Attachment_S_Safety_and_Health_Survey.pdf

National Consolidated Risk Management Survey

SAFETY AND HEALTH

RAC Summary

Survey Area RAC Score Documentation Asbestos Confined Spaces Drinking Water Electrical & Lighting Emergency Planning Guarding & LOTO Hazard Communication

IAQ

Lead Non-ionizing Radiation

Occupancies & Gen Sanitation Noise & PPE PCBs Radon Walking/Working Surfaces

Safety & Health Survey Overall RAC Score:

Building Information

Questions Response Findings/Observations Region GSA Building Number GSA Building Name Building Street Address Building City Building State Date(s) of Onsite Survey Surveyor Type of Occupancies Building Point(s) of Contact for Surveys Date of Building Construction Date of Last Major Building Renovation Has any work been done since the last survey (e.g., any tenant fit-outs, changes in occupancy, etc.)? If yes, please describe in the findings section.

Property Type What is the tenant breakdown?

Primary Tenants Is there a law enforcement tenant in this facility?

Name of O&M or Facilities Management Services Contractor Name of Custodial Services Contractor Identify any Unique Space Type(s). If "other" is chosen, please describe the "other" unique space in the comments section.

Building Size (GSF)

Building Size (RSF) Total Number of Floors Above Grade Total Number of Floors Below Grade

Is the building a highrise according to Rexus?

Is the building a highrise according to FPE?

What is the building construction classification (IBC Code)?

What is the pitch of roof?

Are there photovoltaic (PV) cells on the roof?

Type of Roof Anchoring System Are there antennas?

How many elevators are there?

Identify Fuel Fired Equipment What are the fuel types?

How many confined spaces are there?

What type of confined spaces are there?

How many permit-required confined spaces are there?

What is the potable water source?

Is there asbestos containing material(s)?

Is there lead paint or other lead material(s)?

Is there PCB containing material(s)?

What energy sources are used onsite? (select all that apply) Above-Ground Storage Tanks (ASTs) Are there any ASTs?

If yes, how many are there?

What is their total value?

Tank Size (gallons) Type Tank Location Fuel Type Installation Date Underground Storage Tanks (USTs) Are there any USTs?

If yes, how many are there?

What is their total value?

Tank Size (gallons) Type Tank Location Fuel Type Installation Date Occupant Emergency Plan (OEP) Is there an OEP?

Date of plan

Are persons in plan current?

Is there OEP training for designated persons?

Are there procedures for evacuation of disabled persons?

Are there procedures for after-hours emergencies?

Is there a fire department pre-fire plan?

Documentation

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Documentation

Is there a written program followed on site for bloodborne pathogens?

Is there a written program followed on site for confined spaces?

Is there a written program followed on site for electrical safety & arc flash?

Is there a written program followed on site for fall protection?

Is there a written program followed on site for firing ranges?

Is there a written program followed on site for hazard communication (O&M)?

Is there a written program followed on site for hazard communication (custodial)?

Is there a written program followed on site for hearing conservation?

Is there a written program followed on site for indoor air quality?

Is there a written program followed on site for lead based paint?

Is there a written program followed on site for lockout tagout?

Is there a written program followed on site for material handling?

Is there a written program followed on site for personal protective equipment?

Is there a written program followed on site for asbestos?

Is there a laboratory safety chemical hygiene plan followed on site?

Is there a pressure vessels annual inspection documentation on site?

Other Findings

Overall Documentation RAC

Once the surveyor has reviewed the Documentation findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Documentation RAC

Explanation of User Adjusted RAC

Asbestos

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Asbestos

18 Are there asbestos-containing materials? - - -

Has an asbestos survey been conducted?

If yes, please provide the survey date in the findings section.

Does the building contain surfacing material? If yes, list the locations in the findings section.

Is there friable surfacing material in the HVAC system? If yes, describe in the findings section.

Is there a site-specific, current O&M plan for asbestos?

Are there records for asbestos project monitoring? If yes, describe the level of detail in the findings section.

Are pre-alteration assessments done before O&M and asbestos projects? If yes, describe how those are done in the findings section.

Is there evidence the asbestos has been generally well-maintained?

Other Findings

Overall Asbestos RAC

Once the surveyor has reviewed the Asbestos findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Asbestos RAC

Confined Spaces

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Confined Spaces

Is there a current confined space inventory?

Is the person(s) responsible for entering confined space adequately trained?

