls around the construction area to have fire and smoke ratings equal, or better, to the barrier rating that has been compromised.

Specific Actions (confirm with Safety Dept):

Required Actions: If a fire protection or alarm system is to be rendered non-operational for more than 4 hours out of a 24-hour period, either a substitute system or a fire watch must be initiated. If neither of these methods can be implemented, the area must be closed down and evacuated. All of these measures must be coordinated with the Safety Office, VA Police, and the affected staff.

Specific Actions (confirm with Safety Dept):

Required Actions: If designated smoking areas are impacted or closed due to construction, temporary areas may need to be established.

Specific Actions (confirm with Safety Dept):

G. COMBUSTIBLE LOAD LEVELS: Does the project involve the storage of flammable or combustible materials?

Does the project have the potential for creating flammable or combustible debris?

Required Actions: Surveillance of construction sites will need to be increased to prevent the accumulation of excess flammable or combustible debris. The fire load of the construction area must be kept to a minimum.

Specific Actions (confirm with Safety Dept):

A. EXITS: Does the project/repair have the potential of affecting an exit or other means of egress?

Will the affected exit be used by other than the contractor’s/maintenance personnel?

B. EMERGENCY ACCESS: Does the project/repair have the potential of obstructing access for fire department vehicles, fire fighters, suppression connections, hydrants, or fire lanes?

Required Actions: An alternate exit must be designated and training is required for those persons affected. Safety office will conduct/coordinate training. Means of exiting construction/repair areas must be inspected and documented by contractor/shop designee on a daily basis to prevent blockages due to debris.

Specific Actions (confirm with Safety Dept):

I n f e c t i o n P r e v e n t i o n R e p r e s e n t a t i v e

Yes / No

Yes / No

Yes / No

Yes / No

Safety Representative Signature Not Required:

Class I or II & no Exit/Emergency Access Issues

Does the project have the potential for negatively affecting infection control procedures?

Does the project have the potential of affecting compartmentalization features of the fire safety systems?

Required Actions: Affected personnel must be notified when fire safety systems or infection control procedures are compromised and trained in temporary changes in procedures to compensate for the impaired systems. Examples are the need for alternate fire exits, alarm or sprinkler systems or to evacuate behind secondary fire barriers or compartments due to fire or smoke partition compromises.

Specific Actions (confirm with Safety Dept):

Required Actions: Any construction activities that adversely affect occupational health issues must be reviewed to minimize the effects. If negative pressurization is required for “special ventilation”, then include a daily reporting of the pressure measurement as part of the the daily ILSM log.

Specific Actions (confirm with Safety Dept):

ALL WORK AREAS TO BE PLACED UNDER NPV AND MONITORED USING A RECORDING

MANOMETER SYSTEM.

J. OCCUPATIONAL HEALTH ISSUES: Do construction workers need to be restricted to dedicated corridors, elevators, or exits?

Will the construction activities be hazardous to immune-compromised patients?

Will any disruptions of the water/plumbing system affect the purity of potable water?

Is special ventilation required for the area during construction?

I. HAZARD SURVEILLANCE: Does the project present additional hazards, such as excavations, construction storage or field offices, crane work, high voltage, confined spaces, scaffolding, etc., which warrant increased hazard surveillance?

Required Actions: If yes, then a Qualified Person as defined by OSHA must perform the work and additional project surveillance is warranted to identify potential life safety issues.

Specific Actions (confirm with Safety Dept):

EXTERIOR SCAFFOLDING AND/OR BOOM LIFT ACCESS MAY BE EMPLOYED TO

REMOVE/INSTALL WINDOWS. GC TO FOLLOW ALL APPLICABLE OSHA FALL PROTECTION

REQUIREMENTS, AS ENFORCED BY REQUIRED ON SITE SAFETY/HEALTH OFFICER

REPRESENTING GC.

L. FACILITY-WIDE TRAINING: Does the project present life safety code deficiencies or construction hazards which warrant facility-wide education of personnel concerning the interim life safety measures?

Does the project present occupational health deficiencies which warrant facility-wide education of personnel concerning those procedures?

Required Actions: Training must be provided facility wide to educate staff, patients and visitors to any life safety system that is impaired throughout the entire building. In addition, the St. Louis City (JC)/St. Louis County (JB) Fire Department and

VA Police will be notified.

Specific Actions (confirm with Safety Dept):

Interim Life Safety Measures (ILSM) (con't)

JC BUILDING 2 WINDOW REPLACEMENT 657-19-110

K. ADDITIONAL PERSONNEL TRAINING: Does the project have the potential of affecting structural features of the fire safety systems?

Safety Dept Representative

657-19-110 Project or Repair

Title:

MIKE GOMEZ Date:

Requirement Specific Measure YES NO

A. EXITS N/A

B. EMERGENCY ACCESS N/A

C. FIRE PROTECTION N/A

D. TEMPORARY

PARTITIONS

N/A

E. ADDITIONAL FIRE

FIGHTING

EQUIPMENT AND

TRAINING

N/A

F. SMOKING POLICY N/A

G. COMBUSTIBLE LOAD

LEVELS

N/A

H. FIRE DRILLS N/A

I. HAZARD

SURVEILLANCE

Required Actions: If yes, then a Qualified Person as defined by

OSHA must perform the work and additional project surveillance is warranted to identify potential life safety issues.

J. OCCUPATIONAL

HEALTH ISSUES

Required Actions: Any construction activities that adversely affect occupational health issues must be reviewed to minimize the effects. If negative pressurization is required for

“special ventilation”, then include a daily reporting of the pressure measurement as part of the the daily ILSM log.

K. ADDITIONAL

PERSONNEL

TRAINING

N/A

L. FACILITY-WIDE

TRAINING

N/A

Issue Is it in Compliance?

INTERIM LIFE SAFETY MEASURES (ILSM)

DAILY INSPECTION

DAILY INSPECTIONS ARE REQUIRED TO PREVENT IMPACTS TO LIFE SAFETY

Project or Work

Order #:

JC BUILDING 2 WINDOW REPLACEMENT

COR or Shop Foreman:

For each item above checked as "NO", describe the compliance conflict and its corresponding corrective action and date/time corrected.

Interim Life Safety Measure

N/A N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

EXTERIOR SCAFFOLDING AND/OR BOOM LIFT ACCESS MAY BE EMPLOYED

TO REMOVE/INSTALL WINDOWS. GC TO FOLLOW ALL APPLICABLE OSHA

FALL PROTECTION REQUIREMENTS, AS ENFORCED BY REQUIRED ON SITE

SAFETY/HEALTH OFFICER REPRESENTING GC.

ALL WORK AREAS TO BE PLACED UNDER NPV AND MONITORED USING A

RECORDING MANOMETER SYSTEM.

NEGATIVE PRESSURE RECORDING:

COR/Contractor Representative

Proj 657-19-110 ICRA ILSM Tool (MCM 001S-03 Att B) 072420 Page 1 of 1