Is the building free from permit-required confined spaces? - - -

Is the entry permit system established and utilized?

Is the program communicated to building contractors?

Are the permit-required spaces properly labeled and secured?

Other Findings

Overall Confined Spaces RAC

Once the surveyor has reviewed the Confined Spaces findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Confined Spaces RAC

Drinking Water

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Drinking Water

Is the water from a public or municipal provider? If no, describe the water source in the findings section.

If GSA supplied, is it considered a public water source? - - -

Have there been complaints about the drinking water? If yes, describe and indicate what was done in the findings section.

Has the drinking water been tested? If yes, describe what, where and why in the findings section.

Is there evidence of back-flow prevention on drinking water systems?

If yes, is the backflow prevention checked regularly?

Other Findings

Overall Drinking Water RAC

Once the surveyor has reviewed the Drinking Water findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Drinking Water RAC

Electrical & Lighting

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Electrical & Lighting

Is there a single line drawing for the building electrical? - - -

42 Has arc flash analysis been conducted?

43 Are areas demarked for arc flash?

44 Is there arc flash labeling?

45 Are circuit panels labeled?

46 Do circuit panels have clear access?

Is electrical equipment enclosed or protected from contact?

48 Have abandoned circuits been removed?

Are all parts of live conductors protected from accidental contact?

Are extension cords not being used for permanent wiring?

Are GFCIs installed in all restrooms and rooftops?

Is there lightning protection for the building?

Is there evidence that lock-out/tag-out is used for electrical maintenance?

Is all related electrical equipment guarded?

If no, describe in the findings section and list locations.

Does overall lighting appear reasonable?

(40 light-candles min for work stations)

Other Findings

Overall Electrical & Lighting RAC

Once the surveyor has reviewed the Electrical & Lighting findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Electrical & Lighting RAC

Emergency Planning

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Emergency Planning

Is there an updated occupant emergency plan (OEP) in place?

Have emergency drills been conducted over the past year?

Does the building have blast and/or seismic protection? - - -

Is first-aid readily available? If yes, please identify in the findings section if it is available onsite.

Are any eyewash or shower stations installed? If yes, please identify if they are maintained properly in the findings section.

62 Does the OEP include shelter-in-place?

Other Findings

Overall Emergency Planning RAC

Once the surveyor has reviewed the Emergency Planning findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Emergency Planning RAC

Guarding & LOTO

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Guarding & LOTO

Is equipment properly guarded and interlocked (include guarding by location)?

65 Is lighting guarded in all areas as needed?

Is electrical equipment locked out during maintenance?

Is mechanical equipment locked out during maintenance?

Are gravity and physical hazards locked out during maintenance?

Are pressure vessels locked out during maintenance?

Other Findings

Overall Guarding & LOTO RAC

Once the surveyor has reviewed the Guarding & LOTO findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Guarding & LOTO RAC

Hazard Communication

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC)

Probability Severity RAC Is there a recommended corrective action associated with this item?

Hazard Communication

Do contractors, vendors and tenant agencies have a current and updated hazmat inventory or chemical hygiene plan?

Are the chemicals used onsite extremely hazardous?

Do tenants, contractors and vendors have current safety data sheets?

Other Findings

Overall Hazard Communication RAC

Once the surveyor has reviewed the Hazard Communication findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Hazard Communication RAC

Recommended Corrective Actions

Location Recommended Action

National Consolidated Risk Management Survey

SAFETY AND HEALTH

Hazard Communication

Hazard Communication

Other Findings

Once the surveyor has reviewed the Hazard Communication findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

Indoor Air Quality

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Indoor Air Quality

Is the building a single VAV system? If no, describe the HVAC system for the building in the findings section.

Has the HVAC ever been commissioned or tested & balanced?

Is there documentation that the minimum outdoor air meets ASHRAE 62?

Do the HVAC controls appear to be maintained?

Has the building been free of air quality complaints the past year?

If not, is there an IAQ or unsafe/unhealthful complaint log?

Were any complaints resolved to tenant satisfaction?

Has an IAQ assessment been performed over the past year?

Is there combustion type equipment in the building? If yes, list the type(s) and location(s) in the findings section.

Is any combustion equipment vented outdoors properly?

Are air intakes located away from contamination sources?

Are minimum air filtration (MERV13) installed and clean? - - -

Is there any potential growth or scum in the cooling tower water?

Is there standing water on the mechanical room floor(s)?

Is there any growth on cooling coils or drip pans?

90 Are there any air intakes near exhausts?

Are there any visible mold or signs of water infiltration?

Is the interior of of the supply ductwork insulated?

Other Findings

Overall IAQ RAC

Once the surveyor has reviewed the IAQ findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted IAQ RAC

Lead

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC)

Probability Severity RAC Is there a recommended corrective action associated with this item?

Lead 94 Was the building built before 1980? - - -

Does the building contain lead-paint or other lead? If yes, please identify if the lead is on the inside or outside of the building in the findings section.

Has a HUD-type risk assessment been performed? - - -

If there is a childcare center onsite, has the paint been tested? If yes, describe the findings section.

Other Findings

Overall Lead RAC

Once the surveyor has reviewed the Lead findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Lead RAC

National Consolidated Risk Management Survey

SAFETY AND HEALTH

Lead

Lead

Once the surveyor has reviewed the Lead findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

Non-ionizing Radiation

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Non-ionizing Radiation 99 Are there antennaes on the roof? - - -

Is there an antenna inventory for the building? If yes, describe the level of detail of the inventory in the findings section.

Is there reason to believe there are high magnetic or RF fields?

Are there ultraviolet lights in the HVAC system? If yes, please identify if they are labeled in the findings section.

Are there any laser devices in the facility? If yes, please identify class are they in the findings section.

Other Findings

Overall Non-ionizing Radiation RAC

Once the surveyor has reviewed the Non-ionizing Radiation findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Non-ionizing Radiation RAC

Occupancies & General Sanitation

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Occupancies & General Sanitation

Does the building appear free from insect or rodent problems?

Do common areas appear clean? If no, describe in the findings section.

Do the restrooms appear clean? If no, describe in the findings section.

Do any food area(s) appear clean? If no, describe in the findings section.

Do any fitness area(s) appear clean? If no, describe in the findings section.

For any childcare center, does the center appear clean? If no, describe in the findings section.

For any childcare center, is the playground equipment inspected and maintained?

Do any laboratories appear well-maintained?

Do any firing ranges appear relatively free of dust, clean and well-maintained?

Other Findings

Overall Occupancies & Gen Sanitation RAC

Once the surveyor has reviewed the Occupancies & Gen Sanitation findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted RAC

Noise & PPE

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Noise & PPE

Are there any elevated noise levels? If so, please identify if the areas posted in the findings section.

Is hearing protection equipment available for high noise areas? If yes, describe in the findings section and list locations.

Has any PPE been issued to GSA employees onsite? If yes, describe in the findings section.

Does available PPE appear clean and in good working order?

Other Findings

Overall Noise & PPE RAC

Once the surveyor has reviewed the Noise & PPE findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Noise & PPE RAC

PCBs

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC)

Probability Severity RAC Is there a recommended corrective action associated with this item?

PCBs

Are there any records of the presence of materials containing PCBs at the facility? - - -

Is there evidence of old spills or leaks from PCB containing equipment? If yes, please describe in the findings section.

Have there been any other areas in the building tested for PCBs? If yes, please describe in the findings section.

Has the building undergone any renovation, mitigation or other projects that included PCB removal? If yes, please describe in the findings section.

Other Findings

Overall PCBs RAC

Once the surveyor has reviewed the PCBs findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted PCBs RAC

National Consolidated Risk Management Survey

SAFETY AND HEALTH

PCBs

PCBs

Once the surveyor has reviewed the PCBs findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

Radon

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Radon

Has radon testing been done? If yes, please describe in the findings section.

Has any construction or renovation activity occurred since the survey which could have created a new pathway and triggered the need for a new survey? If yes, please describe in the findings section. Include project description and location(s).

If tested, have all radon levels above the stds (4 and 25) been mitigated? If yes, describe what was done in the findings section.

If there is a mitigation system, is it maintained monthly? If yes, briefly describe the system in the findings section.

Has any childcare center present been tested for radon?

Other Findings

Overall Radon RAC

Once the surveyor has reviewed the Radon findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted Radon RAC

Walking/Working Surfaces

# Questions Response Findings/Observations Regulatory Citation Risk Assessment Code (RAC) Recommended Corrective Actions

Probability Severity RAC Is there a recommended corrective action associated with this item? Location Recommended Action

Walking/Working Surfaces

Are the sidewalks clean, smooth and not broken?

132 Are floor openings properly covered?

Are the interior floors generally even, clean, and not too slippery?

Have elevators/escalators been inspected per ASTM? - - -

Roof Areas 135 Are there roof anchors? - - -

Is yes, are they certified, tested & inspected?

If no, is equipment set back from the edge?

(6' is one recognized distance)

138 If no, is there adequate fall protection?

Stairs 139 Do exit stairs meet NFPA in size?

140 Do exit stair railings meet NFPA?

141 Do fixed industrial stairs meet OSHA?

Do fixed industrial stair railings meet

OSHA?

Other Findings

Overall Walking/Working Surfaces RAC

Once the surveyor has reviewed the Walking/Working Surfaces findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.

User Adjusted RAC

Work Item Summary and Tracking Sheet

# Finding Recommended Action Location

D oc um en ta tio n

Documentation

Other Findings - Documentation

A sb es to s

Asbestos

Action Taken Completion Date

Work Item Summary and Tracking Sheet

Other Findings - Asbestos

C on fin ed

S pa ce s

Confined Spaces

Other Findings - Confined Spaces

D rin ki ng

W at er

Drinking Water

Other Findings - Drinking Water

El ec tr ic al

L ig ht in g

Electrical & Lighting

A sb es to s

Other Findings - Electrical & Lighting

Em er ge nc y Pl an ni ng

Emergency Planning

Other Findings - Emergency Planning

G ua rd in g

L O

TO

Guarding & LOTO

Other Findings - Guarding & LOTO

H az ar d

C om m un ic at io n

Hazard Communication

Other Findings - Hazard Communication

In do or A ir Q ua lit y

Indoor Air Quality

El ec tr ic al

L ig ht in g

Other Findings - Indoor Air Quality

Le ad

Lead

Other Findings - Lead

N on

-io ni zi ng

R ad ia tio n Non-ionizing Radiation

Other Findings - Non-ionizing Radiation

O cc up an ci es

G en er al S an ita tio n Occupancies & General Sanitation

In do or A ir Q ua lit y

Other Findings - Occupancies & General Sanitation

N oi se

P

PE

Noise & PPE Other Findings - Noise & PPE

PC

B s

PCBs Other Findings - PCBs

R ad on

Radon Other Findings - Radon

W al ki ng

/W or ki ng

S ur fa ce s

Walking/Working Surfaces

O cc up an ci es

G en er al S an ita tio n

Roof Areas Stairs Other Findings - Walking/Working Surfaces

W al ki ng

/W or ki ng

S ur fa ce s

Severity and Probability Assessment Guidance

SEVERITY ASSESSMENT GUIDANCE

SCOPE and APPLICABILITY

Environmental Risk Fire Protection Risk Safety & Health Risk

Contamination of air, water soil, and biota or non-compliance with environmental regulations

Effects to occupants or facility as a result of a condition or potential event.

Adverse health effects or injury to facility occupants, contractors or visitors in response to a condition or event

SEVERITY LEVEL DEFINITIONS

CATASTROPHIC Irreversible long-term impacts.

(1) Death, permanent disability or irreversible health effect to occupants or (2) a loss of an entire facility.

Permanent disability, irreversible health effect or death.

SEVERE

Reversible long-term damage (5+ years to remediate).

(1) Severe injury, potential long-term health effect or

(2) major loss or impact to a facility.

Potential long-term health effect or severe injury.

SIGNIFICANT

Reversible medium-term damage (1-5 years to remediate).

(1) Minor injury or reversible health effect or

(2) damage to a portion of a facility requiring an extended period of time to repair.

Reversible health effect or minor injury.

MODERATE

Reversible short-term impact (<1 year to remediate).

(1) First aid, no lost time or (2) damage to a facility requiring a minimal amount of time to repair.

First aid or no lost time.

MINOR De minimis regulatory violation. De minimis code violation. De minimis code violation.

NO IMPACT No risk of impact. No risk of impact to the occupants or facility. No risk of impact.

MODERATE

Reversible short-term impact (<1 year to remediate).

(1) First aid, no lost time or (2) damage to a facility requiring a minimal amount of time to repair.

First aid or no lost time.

PROBABILITY ASSESSMENT GUIDANCE

PROBABILITY LEVEL DEFINITIONS

Likely Imminent or

1 in 10

Probable Probable or

1 in 100

Possible Possible or

1 in 1000

Remote Remote or

1 in 10,000

Unlikely Unlikely or

1 in 100,000

Not Possible Non-existent